Group works to redesign behavioral health system


SHERIDAN — A bill approved this spring created a “seismic shift” in the way the state’s behavioral health system functions, according to Wyoming Department of Health Chief Data Analyst Franz Fuchs.

Now, it’s up to working groups to determine how that shift will look in practice —addressing issues such as eligibility for state-funded behavioral health services under the new system, what the state hopes to accomplish through providing these services, and how local providers, like Sheridan’s Northern Wyoming Mental Health Center, will be reimbursed for its services.

The working groups comprise legislators, Department of Health staff and the directors of the 20 centers throughout the state that are members of the Wyoming Association of Mental Health and Substance Abuse Centers. Paul Demple, CEO of Northern Wyoming Mental Health, is among the WAMHSAC members participating in discussions this summer.

Demple was quick to say few decisions had been made, and there was still much work to be done in the coming weeks.

“Right now, I’m feeling good about the broad general discussions we’re having,” Demple said. “We’re talking about what makes the most sense and how we can effectively use the state’s limited dollars. We have no answers right now. We’re just trying to determine what system makes the most sense for the citizens of Wyoming.”

The department held the second of three public meetings on the behavioral health redesign on Tuesday in Riverton, with a third scheduled for mid-August in Rawlins. By Sept. 1, the working groups will present their work to the Wyoming Legislature’s Joint Labor, Health and Social Services Committee for consideration and discussion.

“I think it’s important to mention that the report (to the committee) is not necessarily the be-all end-all or the final product,” Fuchs said during the first of the public meetings on May 4. “This is an iterative process. We’re sort of moving one step at a time, and trying to build off what’s been written in statute to create some policies.”

This summer’s work is a direct result of the passage of House Enrolled Act 56 by the egislature earlier this year. The bill establishes tiers of people who are priority populations for state-funded behavioral health services.

The bill is a response to the state’s recent behavioral health funding challenges, Demple said. The state funds its behavioral health and substance abuse system largely through general fund dollars. But as the primary source of those general fund dollars —  the energy industry — struggles, the state is having to re-evaluate how to best use the funds it has, Demple said.

“The state has less money to support our services,” Demple said. “I think everybody in the Legislature realizes they don’t have unlimited dollars. So the question is how can we best use the resources we have, and who would get the most benefit from state-funded behavioral health services?”

Legislators in favor of the bill this spring said, in light of the state’s fiscal struggles, it was wise to set priorities on how to spend those limited dollars. In recent years, the state has allocated between $50 and $60 million for community behavioral health services, but that number is likely to decrease, Rep. Lloyd Larsen, R-Cheyenne, said during the legislative session in March.

“Even if you were in a situation where you had a lot of money, rather than waste the money, wouldn’t you want to prioritize and deliver those services in a manner that’s set by policy?” Larsen asked. “That’s what we’re trying to do here.”

The bill outlines three tiers of priority populations for state-funded behavioral health services. The first tier includes five groups such as those in the state and local justice systems; families at high risk; and adults with acute and severe mental illnesses. The second tier is indigent clients with high needs, while the third is indigent clients in need of general access to behavioral health services.

While the statute sets the framework, it is up to the Department of Health and its working groups to develop a workable application of the statute, Fuchs said.

For example, the eligibility working group is responsible for taking the tiers written into statute and figuring out what they mean in practice, Fuchs said. Are people admitted into tiers based on documents, diagnoses or both? Who submits the application to be considered for behavioral health services —  the individual or their healthcare provider? How do people enter and leave priority population status?

The transitions working group is outlining how priority populations are matched with behavioral health providers, Fuchs said. How do people get connected with the help they need after leaving the state correctional facility or state hospital? What is the role of the state? What is the role of the providers? How does local law enforcement fit in?

The outcomes working group is determining what the state hopes to accomplish through its investment in behavioral health services for priority populations. What is success? How is it measured? And who measures it?

The partnerships working group is specifying the state’s contractual relationships to its various behavioral health centers. Is any oversight from the state required? If so, what does that look like?

All of these working groups have convened throughout the summer, and will continue to meet to flesh out the answers to these and other questions. Later this summer, the working groups will come together to discuss how providers will be reimbursed by the state for their services to priority populations.

“We’re deferring (the discussion) for a couple reasons,” Fuchs said. “One is that we want to define what the system is going to look like before we start talking about money…But also for the reason that we want everybody, not just a select working group, dealing with that. So that discussion will probably happen at the end of the summer once we’ve penciled out a framework.”

Demple said there were many important questions to answer and discussions to have in the coming weeks. He encouraged community members to be part of the conversation as well. At bhr.wyo.gov, community members can watch recordings of previous meetings on the issue and submit public comments and questions. The site will also be the home of the working group documents once they are completed.

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