The Mental Health and Mental Retardation Authority of Harris County

What is CBHN? Answer: The Community Behavioral Health Network. So, you say, that is no help – still don’t know what CBHN is. You are correct because CBHN is only just being "birthed" by MHMRA Let me explain. Managed care has brought major changes to the public "Safety Net" of services and supports. First, with the rollout of the 1915(b) Medicaid Managed Care pilot in Harris County, the AFDC recipients and most of the SSI severely impaired populations were placed under STAR and STAR+PLUS Health Maintenance Organizations (HMOs), and their contracted Behavioral Health Organizations (BHOs), to address the behavioral health needs of the covered lives. Second, the Texas Department of Mental Health and Mental Retardation (TDMHMR) each fiscal year is moving to implement its version of managed care through the products developed by the HB2377 pilots defining the procedures to be developed under the Authority functions as the Local Mental Health Authority (LMHA) and Local Mental Retardation Authority (LMRA).

The Authority functions substantially mirror the managed care functionalities expected of BHOs under the Medicaid managed care pilots, plus other TDMHMR specific requirements. These Authority functions, rolling out significant new expectations in FY2000 and 2001, will impact all consumers covered under the Performance Contract with TDMHMR. And, just recently, the 76th Legislature passed the significant new expanded health coverage for children and adolescents between 100% and 200% of poverty called CHIP (Children’s Health Insurance Program). CHIP will cover a substantial portion of the children currently and traditionally served by the public system under a new managed care, integrated health system for each region or statewide. The RFP was released last month and due back in September for those bidding to be selected as a major insurer as a part of the CHIP rollout. The "safety net" and its funding is being dramatically revised – virtually all aspects of care for the traditional public mental health and mental retardation consumers is or will be placed under a managed care umbrella. MHMRA, thus, has a critical choice before it: 1) Decide to be a provider of services exclusively and take what is handed out (lives to be covered, services to be authorized, and funds to be paid per service event); 2) Do nothing, make no decision – hoping it will go away and back to "the way things were." (Let’s guess what the likelihood of an ostrich approach – head in the sand – would bring; or 3) Decide to develop the managed care functionalities to potentially become an active participant at the organizational and policy levels. MHMRA has chosen, at this time, the latter, to commit itself to a change process to develop the capabilities to meet the requirements as a public focused behavioral health organization maintaining the commitment to its underlying public values on behalf of the public consumer.

One of the critical aspects of this new world is – in the language of the insurance industry – the ability to assume risk. Assuming risk means that the entity agrees to cover (pay for) all required services as medically needed for any of the insured persons (within that plan) who seek services. The entity receives only the specific amount of monies agreed to in advance with the payer– often set up as an amount of money paid to the plan per member per month (pmpm). To do this, Texas law provides two different vehicles for assuming a risk bearing relationship in health care: be an HMO or be a 501(a) physician’s corporation. MHMRA has created its own 501(a) called Community Neuropsychiatric Network (CNN) which has assumed a DBA name, Community Behavioral Health Network (finally got to CBHN) – under which it will undertake its public at risk contractual business.

CBHN will be the organizational structure that MHMRA employs to be actively engaged in the competitive managed care environment. We anticipate this organization participating with certain HMOs and/or BHOs as a part of their bid to RFPs to manage the care of those individuals who chose or are assigned to that plan within a defined region of the state. If one or more of CBHN’s HMO partners is selected, CBHN may hold an at-risk contract for the behavioral health component. In addition, CBHN may be providing certain administrative services for the behavioral health component such as: service authorization, utilization management, quality management, provider relations and development, member relations, claims management, etc. We are evolving, developing as a system. Our Board of Trustees is supportive of MHMRA being a player at the decision-making table to ensure that the public commitment to those unable to speak for themselves is maintained. So long as the consumer is maintained at the forefront – so long as the care in a person-centered way is not forgotten our Board will support this evolutionary process. If we can influence the dollars expended for community services and, potentially, bring in new resources for indigent persons without third-party coverage, it makes sense for us to participate. So long as we keep the consumer of services and his/her family at the forefront of what we do, this participation will be consistent with and supportive of the MHMRA mission.

MHMRA is entering a new phase of its evolution. Developing the managed care capabilities will enable us to continue as the Local Authority for Harris County under contract with TDMHMR. In fact, significant aspects of the LMHA and LMRA requirements will be implemented within the Agency this fiscal year. Sometime in the near future, the Local Authority may be required to demonstrate its competence in fulfilling the Authority responsibilities, duties, and requirements for TDMHMR in order to retain that role. And, these specific capabilities will also enable us to contract with CBHN, perform these management functions, and have those applicable services funded though these major, alternate revenue streams. Of significance, developing these competencies in the behavioral health arena will enable MHMRA to ensure that the public values remain at the table such that managing care means, in fact, improved access to efficient services which are clinically justified and result in positive outcomes for the person – not just managing money.