Joint Commission Behavioral Health Update

New Client Welcome!         

Barrins & Associates welcomes three new clients this month:

Passages Malibu Addiction Treatment Center in Malibu, California is a substance abuse treatment facility that provides a full range of alcohol/drug detoxification and rehabilitation services. Passages was founded in 2001 and utilizes a non-12 step approach to addiction treatment with an emphasis on individual therapy. Similar services are offered at its second facility in Ventura, California. Passages is accredited by The Joint Commission.

Harsha Behavioral Center in Terre Haute, Indiana is a freestanding psychiatric hospital that provides inpatient treatment for children, adolescents, adults and older adults. Harsha offers specialized services for geriatric patients as well as for children/adolescents with autism and other developmental disorders. Harsha Behavioral Center is accredited by The Joint Commission.

Ocean View Psychiatric Health Facility is a freestanding psychiatric hospital located in Long Beach, California. Ocean View PHF is part of CNS Network which is a leading clinical research center in Southern California. CNS Network specializes in the testing of new medications for a variety of mental health, neurological and general health conditions. Ocean View PHF is licensed by the California Department of Health Care Services and plans to pursue initial Joint Commission accreditation.

Barrins & Associates is pleased to be working with these organizations on their Joint Commission readiness efforts!

TJC Behavioral Health Home Certification Available in January 2014

A major highlight of the Annual Behavioral Health Care Conference in Chicago last month was the presentation on TJC's new Behavioral Health Home Certification. We have had many questions from readers on this topic and are working with several clients who are considering this new certification. So, we are devoting this issue of our newsletter to answering those questions and providing information about Behavioral Health Homes and the new TJC Behavioral Health Home Certification.

What exactly is a Behavioral Health Home?

A Behavioral Health Home is not a physical location but rather a service delivery model for the integration of primary physical health care and behavioral health care. The creation of Health Homes became an option for states under the Affordable Care Act. The target population is Medicaid enrollees with multiple chronic health conditions including mental health and substance abuse disorders. In order to be eligible for Behavioral Health Home services, the Medicaid enrollee must have the following:

• At least two chronic conditions or
• One chronic condition and at risk for another or
• One serious and persistent mental health condition.

Chronic conditions include diabetes, heart disease, asthma, obesity, mental health disorders and substance abuse disorders. Thus far, there are 12 states that have submitted health home State Plan Amendments that have been approved by CMS: Alabama, Idaho, Iowa, Maine, Missouri, New York, North Carolina, Ohio, Oregon, Rhode Island, Washington, and Wisconsin. Several others are in the process of submitting State Plan Amendments.

There are three different models of Behavioral Health Homes that are recognized by the Substance Abuse and Mental Health Services Administration (SAMHSA):

1. In-house Model: The BH organization provides the behavioral health services and some of the primary physical health services in-house.
2. Co-located Partnership Model: The BH organization arranges for health care providers to offer some basic primary physical health care services on-site at the BH organization.
3. Facilitated Referral Model: The BH organization has processes in place to ensure the coordination of primary physical heath care provided off-site.  

What is TJC's Behavioral Health Home Certification?

TJC'S Behavioral Health Home Certification is an optional certification for organizations that are accredited under the Behavioral Health standards. It is for organizations that are providing integrated primary physical health care and behavioral health care. Behavioral Health Home Certification will be available as of January 1, 2014.

What types of organizations are eligible for Behavioral Health Home Certification?

Organizations that are accredited under the Behavioral Health Standards are eligible for Behavioral Health Home Certification. This includes organizations that are accredited solely under the BH standards as well as those that are accredited under both the BH standards and another accreditation manual such as the Hospital Accreditation manual. For example, a community mental health center with inpatient beds that is accredited under both Hospital standards and BH standards would be eligible for Behavioral Health Home Certification.

What are the requirements for Behavioral Health Home Certification?

The specific requirements for Behavioral Health Home Certification are included in the 2014 Comprehensive Accreditation Manual for Behavioral Health Care. They were included in the October 2013 CAMBHC Update 2 that was mailed to accredited organizations last month. Some of the Behavioral Health Home requirements were added to existing standards by creating new elements of performance. Other requirements are addressed by new standards that were created specifically for Behavioral Health Homes. All of the standards and EPs are easily identifiable by the label "For organizations that elect The Joint Commission Behavioral Health Home option".  

Highlights of key requirements in the various chapters are as follows:

                   Care, Treatment Services Chapter

Physical Exams (CTS.02.01.05 EP 2)

• If the health screening indicates need for a history and physical exam, the BHH arranges for that H&P.

Assessments (CTS.02.02.01 EP 6, 7, 8)

The assessment includes:

• The individual's long and short term physical health care goals
• Screening for metabolic syndrome, diabetes, hypertension, heart disease, asthma, COPD, hepatitis C, HIV/AIDS, obesity
• Assessment of the individual's ability to self manage chronic behavioral and physical health conditions 

Plan of Care, Treatment or Services (CTS.03.01.03 EP 17)

The plan includes:

• The individual's physical health care need and goals
• How the organization will help the individual achieve those goals
• The individual's self management goals  

Coordinated Care (CTS.04.01.01)

• There is an Integrated Care Team assigned to provide services for a designated panel of individuals.
• The team has a Team Coordinator.  

Access to Care (CTS.04.01.07)

• 24/7 access to contact the BHH to request:
• Appointments
• Prescription renewals
• Clinical advice for urgent health care needs
• 24/7 response to urgent care needs
• Facilitating the individual's online access to their health information (e.g. lab results) within 4 business days
• Use of certified electronic health record to provide appointment reminders 

Prevention, Screening and Primary Physical Health Care (CTS.04.02.23)

• Integrated Care Team has information needed to facilitate delivery of integrated physical and behavioral health care.
• BHH staff has access to primary physical health care clinician for consultation at all times.
• BHH staff has access to behavioral health care clinician for consultation at all times.  

Facilitating Provision of Integrated Care (CTS.04.02.25)

Manage transitions in care and facilitate access to integrated care including:

• Acute care
• Management of chronic care
• Prevention services
• Behavioral health services
• Oral health care
• Vision care
• Urgent and emergency care  

Case Management/Care Coordination (CTS.06.01.05)

• The individual served/family partner with the Integrated Care Team to identify needs, preferences, goals in various life domains.
• Integrated Care Team assists individual with achieving goals of independent living.
• All services provided are evaluated.  

Human Resources Chapter

Staff Orientation and Education (HR.01.04.01, HR.01.05.03)

• Staff are oriented and trained on the most common behavioral health conditions and chronic physical health conditions in the population served.  

Information Management Chapter

Information Management (IM.01.01.01)

Organization uses health information technology to:

• Support continuity of care
• Document and track care, treatment, services
• Support disease management
• Support preventive care
• Create reports
• Facilitate electronic exchange of information
• Support performance improvement  

Leadership Chapter

Leadership (LD.04.04.09)

• Organization identifies clinical practice guidelines and/or evidence based practices for both physical and behavioral health care.
• Note: This can include both nationally recognized guidelines and practices as well as practices developed by individual organizations to address their particular circumstances.  

Performance Improvement Chapter

Performance Improvement (PI.01.01.01, PI.02.01.01, PI.03.01.01)

Data collected on

• Disease management outcomes
• Access to care
• Consumer satisfaction
• Data used to improve performance  

Rights Chapter

Right to Information about the Behavioral Health Home (RI.01.04.03)

• Individual is provided information about the functions and services of the BHH.
• Individual has right to:
• Choose clinicians
• Obtain a second opinion
• Seek specialty care 

How will organizations be surveyed for Behavioral Health Home Certification?

It is anticipated that for most organizations, the length of the survey for BHH Certification will be one day. This survey can be conducted either as part of the organization's triennial survey or scheduled as a separate survey. The BHH Certification will be awarded for a period of three years.

We are already providing some primary physical health services for our clients. Does this mean that we will automatically meet the Behavioral Health Home Certification requirements?

If your organization is currently providing primary physical health services, the provision of those services is evaluated under existing standards in the Behavioral Health Manual. Standard CTS.04.02.19 covers primary physical health services provided directly by the organization and CTS.04.02.21 covers primary physical health services provided through a referral agreement with a primary physical health provider. These standards are addressed through the current survey process. The Behavioral Health Home Certification requirements go beyond these existing standards and recognize organizations that are acting as a health home to provide integrated and coordinated primary physical health care and behavioral health care.

If we become certified as a Behavioral Health Home, does that mean that BHH services must be provided to all of our clients?

No, your organization determines the population that will be served by the Behavioral Health Home. This can be a defined subset of the population such as consumers living in a particular geographic area, consumers who are Medicaid enrollees, consumers with a particular diagnosis, etc.

What is the advantage to obtaining Behavioral Health Home Certification?

TJC is currently working with state authorities to acquire each state's recognition for the new Behavioral Health Home Certification. This state recognition will help behavioral health care organizations meet Medicaid requirements and, as a result, may improve an organization's reimbursement structure.

How can we prepare for Behavioral Health Home Certification?

The first step is to study the new BHH Certification requirements as well as some of the background material listed in the Resource section of this article. Based on that research, determine if you organization is well positioned to pursue this certification. If so, contact us to arrange for training and technical assistance on achieving Behavioral Health Home Certification. We are currently working with several clients who are considering this new certification.

Where can I find resources about Behavioral Health Homes and TJC's Behavioral Health Home Certification?

Check out the following resources:

• SAMHSA-HRSA Center for Integrated Health Solutions  
• Medicaid.gov Health Home Information Resource Center
• Behavioral Health Home Certification information on the TJC website