Behavioral health gets a jump on compliance. (HIPAA Watch). - Health Management Technology

While the burden of HIPAA implementation and compliance rests with healthcare providers, payors and information clearing-houses, many experts believe that behavioral health and human service organizations will face additional scrutiny from consumers, who now have the law behind them when pursuing possible medical records privacy breaches.

Meticulous records will be required to meet rigorous security standards, and also to respond to consumer requests. For example, patients will be en titled to a complete log documenting every occasion their records have been accessed, including names, dates and inquiry reason.

Healthcare organizations are mandated to develop, implement and enforce comprehensive policies, procedures and business practices that support total compliance with the law--and to provide documentation that employees have been trained on compliance with those policies, procedures and practices as well. They must also designate a privacy officer and security officer and establish a grievance process for patients to make inquiries or file complaints.

Easing into Compliance

Many HIPAA requirements represent actions that responsible healthcare organizations have been taking all along. For years, behavioral health and public health providers in nearly every state have been subject to stringent confidentiality and privacy laws. Protected classes of healthcare service information like mental health, substance abuse and communicable diseases already require special handling. The vast knowledge the industry has gained through compliance with these laws will help ease the burden of HIPAA compliance.

Consider what your organization is already doing to protect and maintain clinical records, implement quality assurance and improvement measures, and satisfy the staff training, documentation, and reporting requirements of accreditation authorities, licensing institutions and funding sources--and you could be well on your way toward HIPAA compliance.

By promoting the greater use of electronic data interchange and the elimination of inefficient paper forms, administrative simplification is expected to provide a net savings to the healthcare industry of nearly $30 billion over 10 years. Universal code sets and standardized forms for medical conditions, services and other industry-standard language and methodologies will greatly improve and streamline claims processing. This should significantly reduce the number of claims that are denied or returned for lack of data or failure to use proprietary codes.

In behavioral health, one of the greatest benefits to be realized is one that can't be measured in dollars, time saved or paper eliminated, and that is improved client confidence. By guaranteeing the security of confidential personal and medical information, trust and candor between patient and caregiver will grow, giving way to a more relaxed and productive relationship.

Meeting Requirements

Proposed security regulations apply to more than just providers. They require administrative procedures, technical security standards and physical safeguards to protect electronic data integrity, confidentiality and availability.

The keyword is 'electronic' and its reach is extensive. Any information about the physical or mental condition of a client receiving any form of healthcare services through an affected organization, or any information about payment for such services--past, present or future--is subject to HIPAA regulations.

Even seemingly innocuous demographic information is subject to the same security regulations. Once this type of health information has been transmitted, received or maintained electronically, original paper source documents and even verbal discussions that may change the content of the patient's record are also subject to these requirements.

While security regulations apply to entities maintaining or transmitting health information in electronic form, the privacy rules apply to all forms of individually identifiable health information--paper, oral and electronic. Privacy rules are based on the 'minimum necessary' disclosure principle and require that covered entities obtain a general consent from the client to use his or her personal health information for treatment, payment and healthcare operations.

HIPAA also applies to any covered entity's business partners--any person or organization to whom the covered entity discloses protected health information to carry out, assist, perform a function or activity on behalf of the covered entity. Examples include lawyers, accountants, auditors, vendors, consultants and billing firms. Even service providers such as computer maintenance services, temporary staffers and healthcare oversight agencies may legitimately be considered business partners.

HIPAA establishes criminal and civil penalties for non-compliance, and also provides a formal vehicle for consumer complaints and federal investigation of alleged violations. Make no mistake--the DHHS Office of Civil Rights is fully empowered to impose financial penalties of up to $250,000 or jail time of up to 10 years per incident if an investigation finds evidence of non-compliance, negligence or willful disclosure of personal health information.

Taking Action

What can you do--and should you do? Assess your software's capability for supporting electronic standards for HIPAA-related transactions. Perform a gap analysis and risk assessment to determine your vulnerabilities and potential liabilities.

Rally for executive support, assemble an appropriate team, begin the education and awareness process, identify your business partners and build the necessary infrastructure to support total compliance. Don't succumb to rumor and speculation. Get a grasp on what the regulations mean to your organization from both an information technology and an operational perspective. Expect to make a significant investment over the next two or three years. Plan and budget now.

HIPAA establishes the minimum privacy standards covered entities must meet, but leaves detailed policies and procedures for meeting these standards to the discretion of each covered entity. Security standards, though comprehensive, are technologically neutral. Implementation of the standards will be flexible and scalable, to account for the nature of each entity's business, its size and resources.

As of August 2000, the rules on standard transaction and data code sets were final. Some 15 months have passed since their enactment and yet much of the industry waits for a pardon, a miracle or a mistake to be announced.

By October 2002, you must be able to send and receive electronic transactions and healthcare information in accordance with HIPAA standards, or risk being in violation. The privacy rules governing protection of personal health information were released in April 2001 and the clock has already begun to tick towards a June 2003 deadline. Final security regulations are expected by year's end.

We all know how time flies. Get a plan and get it done. Software and consultants can take you so far, but the rest is up to you.

Two Behavioral Health Facilities in Wilkes-Barre, Pa., to Close. - The Times Leader (Wilkes-Barre, PA)

Byline: M. Paul Jackson

Jan. 17--WILKES-BARRE, Pa.--The Wyoming Valley Health Care System will close two behavioral health facilities and move services into Nesbitt Memorial Hospital, system officials said Wednesday.

Jobs will not be lost.

The system will move First Hospital Wyoming Valley and Choices, its substance abuse recovery program, to Nesbitt on July 1, said system President Dr. William Host.

First Hospital 'is not sustainable in the long haul as an acute-care hospital,' he said. 'Running two separate facilities is extremely inefficient.'

The hospital, located at 149 Dana St., has 96 beds and serves inpatient psychiatric patients. Choices, a 28-bed clinic at 518 Wyoming Ave., offers drug and rehabilitation treatment.

The two programs are part of Behavioral Health Services of Wyoming Valley, an affiliate of the health-care system. Behavioral Health Services also includes Advanced Psychological and Counseling Services and the system's community counseling service.

The plans also include:

Relocation of administrative employees from an office at 703 Rutter Ave. into the Choices facility. The Rutter Avenue building will be sold, Host said.

The potential sale of about eight buildings around First Hospital. The buildings are used as offices for about seven psychiatric doctors, said Joseph Knecht, chief executive officer of Behavioral Health Services. Those doctors will move to Nesbitt.

Maintenance of the current Community Counseling Services site. The system does not plan to relocate the counseling center on South Pennsylvania Avenue.

'The relocation of these services is consistent with our health system's long-range strategy and is truly in the best interests of patients, families and the community,' Host said.

Officials estimate the relocation will cost $3 million. 'There are costs associated with renovations and relocations,' said system spokesman Jim Schilling.

About 200 jobs will be transferred, Knecht said.

'I don't see any potential for gain in the efficiencies that would jeopardize anybody's job,' Host said.

The relocation leaves First Hospital vacant. The system has not yet finalized plans for it.

As a nonprofit organization, the health-care system does not pay property taxes. Selling the Rutter Avenue facility to a for-profit company could bring more tax revenue to Kingston, its mayor said.

'While Kingston would certainly prefer to see a general hospital located on the Nesbitt site, I'm pleased that the Nesbitt property will once again be put to productive use,' Mayor James Haggerty said.

The system relocated Nesbitt's obstetrics department to Wilkes-Barre General Hospital last year.

Plans to reorganize the health system's behavioral services unit have been discussed for some time.

The health system contemplated selling four satellite offices -- including First Hospital, Choices and its administrative building on Rutter Avenue -- during failed merger talks with Mercy Health Partners in 2000.

First Hospital was created in 1983, and the Choices facility was established in 1987, Knecht said.

The move puts the two services 'in an excellent location and in a very good building,' he said. 'It puts us in a really good position for the future.'

To see more of The Times Leader, or to subscribe to the newspaper, go to http://www.timesleader.com

MAYA CHILESE APPOINTED AS CHILDREN'S BEHAVIORAL HEALTH MANAGER IN DEPARTMENT OF HEALTH AND HUMAN SERVICES - US Fed News Service, Including US State News

The Nebraska Health and Human Services System issued the following news release:

Scot Adams, director of the Division of Behavioral Health, has announced appointment of Maya T. Chilese as the manager for Children's Behavioral Health, starting on June 4. The Division of Behavioral Health is part of the Department of Health and Human Services (DHHS).

'Integrating children's behavioral health services into the Division is one of Governor Heineman's top priorities for DHHS,' Adams said. 'We are fortunate to have someone with Maya's leadership skills and experience with youth to take on these new responsibilities.'

Chilese's background includes developing youth programming within community coalitions, direct service provision with children, youth and families in both prevention and treatment of behavioral health services.

'I am so pleased to have the opportunity to work towards moving the strategies outlined in the Children's Behavioral Health Plan forward,' Chilese said.

She has served as a therapist and family advocate for the Young Family's Program at the Lincoln Medical Education Partnership, is currently the Area Coordinator for Nebraska Faith Partners Network and Program Developer for The Odds Are, a youth gambling prevention project of Lancaster Human Services. Previous experience includes serving as Director of Project Development at Choices Treatment Center in Lincoln and in a variety of capacities in youth serving agencies over the years.

Chilese has a bachelor's of sociology degree from the University of Nebraska at Lincoln and a master's degree of counseling from Doane College in Lincoln. She is also a Certified Compulsive Gambling Counselor and a graduate of the Leadership Institute, Addiction Technology Transfer Center/Graduate School, USDA.

Chilese will be supervised by Vicki Maca, Community Services Administrator in the Division of Behavioral Health.Contact: Jeanne Atkinson, 402/471-8287.

TENNCARE AMENDS BEHAVIORAL HEALTH ORGANIZATION CONTRACTS: 100 PERCENT OF MANAGED CARE NETWORK NOW AT RISK - US Fed News Service, Including US State News

The Tennessee Bureau of TennCare issued the following news release:

TennCare Bureau Director, Dr. J.D. Hickey announced today that the TennCare Behavioral Health Organizations (BHOs) have accepted new risk-bearing contracts thus moving the Bureau's entire medical and behavioral managed care network into financial risk agreements.

'We are very pleased to have our full network, both medical and behavioral, in risk agreements. We now are positioned to draw down the maximum amount of federal dollars for the behavioral health side just as we already accomplished on the medical health side last fall with our new MCO risk-bearing contracts,' said TennCare Director, Dr. J.D. Hickey.

TennCare mental health services are delivered through two BHOs, Premier Behavioral Health Systems of Tennessee in the Middle and West regions and Tennessee Behavioral Health, Inc., a subsidiary of Magellan Health Services, Inc., in the East, Middle and West regions. The new BHO contracts are effective January 1, 2006 and expire in December 2007. The state retains the ability to cancel the contract without cause with 30 days notice.

'As part of the efforts to reform TennCare, the renewal of these contracts will ensure savings and stability for TennCare Partner enrollees,' stated Tennessee Department of Mental Health and Developmental Disabilities Commissioner Virginia Trotter Betts. 'We look forward to continuing our promising work with Premier and TBH to ensure that all Tennesseans have access to quality mental health services that lead to improved clinical outcomes and recovery from mental illness.'

Assuming financial risk means the BHOs are paid an actuarially-based or capitated rate for enrollees' medical services. The agreement also holds the BHO accountable for paying any extra costs regarding the poor management of medical expenses.

Before the current negotiated contracts for Middle and West Tennessee, Premier was not bearing 100 percent risk and TBH was under a fifty-fifty risk-share agreement. Premier will now bear a fifty-fifty risk-share, along with TBH, for cases of extreme medical cost overage. The East Tennessee region has been in a full-risk arrangement since 2004, and that agreement was renewed under this recent negotiation.

Plans could do a better job of presenting behavioral health - Managed Healthcare Executive

HOSPITALS & PROVIDERS

Members lack benefit understanding, quality information, and a segue into treatment programs

MORE AMERICANS than ever before are using mental health services, yet more than a third of those who need treatment are not getting it. These are among the key findings of a new study, 'Therapy in America 2004,' the first to examine emerging consumer trends and attitudes in mental healthcare.

The nationwide study consisted of a telephone survey of 500 adults and an online survey of 1,730 adults who have needed or have received treatment for a mental health problem within the past two years.

The results of the study have important implications for MCOs as they search for the best strategies to manage mental illness. Depression is the No. 1 cause of disability in the United States and worldwide, and second only to heart disease as a cause of disability. Chief findings from the study show that:

* A surprising number of Americans receive help for mental health conditions;

* More than one-third of those who need treatment do not receive it;

* Prescription medication is the predominant type of mental health treatment; and

* Consumers lack key information for selecting a therapist.

PART OF AMERICAN LIFE

A substantial number of Americans are either in treatment themselves or have friends or family members who have received talk therapy or medication. The good news is that mental health treatment is widespread and widely accepted, and most people are overwhelmingly satisfied with their treatment. More than one in four adults, or an estimated 59 million people, have received treatment for a mental health problem in the past two years via talk therapy, medication, or a combination of the two, according to the study. Of these, the majority (80%) report high levels of efficacy and satisfaction, regardless of the type of treatment received.

However, increased utilization of mental health treatment represents a challenge for MCOs that need to find cost-effective ways to provide behavioral health benefits, which can significantly improve healthcare outcomes. MCOs should choose a behavioral health partner that: 1) has the providers and facilities necessary to ensure its members receive timely and appropriate care; and 2) uses an evidencebased approach to identify issues, manage serious cases, and measure results of treatment to document significant medical outcomes. Outpatient treatment programs using an evidence-based approach can reduce worker impairment, help employers avoid prolonged losses in worker productivity, and reduce unnecessary absenteeism.

The study uncovered the top barriers to receiving care as: cost, lack of coverage, the belief that one's problems are not serious enough, and the lack of confidence that treatment helps. About 37% of those who report having experienced sufficient distress to warrant treatment have not received it. These people-estimated to number 24 million-represent just one in 10 people in the general U.S. adult population.

While the stigma of therapy is less than in the past, it has not disappeared entirely. The fear that therapy would go on their 'record' is mentioned by 22% of respondents, and the concern that friends or family could find out is mentioned by 19%; Women are far more likely to seek mental health treatment than men (63% vs. 37%).

MCOs need to bridge the 'access gap' or void where consumers are caught between what they don't know and what they need to know. Because many consumers are unfamiliar with their mental health coverage, MCOs must do a better job of educating their members about the availability of that coverage. They also must help remove the stigma of receiving psychotherapy or mental health services that still exists and keeps people from seeking treatment. In particular, service organizations need to reach out to men, who are more reluctant than women to seek help. Progressive, managed behavioral healthcare organizations are beginning to embrace tele-Web technology to make psychotherapy accessible to more people.

And lastly, MCOs need a behavioral health partner that has the ability to cost-effectively manage and measure outcomes, to identify people at risk and facilitate an intervention if needed, and to keep at-risk people involved in therapy until they improve.

TALK THERAPY VS. MEDICATION

Talk therapy, particularly goal-focused cognitive therapy, has been shown in numerous studies to be effective alone, or in concert with medication, for many patients. Nonetheless, the study found that 81% of those with a treatment history-an estimated 48 million people-report taking or having taken a prescription medication for a personal, emotional or mental health problem in the past two years. In contrast, only 53% report undergoing psychotherapy.

With recent concerns over the use of antidepressants and possible increased incidence of suicide, it is more important than ever that drug use be monitored. MCOs need a clinical feedback system to identify patients at high risk for suicide, chemical dependency or premature treatment termination and a system to help monitor patient use of antidepressants and other drugs. An effective behavioral health partner should provide a tool that measures a patient's progress and determines how much therapy is needed, and for how long it is needed, for the patient to get better.

The practical factors most people consider when choosing a therapist, such as geographic proximity and cost, fail to address the most important elements of a successful therapist-client match-the therapist's personal style and listening skills. The most common factors cited in the choice of a mental health professional include: recommendation from a doctor, whether the therapist is part of the individual's health plan network, proximity to home or work, and cost.

In contrast, the factors ranked as most important in making therapy successful include: the therapist's listening skills, the therapist's personality, the personal connection with the therapist, the therapist's being active in the session, and the cost.

Since the therapist is such an important factor in getting patients better, MCOs need to supply members with quality rankings so they can select a therapist based on the clinician's quality and capability for general or specific areas of therapy.

[Author Affiliation]

BY JERRY VACCARO, MD

[Author Affiliation]

UNIVERSITY OF FLORIDA RECEIVES $1.1 MILLION TO SUPPORT BEHAVIORAL HEALTH TRAINING, RESEARCH PARTNERSHIPS IN INDIA - US Fed News Service, Including US State News

GAINESVILLE, Fla., Nov. 28 -- The University of Florida issued the following news release:

The University of Florida has received $1.1 million to offer behavioral health training to colleagues in three Indian cities and increase research opportunities between the university and Indian partners.

'Our goal is to reduce the training gap and increase research in perpetration and exposure to violence, addiction to prescribed and illicit drugs, and the most impairing mental symptoms - psychosis, suicidal thoughts and dementia,' said the grant's lead investigator Linda B. Cottler, a professor and chair of the department of epidemiology in UF's colleges of Public Health and Health Professions and Medicine.

In addition to creating training and research opportunities, the project will shed much-needed light on the health problems in certain Indian regions. Dr. Mark S. Gold, a distinguished professor and chair of the UF College of Medicine's department of psychiatry, is the co-director of the project, funded by the National Institutes of Health's Fogarty International Center. Fogarty grants support global projects that address non-communicable diseases across the lifespan.

In a separate Fogarty grant-funded project led by Cottler that concludes this year, the team partnered with Indian colleagues to develop research and training infrastructure with a broad psychiatric focus at the National Institute of Mental Health and Neuro Sciences, India's leading center for education and research in psychiatric and neurological disease. Dr. Sanjeev Jain is head of the institute's department of psychiatry in Bangalore, Karnataka, and serves as UF's primary foreign collaborator.

'Psychiatric disorders in children, adults and the elderly arise from a combination of biological and psycho-social and environmental factors, which may differ across the world,' Jain said. 'These factors may also influence access to care and outcomes. Multidisciplinary and in-depth research will be essential to understand these influences, and this collaboration will focus its efforts on training researchers to address these issues.'

The new project will concentrate on the behavioral health issues of greatest concern in India, Cottler said, and in addition to Bangalore, includes partnerships in two east Indian cities: Gangtok, Sikkim, in the Himalayas and Tezpur, Assam, in the Himalayan foothills.

A major aim of the project is to address India's demand for behavioral health care providers through on-site workshops for health workers in the Indian partner cities, and 12 fellowships for Indian professionals who will train in the United States for several months to a year in epidemiology, community-engaged research and public health policy.

'We want to strengthen the human capital so when we train fellows they will go back to India and train other people and it will be like a pyramid effect,' Cottler said.

Indian mental health clinics may see hundreds of patients a day, some who have traveled several hours, said Dr. Nikhil Jain, a psychiatrist based in Sikkim and a Fogarty grant trainee currently working at UF.

'The other thing we are lacking in Sikkim is epidemiological research,' he said. 'We have absolutely no data on any epidemiology, not just on mental health, but also other diseases. So to start off we need some data to build on our public health structure. That is one very important issue that I am looking forward to learning here during my three-and-a-half months.'

Suicide and substance abuse are two mental health issues of growing concern for the Sikkim population, but the causes are not well-understood, said Sonam Ongmu Lasopa, a Sikkim mental health professional and Fogarty fellow who plans to earn a doctorate at UF in epidemiology. The research and training collaborations with UF may help mental health providers in Sikkim develop treatment and prevention programs based on empirical data, she said.

'The population that we will work with is a population where no health research has ever been done before,' she said. 'It will be an eye-opener for a lot of us because we have some assumptions that may turn out to be wrong.'

The project will also offer several benefits for UF researchers and students, Cottler said.

'The past workshops we have conducted in India have been significant learning experiences for all, whether students, residents, fellows or professors,' Cottler said. 'Each team demonstrates new methodologies; cultural issues are always discussed and focused on as well. The workshops and small discussions will spark ideas for new efforts that could be done collaboratively between the University of Florida, India's National Institute of Mental Health and Neuro Sciences, and our new Indian partners. This is a way to get investigators from all over the university involved in research in India working on common themes. We are excited about this new opportunity.' For any query with respect to this article or any other content requirement, please contact Editor at htsyndication@hindustantimes.com

Behavioral health company expands contract, announces financing. - Health & Medicine Week

2004 NOV 15 - (NewsRx.com & NewsRx.net) -- PHC, Inc., d.b.a. Pioneer Behavioral Health (BULLETIN BOARD: PIHC), announced that its Harmony Healthcare subsidiary has successfully negotiated an expansion of the contract with its largest Nevada payor, PacifiCare of Nevada.

Under the terms of the expanded contract, Harmony will provide additional value-added behavioral health services for PacifiCare's Secure Horizons members.

The contract specifies a rate increase for the approximately 24,000 Medicare Advantage program members (formerly the Medicare + Choice program) currently enrolled in the Secure Horizons program. Harmony expects approximately $150,000 in annualized new revenues from this expanded contract.

Bruce A. Shear, Pioneer Behavioral Health's president and chief executive officer, commented, 'This announcement represents another step in our national expansion strategy, and an important announcement for the citizens of the greater Las Vegas metropolitan area. Over the last 7 years, Harmony and PacifiCare have developed an outstanding, mutually beneficial relationship, with Harmony as a leading provider of behavioral healthcare services for PacifiCare's health management, point-of-sale and Secure Horizons plans.'

Shear continued, 'With Harmony's already-strong presence in the Las Vegas area, this contract expands our mark in that region, which is an important step for our growth strategy. Expanding our footprint in the rapidly growing Las Vegas region, one of the fastest growing metro areas in the country, is an important step for our growth strategy.'

The company also recently announced it has secured an expanded line of credit, secured with its accounts receivables, totaling $3.5 million. The line of credit is provided by CapitalSource Finance LLC, and replaces Pioneer's former bank.

Shear commented, 'This new, expanded line of credit will provide the additional working capital to allow us to achieve our previously announced revenue growth strategy, including the recently announced expansion of our subsidiary, Detroit Behavioral Institute, Inc. at the Detroit Medical Center. As a specialty lender with a focus on healthcare, CapitalSource Finance is a proven partner in debt and equity financings, and we look forward to a mutually productive relationship going forward.'

CapitalSource is a specialized commercial finance company offering asset-based, senior, cash flow and mezzanine financing to small and mid-sized borrowers through three focused lending groups: Corporate Finance, Healthcare Finance and Structured Finance.

PHC, Inc., d.b.a. Pioneer Behavioral Health (BULLETIN BOARD: PIHC) is a provider of inpatient and outpatient behavioral health services and pharmaceutical research.