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Behavioral Health Commission Reviews School-Based Mental Health Services, Behavioral Health Redesign

At the Behavioral Health Commission’s November 13 meeting, Commission members received a briefing on the results of a study of school-based mental health services directed by the 2022 Appropriation Act and adopted several recommendations stemming from that study.  Members also received an update on the implementation of the state’s initiative to redesign behavioral health services funded by Medicaid.

School-based mental health services This study examined ways to maximize school-based mental health services, to include evaluating current offerings within school divisions and opportunities to expand services.  Staff reported that youth in Virginia are experiencing significant mental health challenges, which school staff believe have worsened since the COVID-19 pandemic.  Access to services in schools varies; most school divisions offer broad-based programming and other supports provided by teachers or other school staff, such as a social-emotional learning curriculum, a suicide prevention program, or school events dealing with mental health (considered “Tier 1” supports in the Multi-Tiered System of Supports framework).  However, more intensive supports are more limited; Commission staff analysis of a survey of school divisions indicates that approximately 45 percent of students who require supports considered Tier 2 and Tier 3 under the Multi-Tiered System of Supports are unable to receive them, either because the services are not offered or there is limited capacity to meet demand.  Schools report difficulty in hiring mental health staff, and those staff often have additional responsibilities, such as administrative duties, that limit their ability to provide mental health services.

Infusions of federal pandemic relief funding have enabled school divisions to offer more mental health services in the last several years, but these funds will expire by January 2025.  Recent state investments in a pilot program to support mental health services have shown promise, but staff note that more consistency is needed in order to develop outcome measures, and a reliable funding stream is needed to enable providers to hire staff.  Recent expansion of the services provided in the school setting that can be funded by Medicaid is an opportunity for school divisions to increase Medicaid reimbursement, but Medicaid billing requires investments in administrative infrastructure, and the Department of Education’s current capacity to provide technical assistance is limited.

Commission members endorsed several proposals recommended by staff:

  • Include funding in the upcoming biennium budget to support the School-Based Mental Health Integration Pilot for two more years and direct the Department of Behavioral Health and Developmental Services (DBHDS) to develop performance measures for the program.
  • Include funding in the upcoming biennium budget for the Department of Medical Assistance Services (DMAS) to commission a review of school-based behavioral health services, to include redesigning therapeutic day treatment (a service that was once widespread in public schools, but, as DMAS has noted in the past, has a “problematic rate and unit structure that has made it impossible for providers to deliver the service,” particularly after it was moved from a fee-for-service structure into managed care).
  • Bolster the ability of the Department of Education (VDOE) to provide school divisions with technical assistance with Medicaid billing.
  • Direct VDOE to work with DBHDS and DMAS on a plan to deliver flexible mental health funds to school divisions; include one-time funding in the state budget to provide a bridge between the expiration of federal pandemic relief funds and the implementation of the permanent funding mechanism that would be developed by VDOE, DBHDS, and DMAS.

Implementation of Project BRAVO and Behavioral Health Redesign As part of the Commission’s ongoing monitoring of key behavioral health initiatives, staff were directed to evaluate the implementation and performance of Project BRAVO, the first phase of the state’s behavioral health redesign initiative.  The redesign is intended to improve access to Medicaid-funded behavioral health care services, as well as enhancing these services’ quality and cost-effectiveness; the goal of improving access to community-based services through the initiative is to reduce the need for higher-intensity services.  Project BRAVO included the redesign of nine behavioral health services, including services that were previously not covered by Medicaid or limited by inadequate rates.  Plans to build out additional services in subsequent phases of behavioral health redesign have not moved forward.  Staff review of utilization data for services covered under Project BRAVO indicates that utilization varies among services, with decreased use of some services possibly the result of increased availability of other more appropriate services, as well as changes in program requirements, such as prior authorization.  There is limited data about outcomes of services, making it difficult to evaluate quality and cost-effectiveness.

The staff presentation from the November 13 meeting, which includes summaries of the two reports, is available at this link.  The full report on school-based mental health services is available at this link, and the behavioral health redesign report is available at this link.  The Commission’s next meeting is scheduled for December 5.

VACo Contact:  Katie Boyle

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