Many important terms are used in the mental health policy discussion. MMHPI has distilled them down into a handy reference guide.
1115 Transformation Waiver: a frequently used short-hand reference to the Texas Health Care Transformation and Quality Improvement Program (authorized under a federal 1115 transformation waiver). This waiver allows the state to expand Medicaid managed care while preserving federal hospital funding previously received as upper payment limit (UPL) payments. Under the waiver, two funding pools replace the UPL payment methodology: (1) the Uncompensated Care Pool helps offset the costs to hospitals for treating people who are uninsured; and (2) the Delivery System Reform Incentive Pool (DSRIP) funds programs and strategies that enhance access to health care, quality of care, and cost-effectiveness. Payments are based on performance outcomes and not simply on delivering a service. Eligibility for DSRIP payments requires participation in a regional health care partnership (RHP). Texas has designated 20 RHPs and has identified an “anchor entity” for each to coordinate efforts to develop and implement regional plans. Each partnership comprises participating entities that can provide public funds known as intergovernmental transfers (IGT).
Assertive Community Treatment (ACT): an evidence-based, multidisciplinary team approach that is designed to provide treatment, rehabilitation, and support services to individuals who are diagnosed with severe mental illness and most at risk for homelessness, psychiatric crisis and hospitalization, and involvement in the criminal justice system. The ACT team, composed of members from the fields of psychiatry, nursing, psychology, social work, substance abuse, and vocational rehabilitation, provides direct services that are tailored to meet the individual’s specific needs. Team members collaborate to deliver integrated services, assist in making progress towards goals, and adjust services over time to meet recipients’ changing needs and goals.
Behavioral Health Care: assessment and treatment of mental or emotional disorders and substance use disorders.
Carve-Out: a decision to purchase separately a service that is typically part of a managed care organization plan.
Centers for Medicare & Medicaid Services (CMS): the federal agency responsible for administering Medicare and overseeing state administration of Medicaid.
Children’s Health Insurance Program (CHIP): the Balanced Budget Act of 1997 (BBA), enacted on August 5, 1997, established a new state children’s health insurance program by adding Title XXI to the Social Security Act and amending the Medicaid statute. The program’s purpose is to provide funds to states to enable them to initiate and expand the provision of child health assistance to uninsured children in families with incomes too high to qualify them for Medicaid.
Crisis Services: a continuum of services that are provided to individuals experiencing a psychiatric emergency. The primary goal of these services is to stabilize and improve psychological symptoms of distress and to engage individuals in an appropriate treatment service to address the problem that led to the crisis.
Delivery System Reform Incentive Pool (DSRIP): a component of the 1115 Transformation Waiver that is used to fund specific programs and strategies across Texas to enhance access to health care, quality of care, and cost-effectiveness.
Department of Family and Protective Services (DFPS): the child and adult welfare agency for the state of Texas.2
Department of Aging and Disability Services (DADS): the state agency that oversees long-term care for older adults and people with disabilities in Texas.3
Department of State Health Services (DSHS): the state agency that includes the state behavioral health authority.4
Dual Eligible: an individual who qualifies for both Medicare benefits and Medicaid assistance.
Electronic Health Record (EHR): a digital version of a paper chart that contains all of a person’s medical history. While this term is often used synonymously with “electronic medical record,” an EHR includes a more comprehensive history than data collected in a given provider’s office. EHRs are typically designed to contain and share information from all providers involved in a person’s care. EHR data can be created, managed, and consulted by authorized providers and staff from across more than one health care organization.
Federal Poverty Level (FPL): the income guideline established annually by the federal government. Public assistance programs, including Medicaid, generally define income limits in relation to the FPL.
Forensic Assertive Community Treatment (FACT): an adaptation of the traditional assertive community treatment (ACT) model for people with serious mental illness who are involved with the criminal justice system. FACT is designed to prevent criminal recidivism through criminal justice collaborations.
Health and Human Services Commission (HHSC): the oversight agency for health and human services in Texas. HHSC is the single state Medicaid and CHIP agency for Texas.6
Health Information Exchange (HIE): refers to the electronic movement of health-related information among organizations according to nationally recognized standards. The goal of a health information exchange is to facilitate access to and retrieval of clinical data to provide better coordinated care across providers.
Inpatient Services: 24-hour services, delivered in a licensed facility setting, that provide clinical intervention for mental health or substance use diagnoses, or both.
Integrated Care: the systematic coordination of physical and behavioral health care whereby behavioral health specialty and general medical care providers work together to address both the physical and behavioral health needs of their patients.
Local Mental Health Authorities (LMHAs): DSHS contracts with 38 LMHAs (39 after the development of NorthSTAR 2.0) to provide or arrange for the delivery of community mental health services for a specific geographic area. The LMHAs are required to plan, develop, and coordinate local policy and resources for mental health care.8
Managed Care: a system in which the overall care of a patient is overseen by a single provider or organization.
Managed Care Organization (MCO): an organization that delivers and manages health services under a risk-based arrangement. The MCO usually receives a monthly premium or capitation payment for each person enrolled, which is based on a projection of costs of services for the typical patient.
Medicaid: a joint federal-state entitlement program that pays for medical care on behalf of certain groups of persons with low-incomes. The Texas Medicaid program finances managed care statewide (other than in the seven-county area inclusive of the Dallas service area) through three programs: STAR, STAR+PLUS, and STAR Health.
STAR: a Medicaid managed care program designed to provide for, arrange for, and coordinate preventive, primary, and acute care covered services to non-disabled children, low-income families, and pregnant women.
STAR+PLUS: a Medicaid managed care program that provides integrated acute and long-term services and supports to people age 65 and older and adults with disabilities (SSI).
STAR Health: a statewide Medicaid managed care program that provides services, including covered behavioral health services, to children and youth in foster care and kinship care.
STAR Kids: refers to the new Medicaid managed care program authorized by the 83rd Legislature under SB 7, specifically serving youth and children who receive disability-related Medicaid. Beginning in the Fall of 2016, children and youth age 20 or younger who either receive Supplemental Security Income (SSI) Medicaid or are enrolled in the Medically Dependent Children Program (MDCP) will receive all of their services through a STAR Kids health plan. Children and youth who receive services through other 1915(c) waiver programs will receive their basic health services (acute care) through STAR Kids.
Both STAR and STAR+PLUS currently include all standard behavioral health services; in September 2014, SB 58 expanded these benefits to also include the specialty mental health services designed for persons with a serious and persistent mental illness, known as Medicaid Rehabilitative Services (Rehabilitation) and Targeted Case Management (TCM).
Medicare: the nation’s largest health insurance program financed by the federal government. Medicaid provides insurance to people who are age 65 and older as well as those with disabilities or permanent kidney failure.
Outpatient Competency Restoration (OCR): an effective alternative to lengthy jail stays and costly hospital commitments for some individuals with mental illness or intellectual disabilities. Competency restoration is the criminal justice system process used when individuals are charged with crimes but deemed incompetent to stand trial. To be considered restored and competent to stand trial, a defendant must be able to consult with his or her defense lawyer and have a rational and factual understanding of the legal proceedings.9
Outpatient Services: mental health and substance use disorder services provided in person in a mental health center or substance use disorder clinic, hospital outpatient department, community health center, or clinical practitioner’s office. In contrast to inpatient services, outpatient services provide individuals with more freedom of movement, which allows them to maintain a regular commitment to family, work, and educational responsibilities.
Primary Care: basic or general health care, traditionally provided by family practice, pediatric, and internal medicine providers.
Prior Authorization: an authorization from an insurer that must be obtained prior to the delivery of certain services.
RAISE Early Treatment Program: an evidence-based, strategic intervention targeting the early stages of psychosis that can be facilitated both in community-based and public mental health settings as well as private clinical practice settings.
Recovery: a way of living a satisfying, hopeful, and contributing life even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness or substance use disorders.12
Serious Mental Illness (SMI): refers to adults and older adults whose diagnoses are seen as more severe, such as schizophrenia, severe bipolar disorder, or severe depression. A subgroup of these individuals is defined as having a serious and persistent mental illness (SPMI) that seriously impairs their ability to be self-sufficient and has either persisted for more than a year or resulted in psychiatric hospitalization.
Severe Emotional Disturbance (SED): in epidemiological studies, this term generally refers to children and youth ages newborn to 17 years who have emotional or mental health problems so serious that their ability to function in family, school, or community activities is significantly impaired, or their ability to stay in their natural homes may be in jeopardy.
Supplemental Security Income (SSI): a federal cash assistance program for low-income older people and people of all ages with disabilities. In Texas, SSI recipients are automatically eligible to receive Medicaid.
System of Care Collaborative: refers to a functional, ongoing, empowered collaborative structure trusted to represent all key partners in a health care delivery system in an ongoing planning and system coordination role. A System of Care Collaborative must have the capacity to drive innovation and quality improvement using data on population health, costs, and the customer experience of care.
Telepsychiatry: a type of telemedicine that uses electronic communication and information technologies to provide or support clinical psychiatric care at a distance through the use of two-way, real time interactive audio and video equipment.
Texas Commission on Jail Standards (TCJS): the state agency responsible for establishing minimum standards, inspection procedures, enforcement policies, and technical assistance for: (1) the construction, equipment, maintenance, and operation of jail facilities under its jurisdiction; (2) the custody, care, and treatment of inmates; and (3) programs of rehabilitation, education, and recreation for inmates confined in county and municipal jail facilities under its jurisdiction.15
Texas Commission on Law Enforcement (TCOLE): the state agency responsible for establishing and enforcing standards to ensure that the people of Texas are served by highly trained and ethical law enforcement, corrections, and telecommunications personnel. It was formerly known as the Texas Commission on Law Enforcement Officer Standards and Education (TCLEOSE).17
Texas Department of Criminal Justice (TDCJ): the state agency responsible for the state-run correctional system in Texas.18
Texas Juvenile Justice Department (TJJD): the state agency responsible for juvenile justice and rehabilitation in Texas.19
Trauma informed care: refers to treatment approaches of any kind that explicitly address the consequences of trauma on an individual.