Data Appendices - Department of Health Care Services

246 Pages·2012·5.72 MB·English

California Mental Health and
Substance Use System Needs
Assessment Appendices
February 2012
Submitted to the Department of Health Care Services
Completed by:
Technical Assistance Collaborative Human Services Research Institute
31 St James Ave, Suite 710 2336 Massachusetts Ave
Boston, MA 02116 Cambridge, MA 02140
Contact person: [email protected]
Contents
Appendix A: Department of Health Care Services Data....................................................................................................9
Section I: Service Penetration............................................................................................................................................10
Table 1a: Penetration Rates for Mental Health & SUD Services 2009..............................................................................11
Table 1b: Penetration Rates for SMI Mental Health Services –County Level....................................................................14
Table 1c: Penetration Rates for Broad Definition Adult Mental Health Services –County Level.....................................16
Table 1d: Penetration Rates for SED Mental Health Services –County Level...................................................................18
Table 1e: Penetration Rates for Alcohol or Drug Diagnosis Services –County Level........................................................20
Section II: Service Utilization..............................................................................................................................................22
Table 2: Medicaid Beneficiary Behavioral Health Expenditures 2009-2007.....................................................................23
Table 2.1a: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2009.....................24
Table 2.1b: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2009 –DMC/SMHS
Services..............................................................................................................................................................................26
Table 2.1c: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2009 –FFS............27
Table 2.2a: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2008.....................28
Table 2.2b: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2008 –DMC/SMHS
Services..............................................................................................................................................................................30
Table 2.2c: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2008 –FFS............31
Table 2.3a: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2007.....................32
Table 2.3b: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2007 –DMC/SMHS
Services..............................................................................................................................................................................34
Table 2.3c: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2007 –FFS............35
Table 2.4a: Medicaid Behavioral Health Care Expenditures Among Current Foster Care Medicaid Beneficiaries 2009..36
Table 2.4b: Medicaid Behavioral Health Care Expenditures Among Current Foster Care Medicaid Beneficiaries 2009 –
DMC/SMHS Services..........................................................................................................................................................37
Table 2.4c: Medicaid Behavioral Health Care Expenditures Among Current Foster Care Medicaid Beneficiaries 2009 –
FFS......................................................................................................................................................................................38
Table 2.5a: Medicaid Behavioral Health Care Expenditures Among Current Foster Care Medicaid Beneficiaries 2008..39
Table 2.5b: Medicaid Behavioral HealthCare Expenditures Among Current Foster Care Medicaid Beneficiaries 2008 –
DMC/SMHS Services..........................................................................................................................................................40
Table 2.5c: Medicaid Behavioral Health Care Expenditures Among Current Foster Care Medicaid Beneficiaries 2008 –
FFS......................................................................................................................................................................................41
Table 2.6a: Medicaid Behavioral Health Care Expenditures Among Current Foster Care Medicaid Beneficiaries 2007..42
Table 2.6b: Medicaid Behavioral Health Care Expenditures AmongCurrent Foster Care Medicaid Beneficiaries 2007 –
DMC/SMHS Services..........................................................................................................................................................43
Table 2.6c: Medicaid Behavioral Health Care Expenditures Among Current Foster Care Medicaid Beneficiaries 2007 –
FFS......................................................................................................................................................................................44
Table 2.7a: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries –EPSDT 2009.......45
Table 2.7b: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2009 –EPSDT
DMC/SMHS Services..........................................................................................................................................................46
Table 2.7c: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2009 –EPSDT FFS..47
Table 2.8a: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries –EPSDT 2008.......48
Table 2.8b: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2008 –EPSDT
DMC/SMHS Services..........................................................................................................................................................49
Table 2.8c: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2008 –EPSDT FFS..50
Table 2.9a: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries –EPSDT 2007.......51
Table 2.9b: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2007 –EPSDT
DMC/SMHS Services..........................................................................................................................................................52
Table 2.9c: Medicaid Behavioral Health Care Expenditures Among Current Medicaid Beneficiaries 2007 –EPSDT FFS..53
Figure 1: Total Expenditures by Service Domain 2009.....................................................................................................54
Figure 2: Total Expenditures by Service Domain 2008......................................................................................................54
Figure 3: Total Expenditures by Service Domain 2007......................................................................................................55
Figure 4: Total Expenditures –Adults 2009........................................................................................................................56
Figure 5: Total Expenditures –Adults 2008........................................................................................................................56
Figure 6: Total Expenditures –Adults 2007........................................................................................................................57
Figure 7: Total Expenditures –Youth 2009........................................................................................................................57
Figure 8: Total Expenditures –Youth 2008........................................................................................................................58
Figure 9: Total Expenditures –Youth 2007........................................................................................................................58
Table 3a: Behavioral Health Expenditures by Top Utilizers 2009....................................................................................59
Table 3b: Behavioral Health Expenditures by Top Utilizers 2008....................................................................................60
Table 3c: Behavioral Health Expenditures by Top Utilizers 2007....................................................................................61
Table 4: Characteristics of Current Participants in Behavioral Health Services 2009.......................................................62
Table 5: Enrollment Rates by Eligibility Category 2007-2009............................................................................................64
Table 6a: Number of ED Admissions by Cohort 2009........................................................................................................65
Table 6b: Number of ED Admissions by Cohort 2008........................................................................................................65
Table 6c: Number of ED Admissions by Cohort 2007........................................................................................................65
Table 7a: Number of Encounters –2009............................................................................................................................66
Table 7b: Number of Encounters –2008...........................................................................................................................68
Table 7c: Number of Encounters –2007............................................................................................................................70
Table 8a: Special Analyses: Elapsed Time from Hospital Discharge to Receipt of Medicaid Outpatient Behavioral Health
Service 2009.......................................................................................................................................................................72
Table 8b: Special Analyses: Elapsed Time from Hospital Discharge to Receipt of Medicaid Outpatient Behavioral Health
Service 2008.......................................................................................................................................................................74
Table 8c: Special Analyses: Elapsed Time from Hospital Discharge to Receipt of Medicaid Outpatient Behavioral Health
Service 2007.......................................................................................................................................................................76
Table 9a: Special Analyses: Hospital and Emergency Department Readmissions within 30 Days of Inpatient Discharge
for a Behavioral Health Condition 2009............................................................................................................................78
Table 9b: Special Analyses: Hospital and Emergency Department Readmissions within 30 Days of Inpatient Discharge
for a Behavioral Health Condition 2008............................................................................................................................79
Table 9c: Special Analyses: Hospital and Emergency Department Readmissions within 30 Days of Inpatient Discharge
for a Behavioral Health Condition 2007............................................................................................................................80
Table 10a: System at a Glance –Adults............................................................................................................................81
Table 10b: System at a Glance –Youth.............................................................................................................................81
Table 11a: Number of Months with Service Received –2009 Adults...............................................................................82
Table 11b: Number of Months with Service Received –2008 Adults...............................................................................82
Table 11c: Number of Months with Service Received –2007 Adults................................................................................83
Table 11d: Number of Months with Service Received –2009 Youth................................................................................83
Table 11e: Number of Months with Service Received –2008 Youth................................................................................84
Table 11f: Number of Months with Service Received –2007 Youth.................................................................................84
Section III: County-level Data.............................................................................................................................................85
Table 12a: Current Participants in Behavioral Health Services –County Level 2009........................................................86
Table 12b: Current Participants in Behavioral Health Services –County Level 2008........................................................88
Table 12c: Current Participants in Behavioral Health Services –County Level 2007........................................................90
Table 13a: Special Analyses: Monthly Mental Health Inpatient Services by County 2009...............................................92
Table 13b: Special Analyses: Monthly Mental Health Inpatient Services by County 2008...............................................94
Table 13c: Special Analyses: Monthly Mental Health Inpatient Services by County 2007................................................96
Section IV: Methodology....................................................................................................................................................98
Table 14: Diagnostic Codes for Extracting Population.......................................................................................................99
Table 15: Claims Level Data Requested...........................................................................................................................101
Table 16: Eligibility Categories and Corresponding Aid Codes........................................................................................110
Table 17: Diagnostic Conditions of the Broad Definition Behavioral Health Cohort.......................................................111
Table 18: ICD9 Diagnosis Codes that Correspond with SMI, Substance Use, and SED....................................................111
Table 19: SMI and SED Qualifying Diagnoses Table (full details)....................................................................................117
Table 20: DMC/SMHS Procedure codes.........................................................................................................................124
Table 21: Behavioral Health service categories by Domain............................................................................................126
Table 22: Aid Codes........................................................................................................................................................128
Appendix B: California Alcohol & Drug Program Data...................................................................................................142
Table 1a: System Snapshot –Admissions........................................................................................................................143
Table 1b: System Snapshot –Individuals.........................................................................................................................146
Table 2: Days Waited to Enter Treatment (Best Practice Indicator)...............................................................................149
Table 3: Treatment Service Type (Service & Resource Indicators)..................................................................................150
Table 3a: Treatment Service Type –Medi-Cal Beneficiary (Service & Resource Indicators)...........................................153
Table 3b: Treatment Service Type –Non-Medi-Cal Beneficiary (Service & Resource Indicators)...................................156
Table 4: Length of Stay (Best Practice Indicator).............................................................................................................159
Table 5: Recurrent & Continuous Users..........................................................................................................................162
Table 6:Discharge Status (Resource Impact Indicator)...................................................................................................165
Table 7: Substance Use Conditions (Service & Resource Indicators)..............................................................................167
Table 8: Referral Source (Service & Resource Indicators)...............................................................................................170
Table 9: Medi-Cal Beneficiary (System Indicator)...........................................................................................................173
Table 10: Medi-Cal Beneficiary by County (System Indicator)........................................................................................176
Appendix C: Mental Health Client Services Information Data (CSI)..............................................................................178
Table 1: System at a glance –Individuals........................................................................................................................179
Table 1b: System at a glance –Adults.............................................................................................................................180
Table 1c: System at a Glance –Youth..............................................................................................................................181
Table 2a: System at a Glance –Service Utilization (% Received)....................................................................................182
Table 2b: System at a Glance –Service Utilization (% Received) –Adults......................................................................183
Table 2c: System at a Glance –Service Utilization (% Received) –Youth.......................................................................184
Table 3: System at a glance –Service Utilization (Amount Received –Total Units).......................................................185
Table 4a: Number of Individuals Receiving Evidence-Based Practices............................................................................186
Table 4b: Number of Adults Receiving Evidence-Based Practices...................................................................................186
Table 4c: Number of Youth Receiving Evidence-Based Practices....................................................................................186
Table 5a: Number of Individuals Receiving Service Strategies.......................................................................................187
Table 5b: Number of Adults Receiving Service Strategies..............................................................................................187
Table 5c: Number of Youth Receiving Service Strategies...............................................................................................188
Table 6a: Number of Individuals Receiving Multiple Evidence-Based Practices.............................................................188
Table 6b: Number of Adults Receiving Multiple Evidence-Based Practices....................................................................188
Table 6c: Number of Youth Receiving Multiple Evidence-Based Practices.....................................................................189
Table 7a: Percent of Overall Recipients Receiving an EBP..............................................................................................189
Table 7b: Percent of Recipients Receiving an EBP –Adults.............................................................................................189
Table 7c: Percent of Recipients Receiving an EBP –Youth..............................................................................................189
Table 8: EBP Recipients by County..................................................................................................................................190
2010.................................................................................................................................................................................192
Table 9a: Arrivals& Snapshots –Adults..........................................................................................................................192
Table 9b: Arrivals & Snapshots –Youth...........................................................................................................................192
Table 10a: Service Utilization –Adults............................................................................................................................193
Table 10b: Service Utilization –Youth.............................................................................................................................194
Table 11a: Transitions –Adults........................................................................................................................................195
Table 11b: Transitions –Youth........................................................................................................................................195
2009.................................................................................................................................................................................196
Table 12a: Arrivals & Snapshots –Adults........................................................................................................................196
Table 12b: Arrivals & Snapshots –Youth.........................................................................................................................196
Table 13a: Service Utilization –Adults............................................................................................................................197
Table 13b: Service Utilization –Youth.............................................................................................................................198
Table 14a: Transitions –Adults........................................................................................................................................199
Table 14b: Transitions –Youth........................................................................................................................................199
2008.................................................................................................................................................................................200
Table 15a: Arrivals & Snapshots –Adults........................................................................................................................200
Table 15b: Arrivals & Snapshots –Youth.........................................................................................................................200
Table 16a: Service Utilization –Adults............................................................................................................................201
Table 16b: Service Utilization –Youth.............................................................................................................................202
Table 17a: Transitions –Adults........................................................................................................................................203
Table 17b: Transitions –Youth........................................................................................................................................203
2007.................................................................................................................................................................................204
Table 18a: Arrivals & Snapshots –Adults........................................................................................................................204
Table 18b: Arrivals & Snapshots –Youth.........................................................................................................................204
Table 19a: Service Utilization –Adults............................................................................................................................205
Table 19b: Service Utilization –Youth.............................................................................................................................206
Table 20a: Transitions –Adults........................................................................................................................................207
Table 20b: Transitions –Youth........................................................................................................................................207
Table 21a: Transitions -Received Evidence Based Practices –All 2009...........................................................................208
Table 21b: Transitions -No Evidence Based Practices –All 2009....................................................................................208
Table 22a: Transitions -Received Evidence Based Practices –Adults 2009....................................................................209
Table 22b: Transitions -No Evidence Based Practices –Adults 2009.............................................................................209
Table 23a: Transitions -Received Evidence Based Practices –Youth 2009....................................................................210
Table 23b: Transitions -No Evidence Based Practices –Youth 2009..............................................................................210
Table 24a: Transitions -Received Evidence Based Practices –All 2008...........................................................................211
Table 24b: Transitions -No Evidence Based Practices –All 2008....................................................................................211
Table 25a: Transitions -Received Evidence Based Practices –Adults 2008....................................................................212
Table 25b: Transitions -No Evidence Based Practices –Adults 2008.............................................................................212
Table 26a: Transitions -Received Evidence Based Practices –Youth 2008.....................................................................213
Table 26b: Transitions -No Evidence Based Practices –Youth 2008..............................................................................213
Table 27a: Transitions -Received Evidence Based Practices –All 2007...........................................................................214
Table 27b: Transitions -No Evidence Based Practices –All 2007....................................................................................214
Table 28a: Transitions -Received Evidence Based Practices –Adults 2007....................................................................215
Table 28b: Transitions -No Evidence Based Practices –Adults 2007.............................................................................215
Table 29a: Transitions -Received Evidence Based Practices –Youth 2007.....................................................................216
Table 29b: Transitions -No Evidence Based Practices –Youth 2007..............................................................................216
Methodology....................................................................................................................................................................217
Table 30: Resource Associated Functional Level Scale....................................................................................................219
Appendix D: Mental Health & Substance Use Services Provider Data.........................................................................220
Table 1: Number of Providers by Consumer Service Demographic................................................................................221
Section I: Top 10 Providers by Total Payment & Number of Individuals Served by Service Category.............................222
Table 2: SUD Day Treatment............................................................................................................................................223
Table 3: Mother-Child Habilitative & Rehabilitative Services..........................................................................................223
Table 4: Mental Health Case Management.....................................................................................................................223
Table 5: Mental Health Day Treatment...........................................................................................................................224
Table 6: Mental Health Day Treatment Rehabilitative....................................................................................................224
Table 7: Mental Health Inpatient.....................................................................................................................................224
Table 8: Mental Health Medication Support...................................................................................................................225
Table 9: Mental Health Crisis Intervention......................................................................................................................225
Table 10: Mental Health Crisis Stabilization....................................................................................................................225
Table 11: Mental Health Outpatient................................................................................................................................226
Table 12: Methadone Maintenance................................................................................................................................226
Table 13: Drug-Free Treatment.......................................................................................................................................226
Table 14: Crisis Residential..............................................................................................................................................227
Table 15: Adult Residential..............................................................................................................................................227
Section II: Number of Individuals Served by Provider by Service Category......................................................................228
Figure 1: SUD Day Treatment..........................................................................................................................................229
Figure 2: Mother-Child Habilitative & Rehabilitative Services........................................................................................229
Figure 3: Mental Health Case Management....................................................................................................................230
Figure 4: Mental Health Day Treatment..........................................................................................................................230
Figure 5: Mental Health Day Treatment Rehabilitative...................................................................................................231
Figure 6: Mental Health Inpatient...................................................................................................................................231
Figure 7: Mental Health Medication Support..................................................................................................................232
Figure 8: Mental Health Crisis Intervention.....................................................................................................................232
Figure 9: Mental Health Crisis Stabilization.....................................................................................................................233
Figure 10: Mental Health Outpatient..............................................................................................................................233
Figure 11: Methadone Maintenance...............................................................................................................................234
Figure 12: Drug-Free Treatment......................................................................................................................................234
Figure 13: Crisis Residential.............................................................................................................................................235
Figure 14: Adult Residential.............................................................................................................................................235
Section III: Total Number of Unitsof Service by Provider by Service Category................................................................236
Figure 15: Substance Use Day Treatment.......................................................................................................................237
Figure 16: Mother-Child Habilitative & Rehabilitative Services......................................................................................237
Figure 17: Mental Health Case Management..................................................................................................................238
Figure 18: Mental Health Day Treatment........................................................................................................................238
Figure 19: Mental Health Day Treatment Rehabilitation................................................................................................239
Figure 20: Mental Health Inpatient.................................................................................................................................239
Figure 21: Medication Support........................................................................................................................................240
Figure 22: Mental Health Crisis Intervention...................................................................................................................240
Figure 23: Mental Health Crisis Stabilization...................................................................................................................241
Figure 24: Mental Health Outpatient..............................................................................................................................241
Figure 25: Methadone Maintenance...............................................................................................................................242
Figure 26: Drug-Free Treatment......................................................................................................................................242
Figure 27: Crisis Residential.............................................................................................................................................243
Figure 28: Adult Residential.............................................................................................................................................243
Section IV: Service Descriptions.......................................................................................................................................244
Table 16: Service Type Descriptions................................................................................................................................245
Appendix A: Department of Health Care Services Data
Section I: Service Penetration
10