RD441 - Report on Discharge Assistance Planning – Monday, October 19, 2020

Executive Summary:

The purpose of this report is to provide a summary and recommendations from the Discharge Assistance Program (DAP) Workgroup, Item 321 C.3 of the 2020 Appropriations Act, on the allocation and use of DAP based on the collective views of the behavioral health and developmental disability system stakeholders. The DAP program began in 1997 as a solution to alleviate census pressures at one state psychiatric hospital. The concept was to utilize funds to support individuals with extraordinary barriers to discharge. Since that time, the program has grown to include all eight adult psychiatric hospitals with a budget of over forty million dollars. The program is as critical today as it was two decades ago. The program provides flexibility for stakeholders, including the Department of Behavioral Health and Developmental Services (DBHDS), their eight psychiatric facilities, and Community Services Boards to tailor specific and individualized services for people with serious mental illness that cannot be provided through other state or federal programs. Without DAP, many more individuals would require long-term inpatient psychiatric care in DBHDS facilities.

The workgroup met with key stakeholders to discuss the need for reforms to DAP allocation and recommend services to meet the needs of the DAP population in order to increase the sustainability of the program. The group agreed that DAP funds currently fill gaps created by lack of services and funding options for special populations discharging from a DBHDS psychiatric facility. DBHDS currently has the opportunity to better utilize the DAP funds as well as partner with other state agencies to expand the services needed for those discharging from a state facility.

The workgroup determined that the top challenges encountered in identifying services for recently discharged patients include inconsistent availability of affordable supervised living options, lack of services for individuals with dementia and traumatic brain injury, and administrative burden on parties who manage DAP. To address these issues, the workgroup developed the following recommended updates and investments in the DAP program to promote more effective utilization of funds as well as to continue to provide effective services for special populations.

• Create opportunities to support the culture of least restrictive and highly integrated community living options and avoid long-term inpatient treatment where feasible

• Invest in a needs assessment for individuals leaving state facilities and available, appropriate integrated living options

• Invest in and support rate setting for supervised living options to provide for consistency, effective utilization, and recovery-oriented practices in supervised living arrangements.

• Partner with the Department of Aging and Rehabilitative Services (DARS) and the Department of Medicaid Assisted Services (DMAS) to develop services and funding for individuals with dementia and traumatic brain injury without a serious mental illness

• Support IT infrastructure to reduce administrative burden on DAP management at the community services board level

• Partner with DMAS to include MCOs in discharge planning

• Support programs and mental health professionals in nursing facilities to increase acceptance rate of individuals needing nursing home care leaving state facilities