Report Type: Assessment Community Forum/Survey Governance Plan Recommendations
Behavioral Health Initiative Working Group: Recommendations (Presentation)
YEAR
2023
AUTHOR / ORGANIZATION
BernCo
GEOGRAPHIC SCOPE
Bernalillo County, City/County Joint
What is this?
This is a policy recommendation report produced by a Working Group established by the Bernalillo County Commission under Resolution AR 2023-3 in January 2023. The Working Group met 14 times between February 28 and May 31, 2023, reviewing multiple foundational documents including the Via Positiva Gap Analysis (2021), CJCC-Project Echo Analysis (2019), REDW Internal Audit (2023), New Mexico First reports (2022), and City of Albuquerque Gap Analysis Addendum (2022). The methodology included background document review, client perspective process mapping, iterative recommendation development among Working Group members, and presentations on data sharing and the County budget process. The report was presented to the Board of County Commissioners at a Work Session on June 7, 2023, with recommendations intended for formal adoption.
Summary
This report presents actionable recommendations for building a genuine behavioral health system in Bernalillo County, addressing the current fragmentation of services funded by a voter-approved 1/8 percent Gross Receipts Tax generating over $25 million annually. The six core recommendations include: (1) establishing a Deputy County Manager for Behavioral Health position and developing a collaborative strategic plan with the City of Albuquerque and UNMH; (2) restructuring BHI operations with a new Advisory Council and triennial priority review process; (3) investing in data sharing infrastructure including uniform assessment tools and expanded data warehouse capabilities; (4) increasing funding through Medicaid expansion, opioid settlement funds, and state resources; (5) developing supportive housing across the continuum of care; and (6) improving coordination with Metropolitan Detention Center for re-entry services. The report emphasizes a “No Wrong Door” approach, Social Determinants of Health framework, and creation of a virtual and physical “Hub” system to connect clients with services. Implementation includes specific timelines for hiring leadership, empaneling advisory bodies, and releasing new RFPs by December 2023.
BH Systems Change Recommendations
**Recommendation 1: Build a genuine system of behavioral health care** - Establish Deputy County Manager for Behavioral Health position - Develop collaborative Behavioral Health Strategic Plan with City of Albuquerque, UNMH, and partners - Create virtual and physical "Hub" system for basic needs and service referrals - Expand professional provider network and create paraprofessional pathways - Address continuity of care for released inmates - Expand addiction services including Youth Detox Center **Recommendation 2: Restructure BHI operations** - Implement new governance structure with Advisory Council and Priority Proposal Review Committees - Establish triennial behavioral health priority review process - Develop/adopt County behavioral health performance measures - Build data sharing and No Wrong Door requirements into contracts - Adequately fund program evaluations **Recommendation 3: Invest in data sharing infrastructure** - Build relationships through MOUs and jointly-developed core data sets - Develop uniform assessment tool and release of information form - Expand data warehouse to include other government entities - Determine quality measurements based on outcomes, not just outputs - Encourage Health Information Exchange utilization **Recommendation 4: Increase funding for behavioral health services** - Pursue Opioid Settlement funding - Ensure County is Medicaid provider; assist providers in becoming Medicaid providers - Pursue grant/philanthropic/seed funding - Pursue State funding including capital outlay and Junior Bill funds - Evaluate Section 8 and HUD funding for housing needs - Retain Medicaid consultant for waiver opportunities **Recommendation 5: Support additional housing development** - Develop inclusive housing eligibility criteria guided by Social Determinants of Health - Encourage different levels of supportive housing across continuum - Prioritize pregnant women and women with children - Convene Housing Summit for inter-agency strategies - Consider landlord protection measures **Recommendation 6: Improve MDC coordination** - Re-engage jail leadership in re-entry efforts - Work with CJCC to improve release process - Evaluate kick-out meds and prescriptions effectiveness - Create exclusive treatment pods for Addictions Treatment Program - Review and improve MAT protocols at MDC
How to Use for Systems Planning
**What this report IS useful for:** - Strategic framework for reorganizing behavioral health governance and funding structures - Detailed implementation timeline for BHI restructuring through February 2024 - Identifying partnership opportunities with City of Albuquerque, UNMH, MCOs, and state agencies - Understanding the recommended priority-setting process for $25+ million in annual BH funding - Guidance on data infrastructure investments and uniform assessment tool development - Framework for expanding Medicaid billing and leveraging additional funding streams **What this report DOES NOT provide:** - Specific budget allocations or cost estimates for recommended initiatives - Clinical protocols or service delivery standards - Current provider performance data or program evaluation results - Detailed analysis of existing service gaps (references prior gap analyses) - Community input from the triennial priority process (scheduled for later in 2023)
Key Facts & Data Points
- BHI provides over $25 million annually for behavioral health services - BHI established in 2015, supported by voter-approved 1/8 percent Gross Receipts Tax - Working Group conducted 14 weekly meetings from February 28 to May 31, 2023 - Six major documents reviewed during the process - Six comprehensive recommendations developed - Proposed triennial (3-year) behavioral health priority review cycle - Timeline targets December 1, 2023 for new RFP release with updated funding priorities - Proposes creating new Deputy County Manager for Behavioral Health position - Recommends 5-7 members per Priority Proposal Review Committee
Priority Services & Findings
**SUD Organizations** - Expand addiction services with new facilities including Youth Detox Center - Expand medical detox at the CARE Campus - Expand Addictions Treatment Program in MDC by creating exclusive treatment pods - Review detox protocols and continuity in Medication Assisted Treatment (MAT) at MDC - Pursue Opioid Settlement funding for County priorities through expanded ATAB role - Support development of Certified Community Behavioral Health Clinics (CCBHCs) **Mental Health / Crisis Care** - Create virtual and physical "Hub" system across continuum of care - Implement No Wrong Door policy across all providers - Develop interagency crisis/priority services mapping - Identify high utilizers and prioritize for housing and services - Establish client Hub/social services center with pilot project - Address continuity of care for released inmates with documented behavioral health conditions **Integrated Primary Care** - Pursue Medicaid expansion and assist providers in becoming Medicaid providers - Monthly meetings between County, City, UNM and MCOs for Medicaid utilization coordination - Encourage use of Health Information Exchange (HIE) - Integrate behavioral health with Social Determinants of Health framework - Retain Medicaid consultant to review State plan expansion including 1115 and 1915(i) waivers **School-Based / Youth Services** - Support development and operation of Youth Detox Center - Work with APS, UNM, CNM for student service opportunities - Include APS in regular intergovernmental coordination - Cross-training on Adverse Childhood Experiences (ACEs)
Immediate Actions for Systems Planners
-Hire Deputy County Manager for Behavioral Health and post position immediately -Initiate recruitment process for Behavioral Health Advisory Council members with target empanelment by October 2023 -Engage consultant to lead BHAC selection process to ensure transparency -Review and update all BHI contracts to include data sharing requirements and No Wrong Door policy -Begin planning for December 2023 multi-award RFP release with updated funding priorities -Schedule monthly coordination meetings between County, City, UNMH, and MCOs -Evaluate Social Service Network Referral platforms (e.g., UniteUs) for Hub implementation -Convene meeting with Criminal Justice Coordinating Council to address MDC release process improvements -Retain Medicaid consultant to assess 1115 and 1915(i) waiver opportunities -Coordinate with Bernalillo County Housing Department on Housing Summit planning
Key Contacts
**/ - Addiction Treatment Advisory Board (ATAB) = - Albuquerque Public Schools (APS) = - BernCo Dept of Behavioral Health Services (DBHS) = - CARE Campus = - City of Albuquerque **/ - Criminal Justice Coordinating Council (CJCC) = - HSD Centennial Care = - Legislative Finance Committee = - Managed Care Organizations (MCOs) = - Metropolitan Detention Center (MDC) **/ - Middle Rio Grande Housing Collaborative = - NM Behavioral Health Collaborative = - NM Dept of Health (NMDOH) = - NM Human Services Dept (NMHSD) = - NM Mortgage Finance Authority (MFA) = - NM Supreme Court Commission on Mental Health & Competency = - UNM Hospital (UNMH)