Travis County is seeking public and community provider input on establishing a Local Behavioral Health Authority. Please see the information below and provide your comments beginning February 5 through March 5, 2019. Comments received will be provided to county staff and the Travis County Commissioners Court.
What is a Local Behavioral Health Authority (LBHA)?
Texas Health and Human Services contracts with 37 local mental health authorities and 2 local behavioral health authorities to deliver mental health services in communities across Texas.
The distinction between a Local Mental Health Authority (LMHA) and a LBHA is that the latter is given the authority to support equitable planning in both mental health and substance use while a LMHA is only responsible for mental health.
Local Authorities are required to evaluate the needs of communities in their geographic area and plan, develop policy, coordinate services and use resources to address those needs. Local Authorities are also required to consider public input, the ultimate cost-benefit and client care issues to:
- Ensure people who need services can exercise consumer choice by helping them decide on their services, service provider and location of services.
- Ensure the best use of public money to create a network of service providers and determine whether to provide a service or to contract that service to another organization.
- Make recommendations on the most appropriate services available to people who need services.
To meet the needs of local communities and service areas, LMHAs and LBHAs are charged with the following responsibilities.
- Develop a local plan that incorporates stakeholder input that would be submitted to and approved by HHSC
- Ensure the provision of substance use disorder services, including establishing standards and recruiting and credentialing a provider network
- Coordinate across systems to ensure needs are met
- Provide technical assistance and training to providers and the community
- Oversee quality management and corporate compliance activities
The Texas Statewide Behavioral Health Strategic Plan reflects a larger shift toward more integrated and patient-centered behavioral health services that are easier to locate and access. This shift can also be seen in legislation including SB 1507 passed during the 84th Legislature.
How is a LBHA created?
The Texas Health and Safety Code – HEALTH & SAFETY § 533.0356 - Local Behavioral Health Authorities statute allows tlocal mental health authorities to apply to the department to become a LBHA. The Texas Health and Human Services Commission may designate a local behavioral health authority to support equitable planning and provision of services in both mental health and substance use.
What other communities have a LBHA?
Currently, there are two LBHAs in Texas. North Texas Behavioral Health Authority (NTBHA) is the Local Behavioral Health Authority contracted by Texas Human Services Commission (HHSC) to provide mental health and substance use disorder services to qualified indigent consumers in a six-county region of Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall Counties. Collin County MHMR, dba LifePath Systems, is the Local Behavioral Health Authority in Collin County and surrounding areas.
What would be different in Travis County under a LBHA?
Today, in Travis County, there is not an entity designated with responsibility for substance use disorder planning and service coordination. An LBHA is a mechanism for our community to create a fixed point of accountability that would allow better coordination of our limited resources.
Currently, the state of Texas uses state general fund dollars and federal funds to contract with an array of substance use disorder providers across the state. This includes 68 contracts with 19 providers for Prevention, Intervention and Treatment services within Region 7, a multi-county area that includes Travis. This results in small grant activities that are fragmented and lack coordination across communities. A LBHA would be required to develop and implement a local plan for both mental health and substance use disorder, as is required of a local mental health authority as it relates to mental health. A local plan could be coordinated with existing local networks including the Substance Use Managed Services Organization (SAMSO) and the Downtown Austin Community Court and aligned with organizations needing linkage to treatment such as the Austin-Travis County Sobering Center and Ending Community Homelessness Coalition (ECHO), for example. This would help ensure that we have a local system of coordinated services that leverages all investments.
A local point of authority with responsibility for planning and fund management would support a more focused effort that could incorporate local planning bodies, community forums and other initiatives designed to strengthen community local systems for better effectiveness.
A sample of the Collin County LBHA local plan can be found here, as well as the North Texas LBHA local plan here.
What will be the response from local partners and providers?
Local partners who are invested in seeing a stronger, more effective response to substance use disorder will be supportive of a LBHA. Each of these entities and their affiliated departments and organizations could benefit from a single point of authority for substance use disorder as this issue cuts across many systems and services –justice and public safety, health, emergency response, public health, homelessness, and poverty.
Providers, non-profit and for profit, that currently have state contracts for substance use disorder services may perceive this as a threat to a revenue source. In particular, current federal law prohibits contracting with for-profit entities for Substance Use treatment with block grant dollars, which would come through the LBHA. When Collin Co. achieved LBHA status, this issue was addressed by having a moratorium on changes to state contracts to allow time for providers to adjust to the new arrangement. Some for profit entities have chosen to develop non-profit lines of business in order to be eligible for the federal block grant dollars.
Integral Care currently uses other dollars to contract with for profit providers to ensure that we have adequate access to substance use disorder services in the community.
What qualifications and experience does Integral Care have to be an LBHA?
For 50 years, Integral Care has served as the Local Mental Health Authority for Travis County, developing and executing a plan for service provision and establishing and maintaining a large network of contract providers. Over this time, Integral Care has received and managed millions of dollars in state contract awards, as well as local and private funding. The organization has the infrastructure in place to meet the extensive requirements of state contracts.
As the mental health authority and a provider of both mental health and substance use disorder services, Integral Care staff witness on a daily the high rate of co-occurrence of mental illness and substance use disorder. The deep experience of Integral Care’s staff with addressing both conditions makes the agency uniquely qualified to serve in the role of the LBHA.<p?>
In recent years, Integral Care has strengthened its capacity in the area of substance use disorder. The organization’s Medical Director, Dr. Craig Franke, is board certified in addiction as is another team psychiatrist, Dr. John Nguyen. Through their leadership, Integral Care has expanded and deepened services, adding medication assisted therapy in partnership with funding from the Community Care Collaborative. Most recently the agency received funding from the Substance Abuse and Mental Health Services Agency to establish a substance use disorder HUB to better coordinate and streamline access to care. These build upon our long standing methadone maintenance and office based opioid treatment programs.
In 2018, Integral Care became a Certified Community Behavioral Health Center (CCBHC) which requires increased integration of substance use disorder, mental health and physical health care, raising quality standards for services delivered and meeting specific metrics. As a CCBHC, Integral Care is in a stronger position to receive, coordinate and distribute funds as more federal resources flow to communities for substance use disorder. CCBHC status will strengthen the potential impact of a LBHA for our community.
Integral Care also already has more than a decade of experience operating a Substance Abuse Managed Services Organization (SAMSO) locally funded through Travis County and the City of Austin. The SAMSO is a network of providers contracted to provide services across Travis County.
A key role of an authority is planning. Integral Care has led community planning efforts in Substance Use and Children’s Mental Health and collaborated across the community in the areas of homelessness, public safety and criminal justice. At the request of Central Health, City of Austin and Travis County, Integral Care oversaw a community planning process that produced the Travis County Plan for Substance Use Disorders, published in 2015.
