2019 Report on Demonstration Project in CPS

 

 

Bringing Telebehavioral Health to Illinois Schools

A Report to the Otho S.A. Sprague Memorial Institute

 

Fourth Quarter

April 2019 

Overview

This project, Bringing Tele-Behavioral Health to Illinois Schools (TBH), has been organized by the Illinois Telehealth Initiative (ITI), a program of Partnership for a Connected Illinois (PCI), with the aim of establishing demonstrations in TBH in five school-based clinics in Chicago Public Schools in partnership with Erie Family Health Centers and Rush University Medical Center who operate school clinics.

Accomplished to Date

The demonstration project of tele-behavioral health in five Chicago Public Schools was an exciting first step in providing behavioral health care to a seriously underserved student population. The project identified financially sustainable business models in four CPS high schools and one elementary school.  Over 100 students and their families were connected at their school to behavioral health providers at remote locations.  The project was successful because it:

 

  • invested in the needed education of providers, school and clinic staff, students and family;
  • used Psychiatric Mental Health Nurse Practitioners as qualified, reliable and economical providers;
  • used reliable equipment and software integrated into the organization’s larger IT and medical records system;
  • identified a Medicaid reimbursement issue and effectively presented this issue to policy makers and statewide advocacy groups likely leading to a change in Medicaid reimbursement; and
  • explored opportunities to expand to other school-based health clinics and schools without clinics.

 

Challenges and Lessons Learned

 

Psychiatric Mental Health Nurse Practitioners

Availability of behavioral health providers for the students was a challenge.  We had two psychiatrists leave during the demo period. The departures led to delays.  Psychiatrists are in huge demand.  The use of Psychiatric Mental Health Nurse Practitioners (PMHNP) with child and adolescent experience was more stable and economical.  The use of PMHNP’s is encouraged by a recent Illinois law which allows for Medicaid reimbursement for tele-psychiatry provided by PMHNP’s.  (P.A. 100-0790 effective 8/10/18).

 

Type 56 Clinics

Rush’s SBHC’s do not qualify for Medicaid reimbursement for providers of both onsite and tele- behavioral health services. This is a major impairment to a financially sustainable business model for school-based tele-behavioral health (TBH). The Illinois Health and Hospital Association (see IHA letter attachment A) and EverThrive-IL have advocated with the Illinois Department of Healthcare and Family Services to designate a needed CPT billing code to allow for reimbursement of Type 56 school-based health centers. We are hopeful that the new administration will support this effort.

 

Equipment

Selection of equipment and software set-up delayed the launch of the project because it involved organizational tech departments who sought to blend the project equipment/software with that of the larger organization.

 

Education

The project anticipated the lengthy time needed for educating stakeholders. We built in time and funding for Rush and Erie to:

  •  Conduct presentations to the students, family, school staff, teachers, provider organization staff, community agencies and community groups;
  • Hold team meetings in TBH workflow processes and evaluation;
  • Attend meetings with Rush and Erie tech departments to provide social work perspective on template development and software buildout;
  • Develop materials for staff training and
  • Develop and manage evaluation dashboards.

 

Expansion to other schools

Erie took the initiative to expand the project beyond their two schools to another SBHC they operate, Mary Ward Elementary School and is exploring the possibility of expanding to their clinics at Lakeview and Amundsen High Schools.  Rush also took the initiative to contact nearby schools without clinics to explore possibilities for TBH services to their students. They are exploring their ability to use their EPIC software in schools without Rush employees who maintain the security systems on the software.

 

Financials

See attachment B,  which describes the funds received, paid and prospective payments. A remaining $11,606.12 is requested from Sprague to reimburse funds already expended or committed.

 

Evaluation

Ramya Kumaran, a results-driven evaluation and research professional, was retained by the project to complete a final report on the telebehavioral health program’s results. That report, attachment C, has been delayed and will be forwarded separately.

 

Change in Regulatory Environment

Since the start of this demonstration project, the Medicaid laws and regulations have changed, enhancing Medicaid reimbursement for telehealth and removing unnecessary regulatory barriers which discouraged the use of telehealth.  The number of professions providing reimbursement to telehealth professionals has been expanded to include Psychiatric and Mental Health Advanced Practice Nurses, psychologists, social workers  and mental health professionals and clinicians.  The telehealth originating sites have been expanded to include any Medicaid eligible facility which has been interpreted as including schools. This interpretation would also make schools eligible for a $25 Medicaid telehealth origination fee.  The new laws also included a provision that a licensed health care professional is not required to be physically present in the same room with the patient during telepsychiatry consultation.  In the past, this regulation made telepsychiatry consultations financially burdensome, requiring reimbursement for the provider, as well as a person at the originating site who was required to be present during the entire consultation. 

 

Next Steps

In April, PCI convened a meeting of Rush, Erie, UI/Mile Square, EverThrive-IL, CDPH and Dr. Ken Fox, Chief Health Officer of CPS.  The meeting was held to report on the demo project and to seek CPS support on next steps in expanding telebehavioral health to other school-based health clinics and to schools without clinics. A slide presentation from this meeting is attachment D. Dr. Ken Fox, Chief Health Officer at CPS, agreed to convene a meeting of all of the school-based health centers to discuss telebehavioral health services. Dr. Fox would like the meeting to include presentations by Rush and Erie on their experience in telebehavioral health services. He also suggested that we might include presentations from other states on the models they developed for telebehavioral health in schools without clinics.

 

Future Funding

Various possibilities exist on future funders for launching telebehavioral health in more schools.  The Healthcare Advisory Committee of Forefront is interested in a presentation on this effort.  We currently have a proposal pending with the Michael Reese Health Trust for a planning grant to develop a readiness tool for SBHC’s to launch a telebehavioral health program.  We also filed a Letter of Inquiry with the Blue Cross Blue Shield Illinois Foundation for a proposal that would fund the launch of the program in ten schools with clinics.

 

There is a possibility for federal and state funding for the lunch of these programs.  Various programs exist for helping children of opioid users and for early identification of children “at-risk” for violence and behavioral health issues.  We are currently reaching out to the behavioral health provider community, hospitals, FQHC’s and  state agencies that administer these programs to find opportunity for funding of telebehavioral health programs in schools.

 


Partnership for a Connected Illinois 1337 Wabash Ave. Springfield, IL 62704 Phone: (217) 886-4228 Fax: (217) 718-4546 info@broadbandillinois.org