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Managed Care Principles 

This policy statement by the NAMI Maryland (NAMI MD) was developed in the context of the rapid restructuring of the public mental health care system.

NAMI Maryland's Principles for Managed Care are:

1. Maryland must continue to be accountable for the delivery of treatment and services for persons with severe and persistent brain disorders ("mental illness"). Maryland cannot relinquish this responsibility, even when contracting out the services.

2.The priority population must include all eligible adolescents, adults and elderly persons with severe and persistent brain disorders ("mental illness").

3.There must be continued eligibility for persons who are Medicaid eligible and employed, but cannot obtain health coverage through their employers.

4. Maryland must continue to develop and maintain a comprehensive community support system of treatment and services for the priority population. Services must, at a minimum, be those required in the State of Maryland Department of Health and Mental Hygiene, Comprehensive Mental Health Services FY 1995 - FY 1999, "A Consumer-Oriented System Into the Year 2000". Maryland must continue to maintain short and long-range mental health plans.

5. There must be meaningful participation of consumers and families at every stage of the redesign, implementation, evaluation and monitoring of the Managed Care system.

6. All planning and delivery of services must be culturally sensitive to ethnically diverse populations and the communities in which they are located.

7. Maryland's contract with Managed Care Organizations (MCO's) for the management and / or delivery of Medicaid funded services for the severely and persistently mentally ill must not allow the dropping of chronic heavy users of services for "cost avoidance".

8. Public resources saved by reduced utilization of state hospitals and through other system efficiencies should be reallocated to expand services to the priority population in accordance with the State of Maryland Department of Health and Mental Hygiene, Comprehensive Mental Health Services FY 1995 - FY 1999, "A Consumer-Oriented System Into The Year 2000".

9. Provider personnel, both administrators and treatment staff, must have an understanding of services and persistent brain disorders. They must have training to work with the priority population - including training in the family and consumer perspective - and must accept accountability for the quality of services.

10. All treatment or clinical staff must be appropriately credentialed by the State Mental Health Authority.

11. For individuals who meet the priority population definition, a comprehensive array of community support services must be available and open to the incorporation of new treatment modalities. Community support services must be available but not limited to; new generational medications, inpatient treatment, residential support services, intensive care management, psychosocial rehabilitiation, consumer-run services, vocational rehabilitiation, mobile outpatient services and round-the-clock crisis services seven days-a-week.

12. The Mental Hygiene Administration will adminster the specialty mental health services, through the Core Service Agency (CSA) system, which will be responsible for linkages between housing and other support services.

13. There must be appropriate consumer and family involvement in individual treatment delivery and access to peer support groups.

14. Grievance procedures must be in place that are user friendly and time sensitive to the life threatening nature of psychotic episodes.

15. Maryland must provide a "freely accessible" and "timely" report accounting for the number of recipients who:

• fail to present for services;
• are in jail or prison;
• have been placed in a state hospital;
• have died.

 

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