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Minnesota’s Collaborative Psychiatric Consultation Service – General Q & AThe 2010 Legislature (M.S. 245.4862) directed the Department of Human Services (DHS) to develop a Collaborative Psychiatric Consultation Service. DHS has entered into a two‐year contract with the Mayo Clinic and its partners to develop and provide this service. Statewide availability of the service is expected to begin August 1, 2012.

What are the needs that led to this legislation?
  • For both children and adults:
  • The need for better collaboration between primary care and behavioral health
  • The need for improved access to scarce psychiatric resources
  • Concerns about overuse and inappropriate use of psychotropic medications for children, partly indicated by multiple studies indicating that over 60% of all children who were receiving psychotropic medications were not receiving specialized mental health services
  • Data showing adults with serious mental illness die 25 years younger, partly due to lack of coordination between physical health and behavioral health
  • Pilot projects showing that psychiatric consultation and collaborative care can improve the quality of care while reducing costs

What will be provided when the service is fully implemented?
  • Outreach, support and education for local collaborative partnerships including mental health, primary care and other providers
  • Triage‐level assessment to determine most appropriate response to each request for consultation
  • Referrals to other services as appropriate
  • Consultation to primary care practitioners, emergency rooms, local crisis services and mental health professionals, including:
  • Mandatory consultations relating to psychotropic prescriptions that exceed certain thresholds for children on Medical Assistance fee‐for‐service (see below)
  • Voluntary consultations to improve collaboration between primary care and behavioral health
  • Both types of consultations will be provided Monday – Friday, 7 a.m. to 7 p.m., usually with a same day response
  • Rapid access to direct psychiatric services, probably limited to a one‐time in‐person (or interactive video) appointment for individuals who are at risk of hospitalization and only when local services are not available, with recommendations provided and subsequent care management retained by primary care

How did DHS choose the Mayo Clinic?
  • DHS issued a request for proposals (RFP) June 6, 2011
  • The RFP was developed after extensive consultation with the Children’s Psychiatric Consultation Protocols Workgroup. This workgroup and its subgroups included over 100 stakeholders, including pediatricians, family practice physicians, nurses, mental health professionals, families, advocates, school staff and many others who care for children and youth with mental health needs.
  • After a competitive bidding process, DHS entered into contract negotiations with the Mayo Clinic and its partners
  • Mayo proposed to provide statewide consultation services through a consortium called MhINT, which stands for Mental Health Integration and Transformation. This consortium includes the Mayo Clinic, PrairieCare, Sanford Health and Essentia.
  • Contract negotiations were concluded May 2012. The final contract incorporates many of the suggestions that DHS received from stakeholders.

How will the service be provided?
  • Beginning August 1, 2012, the Mayo Clinic and its partners will operate a call center Monday through Friday from 7 a.m. to 7 p.m.
  • One statewide call‐in number will be answered on a rotating basis by the members of the consortium
  • The consortium will provide a statewide multidisciplinary team, including board‐certified child and adolescent psychiatrists, adult psychiatrists, licensed clinical social workers and support staff. Other consortium staff such as advanced practice registered nurses, registered nurses, psychologists, pharmacologists and others will be consulted as needed.
  • Triage professionals (licensed social workers) will answer calls and determine the most appropriate response
  • Based on the triage protocol, calls may be referred to a project psychiatrist for phone consultation with the primary care physician (PCP), referred for emergency or crisis services, referred to and linked with community based mental health providers, or scheduled for a face‐to‐face evaluation

Is this new service connected to new medication review requirements?
  • Yes, partially; the 2010 Legislature directed DHS to develop consultation requirements for certain psychotropic medications for children (M.S. 256B.0625, subd. 13j)
  • The first priority of the service will be the required consultations; these mandated medication reviews are expected to be outlier cases but may initially constitute the majority of the consultations
  • As prescription patterns change, the need for mandatory consultations is expected to go down, thus allowing most of the ongoing service to be voluntary
  • DHS consulted with experts in the field and reviewed research to determine which medications and dose ranges will require a collaborative consultation
  • The new medication review requirements will be phased in (beginning with children under 5) after the new consultation service is available
  • More information about the new medication review requirements is on the DHS Pharmacy Program website under “Antipsychotic and ADHD Medications for Children.”

Which recipients are included in the new medication review requirements?
  • The new medication review requirements apply to children on MA fee‐for‐service
  • Some of the managed care plans have implemented similar requirements and have their own consultation services
  • DHS will work to coordinate requirements and services for fee‐for‐service recipients with managed care requirements and services

Will this new psychiatric consultation service be affected by recent legislative changes?
  • Currently, about 25% of all MA children are in fee‐for‐service
  • The final 2011 Human Services budget bill included a provision which began moving disabled MA adults into managed care as of January 2012, except for individuals who opt out or who may be excluded under criteria other than disability. It appears this will eventually result in a significant decrease in the percentage of MA children in fee‐forservice, but it is not clear how quickly that will happen or how many children will opt out.
  • We do not expect that this will change the total number of psychiatric consultations needed during the coming two years, but it may affect the mix of mandatory vs. voluntary consultations

Are similar services available elsewhere?
  • A similar state‐funded service is already provided for children in the states of Washington and Massachusetts; consultation programs have also been successfully established within health systems and academic centers around the country
  • Minnesota is learning from the experience of these and other states

How will this service affect Minnesota’s shortage of qualified psychiatrists and other mental health professionals?
  • Pilot projects have demonstrated that similar services have improved access and quality of care by making more efficient use of both primary care and specialty mental health services
  • Minnesota’s new psychiatric consultation service will work towards improved integration of, and collaboration between, primary care and behavioral health services

How will we know if the service is effective?
  • DHS will track the costs for the services provided and associated impacts on utilization trends for emergency room, inpatient psychiatric hospitalization, psychotropic medications, residential treatment, day treatment, partial hospitalization, outpatient therapies, rehabilitation services and total health care
  • Evaluation of this service will be coordinated with projects relating to depression and primary care, substance abuse screening and intervention in primary care, the Minnesota 10 by 10 project and implementation of evidence‐based treatments