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Confirmation Approval Resolution of 2006

Wednesday, May 31, 2006
Stephen T. Baron

Good afternoon, Chairperson Catania, members of the Committee on Health and staff. I am Stephen T. Baron, Acting Director of the DC Department of Mental Health. Thank you for this opportunity to present my qualifications to lead the Department and my assessments of the Department’s more immediate needs. I want to express my appreciation to Mayor Anthony A. Williams for his confidence in me to lead the Department of Mental Health. I am proud to be asked to join this administration.

I also want to thank Brenda Donald Walker, Deputy Mayor for Children, Youth, Families and Elders, for her support of my nomination and her leadership to a number of areas. Deputy Mayor Walker took the lead to engage the firm of KPMG to assess DMH administrative and operational issues. This report is essential to helping me formulate plans to hopefully take the Department to a higher level of service delivery and responsiveness.

The Deputy Mayor has a commitment to cross-systems collaboration through the Interagency Collaborative Team for issues relating to children and youth and the Criminal Justice Coordinating Council task force on integrating substance abuse treatment and mental health services. Both of these areas are of great importance to DMH and to the District as a whole.

Prior to joining DMH, I was president of Baltimore Mental Health Systems, Inc. (BMHS), for over 17 years. As president of the mental health authority, I oversaw the city’s public mental health system of more than 100 agencies that provide services to more than 32,000 individuals.

There are several major accomplishments that occurred during my tenure at BMHS, including establishing a range of community-based psychiatric crisis programs, developing an innovative community-based capitation for adults who are either long-term residents of state psychiatric programs or have had multiple short-term hospitalizations, development of affordable housing, a number of significant interagency collaborations including but not limited to the public schools, the courts and police as well as implementing a process to monitor provider outcomes.

I have been in the District since April 10th as the Acting Director and to put it mildly we have a number of major challenges. I would like to list a few of these challenges and speak about some of our plans to address them. In doing so, I realize that DMH has only existed in its current configuration for 5 years. However, the Department realizes it must address a number of significant operational issues.oHH

  • Providers have not been paid on a regular basis. This is basic to the District’s public mental health system and undermines all levels of trust and confidence in DMH.
  • The basic operations structure we operate in is overly complicated, inefficient and administratively burdensome at a number of levels. We need to focus on our organizational, financial and policy/procedural infrastructure issues identified within the KPMG Interim Report.
  • The system has grown without well defined planning as there are a number of questions related to size of the system, efficiencies, access and accountability.

Payment of providers is a priority of DMH staff. In the short term I am happy to report through the hard work of DMH staff and active support from the Office of the Chief Finance Officer we are warranting and paying claims weekly. As Councilmembers, you know well from the communications you have received providers that the problem is not solved. We are committed to working with all providers to resolve their difficulties. Today, we began meeting with each of them to identify their specific problems. But we realize that this is a short-term strategy.

The long-term solution will be based on determining whether DMH has the ability to adequately perform all the tasks to ensure that a claim is appropriately authorized, adjudicated and paid in a timely and consistent manner.

Over the next several months we will examine other options to internal claims processing including, but not limited to, having the Medical Assistance Administration assume claims payment responsibilities, contracting out the administrative services functions or a combination of these strategies.

As noted above, there is need for a collaborative planning process. This process will focus on the service system and should address:

  • Finalizing the priority populations to be served, which is at the heart of determining our core businesses, upcoming budgets and the range of services needed.
  • Determining the potential service demand (for both Medicaid and non-Medicaid individuals), the structure within which that demand will be met, and the types of providers and the services needed.
  • Clarifying the role of the DC Community Services Agency. The DCCSA serves the largest number of consumers in the public mental health system and the largest number of non-Medicaid individuals.

St. Elizabeths Hospital is another area that needs to be addressed. St. Elizabeths, like many state psychiatric hospitals, faces a number of challenges that we are addressing.

Last week, the Civil Rights Division of the US Department of Justice issued a report alleging a number of physical infrastructure, staffing and clinical care issues based upon a site visit in 2005 and a records review. We are reviewing that report very carefully. It should be noted that since the DOJ site visit last June, we believe, St. Elizabeths has made important progress in certain areas identified in the DOJ report.

I look forward to DMH providing a better physical space for patients and staff to carry out the important mission of providing quality patient care as we are progressing towards construction of a new 292-bed hospital. Hopefully, in three years, from the beginning of construction, we will have a new hospital, to house our improving clinical services.

I accepted Mayor Williams’ offer to lead the Department of Mental Health because I believe in my ability to translate the Department’s potential for state-of-the-art service delivery into reality. There is tremendous potential here. We are fortunate to have a skilled workforce, a committed advocacy community, and an experienced provider base to build upon.

The District of Columbia’s public mental health system should be and can be a national leader and be the jurisdiction that personifies easy access to care, a robust range of services, strong interagency collaborations and partnerships, consumer centered and a coherent financing system that supports comprehensive individualized care for District residents.

Mr. Catania, thank you very much for this opportunity to share my views of the Department of Mental Health and its future. I welcome your questions.