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Department of Mental Health Fiscal Year 2007 Budget

Monday, April 10, 2006
Ella Thomas

Good morning, Chairperson Catania, members of the Council and staff. I am Ella Thomas, Deputy Director of the Office of Programs and Policy, DC Department of Mental Health (DMH), and formerly Interim Director of the Department. I would like to introduce Mr. Stephen Baron, Acting Director of the Department. Since today is his first day, I will deliver testimony supporting the Mayor’s budget request for FY 2007 and Mr. Baron will have remarks at the end of my testimony. At the table with me today are Marcia Jones, Chief of Staff; Joyce Jeter, DMH Fiscal Officer; Anne Sturtz, General Counsel; and Marie-Claire Brown, Chief Contracting Officer.

I would like to thank you, as the Chair of the Committee on Health, for your support during my tenure as the Interim Director and especially for your help in resolving the FY 2005 payment issues. I also would like to thank Mayor Williams for the privilege of leading DMH on an interim basis.

The FY 2007 budget request is for $227,427,848 that includes 1,604 FTEs and services provided through the three DMH components: the Mental Health Authority (MHA), St. Elizabeths Hospital and the DC Community Services Agency (DCCSA). This budget also funds services provided by the Community Contract Providers.

The MHA budget request is $39,139,917 to support 294 FTEs who provide administrative functions, such as contracting and procurement, claims processing through our Administrative Services Office; technical assistance and support to community-based providers through our Provider Relations Office; provider oversight through the Office of Accountability; emergency psychiatric and homeless outreach services through our Comprehensive Psychiatric Emergency Program (CPEP) under our Office of Programs and Policy (OPP). In addition, under OPP, we provide consumer enrollment, care coordination and management of our federal and local grants. As you know, we also operate the School Mental Health Program (SMHP) under OPP.

Our budget request for St. Elizabeths Hospital is $85,801,562 and supports 957 FTEs who provide inpatient care to 420 patients, half of whom are forensic patients. St. Elizabeths cares for individuals brought to the hospital involuntarily by the U.S. Marshal Service and the Secret Service. As a result, St. Elizabeths incurs costs for patient security and public safety. St. Elizabeths Hospital is 150 years old and requires a great deal of maintenance in order to protect the health and safety of the patients, staff and visitors.

Our budget request for the DCCSA is $34,784,722 to support 335 FTEs and provide comprehensive community-based counseling, medication management in locations across the District and supports to consumers in their own homes. In addition to providing these services, the DCCSA provides competency restoration training for the Superior Court and psycho-education and therapeutic nursery services with DC Public Schools. The DCCSA expects to serve 6,000 consumers in FY 2007, more than any other Core Service Agency.

Our budget request for the Community Contract Providers is $65,770,286 for the community contract providers and residential treatment contractors. Through these contracts DMH pays for community based services – our Mental Health Rehabilitation Services (MHRS) -- delivered by a network of certified providers, housing services, socialization, supported employment, crisis stabilization beds, acute care beds, residential treatment center beds for children and youth and several other special intensive in-home services for both children and adults.

Earlier this year Deputy Mayor Brenda Donald Walker requested that the consulting firm of KPMG conduct a review of certain DMH operations. In March, the Deputy Mayor released to you and to others the interim KPMG assessment report of our Medicaid and budget-related processes, which includes a series of recommended action steps. In reviewing the recommended action steps, I am pleased to say that we had already taken corrective steps in the following areas:

Re-instituted the authorization process into the clinical practice and claims processing system fo community-based services. Despite the technology challenge in implementing this system, this allows us to approve appropriate care and manage costs, necessary steps to preserve the MHRS system.
Required that DMH-certified providers join the Medicaid managed care organizations’ networks so that DMH is the payer of last resort.
Imposed a moratorium on certifying additional MHRS providers as we consider how to manage growing the system in the future.
KPMG is now embarking upon the second phase review of our systems. In the meantime, with the new Director, we will continue our review of the recommended action steps from the first phase and determine which ones we can immediately implement.

Overall, in light of our remarkable recent history of program creation and expansion, our FY07 goals are quite modest. We are simply seeking sufficient funding to adequately fulfill the many obligations that we have incurred over the past five years.

In the direct services area, our goals include: operating a safe and therapeutic hospital as we await the construction of a new facility; providing quality services through the DCCSA; providing the dedicated CPEP staff a safer and better location to provide emergency services; continuing the Jail Diversion Program, and continuing the success of the School Mental Health Program.

In conclusion, in our Mental Health Authority role we intend to use our FY07 dollars more effectively. We aim to improve our stewardship over programs and activities under DMH’s supervision, including MHRS, adult residential services, housing, and psychiatric residential treatment services for children.

At this time, Steve Baron will offer some remarks, after which staff and I will be happy to answer any questions you may have.