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Fiscal Year 2012 Budget Request

Tuesday, April 12, 2011
Stephen T. Baron, Director, Department of Mental Health

Testimony of Stephen T. Baron, Director, Department of Mental Health
on the Fiscal Year 2012 Budget Request
 before the
 Committee on Health, David A. Catania, Chair
April 12, 2011

Good Morning, Chair Catania, Members of the Council and Committee Staff.

I am Steve Baron, Director of the Department of Mental Health and I am here to present the Department’s Fiscal Year 2012 budget request. With me are Michael Neff, Chief Administrative Officer, and Joyce Jeter, Agency Fiscal Officer.  Other senior staff in the audience are available to answer questions as needed. 
The Department’s proposed FY 12 budget of $172 million dollars (172,920,665) funds a range of mental health services and supports to residents of all ages. It supports the operations of Saint Elizabeths Hospital, the District’s public psychiatric facility. 

 The proposed budget also allows DMH to:

• Operate a pharmacy that provides medications for uninsured individuals
• Maintain same day service in the government run clinic
• Operate a 24/7 Access Help line for suicide prevention counseling and to access services
• Provide emergency services, including mobile services for children and adults in the community
• Maintain supported housing subsidies and supportive employment at current levels 
• Support a projected enrollment increase of individuals to be served in the community, and
• Meet the requirements of the Dixon court order and the Department of Justice Agreement.

The proposed budget reflects Mayor Gray’s commitment to maintaining funding for individuals with the most severe mental illness.  As the Mayor has said, tough decisions were made and the proposed budget reflects a reduction of $8.8 million dollars from last fiscal year, which I will discuss in more detail later in my testimony. 

I will first briefly talk about the proposed budget for Saint Elizabeths Hospital.

  • Funding Saint Elizabeths Hospital 

The Hospital’s proposed budget continues to reflect cost savings in operations a year after the move last April from 12 out dated buildings into one, brand new, state of the art facility.  The budget request supports the necessary direct care and clinical positions, allows the Hospital to continue to recruit high quality clinical staff, and to train them on best practices in patient care.  Resources are targeted at meeting the requirements of the Department of Justice Settlement Agreement.  We are in the 4th year of the Agreement and during the last visit received our most positive feedback to date on the progress at the Hospital.  The next visit is in mid-May.
We also have sufficient funding in our capital budget to complete the last phase of the new hospital construction project which is building a new recreation yard for forensic patients. Projected project completion date is January 2012. 

I will now address our budget request in other areas of the Department.  Because of budget actions taken during the past few years to streamline operations and reduce administrative costs, reductions in service areas are unavoidable.  However, we are doing our best to minimize the impact by replacing local dollars with federal dollars where possible, by rigid residency screening, and by identifying new revenue sources. We also continue to strengthen auditing and claims review in the Office of Accountability to make sure that every dollar is properly spent. 

The $8.8 million reduction is primarily in the following areas:

Personnel Services
Acute Care Beds
Community Residential Facilities
Children’s Services
Mental Health Rehabilitation Services

  • Personnel Services

We project savings of about $2 million dollars in personnel services mainly from eliminating vacant positions and realigning certain functions.

  • Acute Care Beds in community hospitals

We identified savings of $ 1.2 million in contracts for local acute care beds with community hospitals as Medical funding is available for these services. 

  • Community Residential Facilities

Funding for community residential facilities and supportive independent housing is reduced by $415,000. We believe we can make these changes with minimal impact on consumers.  We intend to eliminate just 5 beds in residential facilities—less than 2%--leaving more than 220. We also are working closely with our providers to move individuals into more independent settings when appropriate. 

Let me now describe the two areas where we anticipate the most impact: Children’s Services and Mental Health Rehabilitation Services.

  • Children’s Services

The proposed budget includes a reduction of $900,000 in three areas.  Let me describe each in detail and the possible impact. First, $300,000 in local funding for the primary project, an early childhood screening and intervention, will be replaced by federal community block grant funds.  We believe this is a reliable funding source and this program reflects the block grant’s focus on prevention and early intervention.  As evidence of the stability of these funds, the federal community block grant has funded up to 50 rental housing subsidies for the past 13 years.

The second $300,000 reflects the elimination of a contract with Children’s Hospital for emergency room services. We are confident that this will not mean these services are discontinued because we know that nearly all the children paid for by the contract are Medicaid eligible.  Children’s Hospital can claim for these services. 

The last $300,000 is a reduction in the budget for the Assessment Center which conducts court-ordered assessments for youth involved in the juvenile court.  We hope to offset this reduction by working with the Court to institute a fee for certain assessments that are ordered where the parties involved, such as domestic relations, can afford to pay.  However, we are concerned that this reduction will mean that fewer court ordered assessments for CFSA or DYRS youth can be done.  This brings me to a reduction that is not in DMH’s budget but would have an impact on children’s services.

We are aware that the proposed budget of the Child and Family Services Agency does not include $2.5 million for the MOU which allows us to perform the children services required as part of the LaShawn Annual Implementation Plan.  However, we have been assured that the Agency will make funds available to continue these services. This includes $200,000 targeted for the Assessment Center. Without these funds, the impact on the Assessment Center will be even greater.

The final area I want to discuss is Mental Health Rehabilitation Services. 

  • Mental Health Rehabilitation Services

This program represents the core services for about 18,000 consumers. The proposed budget includes a reduction of $3.1 million.  The budget submission mentions a benefit cap that would achieve these savings.  Let me first say that basic mental health treatment—counseling, time with a psychiatrist, medications, and services for individuals in our most intensive services program would not be affected by the reduction.  We are considering establishing a benefit plan for community support which now covers a range of services designed to help an individual develop life skills and maintain independent living in the community.  But, we are still figuring out what the plan would look like.  We are working with providers and with this Committee to achieve the savings in the way that best protects the needs of the consumers and the stability of the provider network. 

In addition, we continue to focus on identifying the makeup of the approximately 1,500 consumers whose services are paid with local dollars only to make sure we are taking advantage of every available federal dollar.  This work already is paying off.  We have determined that about 300 are Medicare recipients who are eligible for Medicaid reimbursement for outpatient services.   Once they are enrolled with the appropriate program at the Department of Health Care Finance, we expect to realize significant savings which can be reinvested in maintaining mental health services. 

We’ll do the same kind of vigorous work with the remaining 1,200 local only consumers. We already know that 1,100 are listed as without insurance.  A small number are undocumented residents and others are in the process of enrolling with Medicaid.  The bottom line is we’ll know if any other resources are available to them to contribute to their mental health care costs.  We’ll make sure that individuals who have the resources will contribute to their treatment costs.

  • Exiting Dixon

As you are aware, under the terms of a lawsuit dating back to 1974, a Court Monitor evaluates the Department’s progress in meeting 19 defined performance measures—called the “Dixon Exit Criteria.”  At last year’s budget hearing, we had met eight of those criteria and today that number has grown to thirteen.  Within the proposed budget, we have the staff and resources in place to address each criterion.  Given our substantial progress, we believe that we will see an end to court oversight next fiscal year. 

Before I conclude my testimony, I want to say how excited we are to work with you on the Mayor’s Live Well DC! initiative led by the Department of Health.  This is very critical to the population we serve. Live Well DC! is consistent with the work that we are doing to change the culture among our provider network to promote better physical health of our mental health consumers and to monitor the side effects of necessary psychotropic medications on their overall health.

As you know, adults with serious mental illness treated in public systems die 25 years earlier than Americans overall.  Further, African Americans and other racial minorities are more likely to suffer from a serious chronic illness like diabetes or heart disease.   In the next few weeks, we hope to work with the Committee to make changes in the mental health information law that will make it easier to exchange mental health and physical health care information between mental health and primary care providers.  We know that good mental health is critical to the health and wellness of the community.

Mr. Chairman, we appreciate the consistent support that the Committee has shown the Department, and I am available to answer any questions.

Thank You.