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Public Oversight Hearing on the Delivery of Mental Health Services in the District of Columbia

Friday, February 10, 2006
Ella Thomas

Good morning, Chairman Catania, members of the Committee and staff. I am Ella Thomas, Interim Director of the DC Department of Mental Health. I appreciate this opportunity to discuss issues critical to the success of the Department and the public mental health system.

I was appointed Interim Director by Mayor Williams on October 17. Within that first week, I was confronted with multiple irregularities in our contracting and payments to providers that we are finally correcting with your support and that of Deputy Mayor Brenda Donald Walker. 

While this experience has been most difficult, at the same time it was instructive in revealing many of the Department’s weaknesses that were not readily apparent as a result of our rapid growth and development.

Since our beginning in 2001, we created a new public mental health system that is community-based, that expands the range of services available to children, youth, adults, and families. 

The DC Community Services Agency serves the largest number of consumers.  At the end of last year’s annual Consumer Services Review, the DCCSA was ranked first among the Core Services Agencies reviewed.

Additionally, St. Elizabeths Hospital, for 150 years, has been the international cornerstone of psychiatric care.  It continues to meet the District’s public psychiatric hospital needs.  Another milestone reached is construction of the new hospital building. This year we expect to begin the 36-month countdown to occupying the new space.

Yes, there have been many successes and we have built a framework for the delivery of mental health services in the District. But now we must address the infrastructure issues that threaten the progress made and our future.

Therefore, we are refocusing the Department to incorporate the business functions of a health insurance program, so that in the future, we will make more informed decisions about covering necessary services.

The following actions have been taken or are being taken to improve our organizational accountability:

  • DMH recently reintegrated its authorization process into the clinical practice and claims processing system for community-based services.  This allows us to approve appropriate care and manage costs.
  • DMH requires its providers to have relationships with Medicaid managed care organizations so that DMH is the payer of last resort.
  • DMH is in the process of hiring an eligibility specialist who will assist providers in addressing Medicaid eligibility issues and to ensure that eligible consumers are enrolled in Medicaid.
  • The Deputy Mayor’s Office retained KPMG to do a management review of DMH’s contracting processes and procedures and budget needs, which began in early December 2005.  A preliminary report has been delivered and briefings on the findings and recommendations are underway.
  • DMH also is considering solutions to control and manage the number of providers.
  • Nevertheless, DMH still projects a budget shortfall in FY 2006. Therefore, we have requested supplemental funds in the amount of $19 million and will request a similar increase in our FY 2007 budget.  Thirteen million dollars are for community-based services for non-Medicaid consumers; $3.9 million for St. Elizabeths and $2 million for increased consumer costs under Medicare Part D.

We have made a number of key leadership changes. I feel confident that my new team will help position the department for success. I do not underestimate the challenges we face in implementing these corrective actions.

I will conclude my remarks here and welcome any questions about these or other DMH issues.  Again, thank you for this opportunity.