At the Behavioral Health Commission’s November 12 meeting, members adopted a series of recommendations from studies discussed earlier this year, received a presentation from staff on local contributions to Community Services Boards (CSBs), and received a report from the Office of the Executive Secretary of the Supreme Court of Virginia on jail diversion programs. The following day, members of the Commission’s Executive Committee discussed potential studies for the next two years, winnowing a lengthy list of proposed topics to three priorities that the full Commission will consider at its December meeting.
Local contributions to CSBs: Last fall, the Commission requested staff to undertake a review of the required local match for CSBs, to include funding contributed by each locality and factors that limited local contributions. As this study was added to staff’s workplan later in the Commission’s traditional process of planning its yearly project list, it was classified as a “limited scope” study and did not include policy recommendations. Staff reported that although most CSBs receive local funding in excess of required contribution levels, since FY 2022, at least 11 CSBs have not met the local match requirement of 10 percent of combined state and local funds each year. The lost revenue from localities contributing less than the required match represents approximately $3.4 million, or 0.3 percent of total CSB funding. Small population sizes, stresses on local revenue, and competing local needs have been cited by CSBs in their applications to the Department of Behavioral Health and Developmental Services (DBHDS) for waivers from the match requirement. DBHDS has routinely granted waiver requests in the past, and VACo has historically supported this flexibility to accommodate budget pressures at the local level.
Commission staff also pointed to several other issues affecting localities’ ability to match state funding, including significant infusions of state funding into the CSB system in recent years, which trigger associated local matching requirements; providing the additional local match can be particularly challenging when local budgets have been adopted before their CSB allocations are known. Staff also explained that CSBs serving as hubs or fiscal agents for regional projects are at a particular disadvantage, as the regional funding is included in the calculation of state funding that must be matched from the local dollars provided to that CSB, even though the regional dollars benefit several CSBs. Staff noted that a flat 10 percent matching requirement does not account for local ability to pay, a point made by JLARC in its study of the CSB system in 2019. Members proposed including language in the next state budget that would direct DBHDS to examine whether a 10 percent match is fair, consider what formula should be used to require local contributions, and examine enforcement mechanisms. Staff’s presentation is available at this link and a report is available at this link.
Policy options from earlier studies: Members discussed staff recommendations on studies that were presented earlier in the year on the implementation of the Marcus Alert system, alignment of crisis services with the civil commitment process, and evaluation of the STEP-VA system. Key recommendations adopted by members include:
- Provide $7.8 million in the upcoming budget to enable the 13 CSBs that have not yet implemented the Marcus Alert system to begin necessary planning. Revise the current fixed allocation of $600,000 per CSB to allow DBHDS to distribute funds based on needs. Require CSBs to distribute a portion of funding to Public Safety Answering Points (PSAPs) for costs associated with the program.
- Establish pilot programs to allow mobile crisis teams to be dispatched from 911 call centers (currently these teams are only dispatched from the 988 centers).
- Direct DBHDS to identify strategies to incentivize crisis receiving centers and crisis stabilization units to serve more individuals subject to emergency custody orders or temporary detention orders.
- Appropriate STEP-VA funding in one consolidated amount rather than by individual step, to allow flexibility in directing funds based on community needs.
- Develop a strategic vision for STEP-VA.
- Direct the Department of Medical Assistance Services to identify steps necessary to transition to a prospective payment system for CSBs, which is a component of the national Certified Community Behavioral Health Clinic model. Under the prospective payment system, the state would develop a daily or monthly rate that would cover the full cost of providing a set of required services; currently, STEP-VA’s Medicaid funding is provided through per-service rates, and CSBs have struggled with Medicaid billing and reimbursement.
A full list of recommendations is available at this link.
Jail diversion and Expedited Diversion to Court-Ordered Treatment (EDCOT): Commission staff had conducted a limited-scope study of this issue in 2023, and budget language directed the Office of the Executive Secretary of the Supreme Court of Virginia to examine existing jail diversion programs and the feasibility of implementing an EDCOT program. Under EDCOT, a defendant with serious mental illness is diverted from the criminal justice process to a civil court-supervised outpatient treatment process; the diversion would occur after the individual had been charged but prior to adjudication of the criminal case. The workgroup examining EDCOT raised a series of legal and ethical concerns about the process, noting that the process as proposed in 2023 legislation “would exert a significant amount of control over an individual without an adjudication of guilt,” and raising concerns about the availability of legal and clinical staff to implement such programs. The workgroup recommended that rather than pursuing an EDCOT process, the state should support programs that divert individuals from criminal justice involvement prior to being charged with a criminal offense. Staff’s presentation is available at this link and the full report is available at this link.
On November 13, the Commission’s Executive Committee met to consider potential staff work for next year. Several studies have already been assigned to staff for 2026 reporting, including a study of behavioral health services in jails and oversight of behavioral health redesign and the discharge assistance program. Based on staff capacity to conduct additional work, Committee members planned to recommend to the full Commission that next year’s workplan include (1) a review of the availability and effectiveness of programs and services for substance use disorders in schools; (2) analysis of the use and effectiveness of mandatory and assisted outpatient treatment; and (3) a review of the competency restoration process. Some of this work may not be completed until 2027, depending on additional assignments from the legislature during the 2026 session. In addition, the Commission will ask JLARC to consider a study of “right-sizing” the state hospital system, as well as how best to serve individuals in crisis who have neurodevelopmental or neurocognitive disorders.
The full Commission’s next meeting is scheduled for December 2.
VACo Contact: Katie Boyle