At its July 1 meeting, the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century received briefings from Jeff Lunardi, who leads the new health and human resources unit at the Joint Legislative Audit and Review Commission (JLARC), on funding for Community Services Boards (CSBs) and the implementation of STEP-VA.
As reported in the last County Connections, JLARC undertook the study of CSB funding at the request of the Joint Subcommittee. Among the report’s findings, JLARC staff pointed out that CSB funding is largely based on historical allocations, that local support varies considerably among CSBs, and that the expected local match of 10 percent of the total state/local funding is the same regardless of local ability to pay. JLARC staff suggested several alternative funding methods (a funding formula, a reimbursement model paying for services rendered, and a grants-based option), pointing out advantages and drawbacks to each option. The report suggests that the General Assembly determine whether the overall goal for the CSB system should be consistency in service offerings statewide, or services that are tailored to meet local needs, before deciding on a funding allocation method.
Lunardi also reported on JLARC’s review of the implementation of STEP-VA, the standardized array of services mandated by the General Assembly to be offered by July 1, 2021. That report found that the first “step,” same-day access to assessments for individuals seeking services, has been generally successful, although CSBs are concerned about their ability to provide timely follow-up care, and availability may need to be expanded in the future. JLARC suggested a two-tier approach to the second step, primary care screening, which is in the process of implementation now as part of a phased approach that begins with screening adults with serious mental illness and children with serious emotional disturbance; JLARC advised that the second phase, which expands primary care screening to all CSB clients, should be piloted before it is instituted in all CSBs. JLARC staff also recommended that the remaining steps be delayed by one year while funding mechanisms and performance metrics are fully developed.
Joint Subcommittee members had a lively discussion about the reports’ findings and recommendations, with additional comments by Jennifer Faison, Executive Director of the Virginia Association of Community Services Boards, and Dr. Hughes Melton, Commissioner of the Department of Behavioral Health and Developmental Services, who were invited to provide responses to the reports. Several members of the Joint Subcommittee expressed interest in developing a funding formula for CSBs that would be similar to the allocation of K-12 funding, with state contributions and a required local match funding a standard set of services. Delegate Vivian Watts cautioned that the school funding formula does not fully capture variations in cost of living between localities, nor does it address the disparity between counties’ and cities’ taxing authority and thus their ability to raise revenue. Other issues discussed included the inadequacy of Medicaid rates in covering the true cost of providing services, how inflation should be captured in any potential funding formula so that payments keep pace with costs in the future, and whether funding formula changes should apply to current base funding or only to new dollars. Ms. Faison had suggested the latter approach as less disruptive to the provision of services, but some committee members suggested that they would prefer to apply a new methodology to base funding as well. Several Joint Subcommittee members reiterated their preference to adhere to the planned schedule for STEP-VA, suggesting that services would need to be initiated, not fully built-out, to comply with the 2021 deadline.
Joint Subcommittee members also received a briefing from Martha Montgomery of the Office of Student Services at the Virginia Department of Education on efforts at the Department to provide mental health services in schools. She discussed recent legislation to lower the required ratios of students to school counselors and reported on the Board of Education’s recent consideration of proposals to create a new staffing category in the Standards of Quality for specialized student support personnel, which would include school psychologists, school social workers, and school nurses. She also discussed several projects conducted under the Virginia Tiered Systems of Support, including training for school staff on trauma-informed practices and Youth Mental Health First Aid, which teaches school staff and other adults how to help young adults experiencing mental health problems.
VACo Contact: Katie Boyle