Mental Health Commission Discusses Major Changes to Structure, Funding of Public Behavioral Health System

August 23, 2019

The System Structure and Financing work group of the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century held a wide-ranging discussion at its meeting last week as it grappled with fundamental questions about how behavioral health services should be organized, funded, and delivered in Virginia. Joint Subcommittee Chairman Senator Creigh Deeds encouraged workgroup members to contemplate broad questions, such as whether the state’s existing network of 40 Community Services Boards (CSBs) represents too many entities, or too few; how the relationship between the state and the CSBs should be calibrated; and what the overall goals of the publicly-funded system should be.

Rather than scheduling formal presentations for the work group’s meeting, members instead invited experts from the audience to respond to questions and offer items for consideration. Members initially called upon Deputy Commissioner of the Department of Behavioral Health and Developmental Services (DBHDS) Daniel Herr to discuss recent media reports about individuals who are clinically ready for discharge from state hospitals, but who must wait for appropriate placements, such as assisted living facilities that are able to provide higher levels of care. Deputy Commissioner Herr explained that DBHDS has used some funding provided by the General Assembly to assist with discharge planning to meet the needs of some of these individuals in the community, but pointed out that finding placements can be challenging, as reimbursement rates for many assisted living facilities do not account for the intensity of care that must be provided for individuals leaving the state hospitals. Members discussed a similar situation regarding Auxiliary Grants, which are intended to supplement income for certain individuals residing in assisted living facilities, adult foster homes, or supportive housing, but often do not cover the costs of care for recipients and thus are not accepted by some providers.

Deputy Secretary of Health and Human Resources Marvin Figueroa and Virginia Hospital and Health Care Association Director of Intergovernmental Affairs Jennifer Wicker also discussed issues surrounding overcrowding at the state hospitals, which is the subject of a legislatively-directed workgroup that has been meeting since April. The workgroup is discussing potential extensions to the initial period of time during which an individual in crisis may be held, particularly for individuals who may be intoxicated, as well as possible alternatives to hospitalization. Delineating the proper role of the state hospitals relative to private hospitals, such as by defining the population the state hospitals are intended to serve, was a topic of discussion members agreed to pursue in future meetings.

Members also discussed how DBHDS should oversee the provision of services in communities. Senator Deeds voiced his view that more accountability is needed from the CSBs, in part to assure policymakers that investments in behavioral health services are being well-spent. He suggested that dispersing DBHDS staff into regional offices throughout the state might offer better support for CSBs. Deputy DBHDS Commissioner Heidi Dix offered that the Department is engaging regional consultants more extensively, and noted that funding for program administration, including data collection and analysis, is an important aspect of service provision. Jennifer Faison, Executive Director of the Virginia Association of Community Services Boards, encouraged members to provide these funds separately and avoid redirecting funding for services to program administration. Senator Hanger, who chairs the System Structure and Financing Work Group, suggested that he would prefer to provide more state support to CSBs rather than to exert more state control over their operations. He reiterated his interest in the state’s sustained commitment to implementing STEP-VA, indicating that he prefers the state to be “aggressive” in continuing the roll-out of services.

Members agreed to continue the discussion in future meetings and encouraged interested parties to submit ideas for consideration. The Joint Subcommittee’s next meeting is scheduled for September 23.

VACo Contact: Katie Boyle

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