Testimony on FY2012 Budget

The Executive Office of Health and Human Services is holding two hearings on the FY 2012 budget (Dec. 13 and December 29 in Northampton).



We strongly encourage ABH members to submit testimony by December 29. I have pasted below a copy of ABH’s testimony. Please feel free to use it as a model for your own comments.



Testimony can be submitted to:

Secretary JudyAnn Bigby, Executive Office of Health and Human Services

One Ashburton Place, Room 1109

Boston, MA 02108

Or emailed to: eohhshearings@massmail.state.ma.us

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December 9, 2010

Secretary JudyAnn Bigby, M.D.
Executive Office of Health and Human Services
One Ashburton Place, Room 1109
Boston, MA 02108

Re: FY 2012 Budget
Dear Secretary Bigby:

On behalf of the membership of the Association for Behavioral Healthcare (ABH), thank you for the opportunity to comment on FY 2012 budget recommendations for EOHHS and its departments. As you know, ABH is a statewide association representing eighty-nine community-based mental health and substance abuse provider organizations. Our members are the primary providers of publicly-funded behavioral healthcare services in the Commonwealth, serving approximately 117,000 Massachusetts residents daily and employing 22,000 people.

As you consider the FY 2012 budget, we strongly urge you to ensure that community-based behavioral health services are held harmless from further budget cuts.
Stability for the Community Services
Lack of access to critical health care services remains a significant barrier to preventing and treating health disorders before they intensify and require costlier treatment in more intensive settings. ABH providers know from experience that access barriers to community-based mental health and substance use disorder services can be debilitating or even fatal.

While we have been encouraged by the administration’s recognition of the importance of community mental health and substance use disorder services, the community behavioral healthcare system is still struggling with the budget cuts of a few years ago. Thousands of individuals and families are not able to access services and supports for mental health and/or substance use disorders. In light of this unacceptable situation, existing levels of services must be maintained in order to ensure that individuals are able to access needed care and to provide stability for the community behavioral health system to the greatest extent possible.
ABH strongly supports the philosophy of Community First – that whenever possible, individuals should live and be served in community settings, with minimum lengths of stay in acute and continuing care hospitals, and maximum diversion from inpatient care through use of community-based emergency services and alternative levels of care. To achieve the goal of Community First, however, the Commonwealth must commit the financial resources necessary to allow adults and children with mental illness and/or substance use disorders to live successfully in their own communities. ABH and our members believe that current community resources are not sufficient to truly support recovery and resiliency for clients.

Fair and adequate reimbursement rates are the cornerstone of a stable community-based behavioral health system. Inadequate rates directly impact the ability of providers to ensure that clients have access to the services they need to live in their communities. Over the years, the erosion of behavioral health rates has forced providers to make the difficult decision to close clinics or reduce access. As EOHHS considers the FY 2012 budget, it must not ignore this critical issue.

Department of Mental Health
ABH believes that the community-based service system needs to be fundamentally strengthened, and better coordinated to appropriately serve Department of Mental Health (DMH) clients. Providers report serious concerns about their programs’ level of staffing and resulting ability to meet the acute needs of individuals being more rapidly discharged from inpatient care, including for some, following lengthy hospital stays. Issues of medical co-morbidity, forensic involvement, aging, and increasingly complex psychotropic medication needs are further challenges for community services given the limited availability of current resources.
In re-allocating DMH financial resources to open the new DMH hospital, resources must not be taken from already-vulnerable community services. The community-based continuum needs additional resources and staffing. Many individuals being discharged from state hospital beds need specially-focused resources to support their acute needs in the community.

The budget reductions of the past few years have eliminated or dramatically reduced many community services that had served DMH clients. The crisis in outpatient services is perhaps the most high profile example of this problem. In recent years, there has been a significant reduction in outpatient capacity which has reduced access to vital, cost-effective services for individuals with severe and persistent mental illness. DMH and MassHealth need to provide adequate rates for outpatient mental health and sufficient resources to provide the full range of community-based services so that individuals living with mental illness may truly benefit from the Commonwealth’s commitment to Community First.

Adequate funding for the Department of Mental Health (DMH) is essential in order to maintain treatment for individuals across the Commonwealth in need of mental health services. DMH offers individuals with mental illness many critical community-based services that are not available through MassHealth or private insurance. We urge you to maintain funding for the DMH community accounts (line items 5042-5000; 5046-0000; 5046-2000; 5047-0001; and 5055-0000) in order to avoid a shift toward more expensive interventions such as emergency rooms, acute inpatient care and homeless shelters.

Bureau of Substance Abuse Services
While we were disheartened by the results of Question 1 in the November election, we are extremely grateful for Governor Patrick’s commitment to preserve funding for substance use disorder treatment and prevention services for the remainder of FY 2011 which will ensure that 100,000 Massachusetts residents continue to receive the treatment they need to remain in the community and to be productive members of society.

Going forward, we strongly urge you to continue this commitment and maintain funding for the DPH/Bureau of Substance Abuse Services (line items 4512-0200, 4512-0201, 4512-0202, and 4512-0203). These critical substance abuse prevention, treatment and recovery support services are an essential part of the Commonwealth’s safety net and we are sincerely grateful for your continued support. If funding for addiction treatment is cut, access to treatment is reduced, and
the state will end up paying more to serve these clients in emergency rooms, our court system and prison beds.

MassHealth Behavioral Health
Medicaid finances medically necessary behavioral health services for individuals and families and helps ensure stability for some of the most vulnerable individuals in our society. For example, MassHealth psychiatric day treatment services provide essential services for individuals being discharged from state hospitals and help ensure that individuals are able to remain in their communities. In addition, MassHealth behavioral health services also include vital substance use disorder services for individuals across the Commonwealth.

As you know, service implementation for the Children’s Behavioral Health Initiative (CBHI) is underway. As the state continues to work to develop this new system, funding is necessary to ensure successful implementation of the Rosie D. court order. This funding is essential to strengthen our community-based mental health system to better serve children living with Severe Emotional Disturbance (SED) in Massachusetts.

MassHealth behavioral health services do more than keep ill people off the streets; they keep people alive. As such, the Commonwealth must take steps to ensure that these valuable services continue to be available to the state’s residents.
Community-based provider organizations embrace on a daily basis the opportunity to help individuals return to live in the community and begin to recover with the support of homes, jobs, peers, family and friends. Those same organizations, however, find it extremely frustrating and sometimes very troubling to try to do so without the resources necessary to allow individuals to achieve recovery to the fullest extent possible. For these reasons, we look forward to working with the Commonwealth on the difficult challenges that lay ahead.

If you have any questions or comments, I am happy to address them at your convenience. Thank you for your consideration.