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.

DiGravio and Frangules: Liquor stores don't deserve a tax break

Milford Daily News, October 21, 2010

Massachusetts voters face a critical choice on Election Day, and not just in the campaign for governor. Question One on the ballot will ask voters to create a special tax exemption for alcohol at retail stores - and slash $110 million from a budget already facing a $2 billion deficit. It's a reckless fiscal and public health policy measure that should be voted down.

If approved, Question 1 would change the state's sales tax law to carve out a special exemption for alcohol sold at retail stores. Alcohol would still be taxed at restaurants and bars. The only items that are exempt from the state's sales tax are basic necessities, like food, clothing and prescription medicines. Alcohol is not a basic necessity and doesn't deserve a tax break.

In radio ads currently running in Massachusetts, proponents of Question 1 argue that residents are flocking to New Hampshire and buying tax-free alcohol there. Aside from the dubious financial wisdom of spending time and gas money on a trip to New Hampshire to buy alcohol, the ads are not true. Actually, sales in New Hampshire are down slightly from their 10-year average of 5.1 percent growth. There has been no spike in alcohol sales in New Hampshire.

However, alcohol sales are up in Massachusetts by 4 percent in the past quarter, according to the Department of Revenue.

As public and fiscal policy, it makes no sense to exempt alcohol from the sales tax. Forty-five other states (all the states that have a sales tax) apply it to alcohol. The Massachusetts alcohol tax is clearly in the mainstream for all states.

Every dollar of the tax goes to essential addiction prevention, treatment and recovery and public health services, through the dedicated Substance Abuse Treatment Fund. This fiscal year, it will bring in about $110 million in revenue to support vital health programs.

The Committee Against Repeal of the Alcohol Tax is a group of more than 160 healthcare, human service, community, union and business groups that have banded together to get out the message about the impact of the alcohol tax repeal.

According to a poll conducted this spring by the Committee, 58 percent of voters are opposed to repeal. A State House News Service poll recently found the numbers had climbed slightly to 60 percent and a Boston Globe poll found similar opposition to the alcohol tax break. But proponents of the repeal are spending over $1 million to secure a Yes vote.

So who's behind Question 1? The liquor industry, which stands alone on this crusade. Not one organization outside the industry has endorsed the campaign or even contributed money to it. Even business associations have spurned the liquor industry. They argue that the state cannot afford the lost revenue, and that it would be unfair to give preferential treatment to alcohol in the state's tax code.

The alcohol sales tax, paid only by those who purchase alcohol, goes directly to a fund for treatment of addiction. We can't afford to repeal this tax. That is why people should vote no on Question 1 on November 2.

Vic DiGravio is president and CEO of the Association of Behavioral Healthcare. Maryanne Frangules is executive director of the Massachusetts Organization for Addiction Recovery. They co-chair the Committee Against Repeal of the Alcohol Tax.

Roger Oser, Principal of Ostiguy High School: Vote NO on 1

Massachusetts passes criminal offender record reform law

On the final day of the 2010 legislative session, the House and Senate approved a criminal records reform bill that had been near the top of ABH”s agenda. When signed by the Governor, the new CORI law will limit access to criminal record information and give first-time offenders a chance at rehabilitation.

“This is for people who made one mistake, who have shown they rehabilitated themselves, to be able to go on with their life,” said Lew Finfer, leader of a coalition lobbying for the changes.

Under the new law, when a defendant is found not guilty, or the case is continued without a finding, the charge will not show up on an employer’s criminal background check. Offenders will have a chance to seal their criminal records with five years of good behavior for a misdemeanor, and 10 years after a felony. Law enforcement agencies will have access to an unedited criminal record, and a sex offender’s records cannot be sealed.

ABH sought the changes to enable persons who have had trouble finding work because of one mistake to get their lives back on track. Many individuals with mental health and/or substance use disorders have criminal records because of the way their illnesses manifest themselves, and the old CORI system impeded their ability to live and work in the community.

In testimony to the Judiciary Committee last year, I stated:

“Access to substance abuse and mental health services, employment opportunities, and the ability to live and thrive in the community are fundamental to the recovery process.”

The Legislature did the right thing in reforming the CORI laws. This was a major step forward for individuals in recovery.

Governor Patrick Signs Substance Abuse Treatment Fund into Law

June 30 was a landmark day for the public health community in Massachusetts. Governor Deval Patrick signed the Fiscal Year 2011 budget into law that day, and budget bill included creation of a Substance Abuse Treatment Fund in the Department of Public Health. Proceeds from the alcohol sales tax -- about $110 million this year -- will go into the fund and ensure secure revenues for these critically important services that help more than 100,000 Massachusetts residents.

Association for Behavioral Healthcare Statement on FY 2011 Budget

The Association for Behavioral Healthcare is pleased that the Legislature level-funded some of the most critical behavioral health services provided by the Commonwealth in the FY 2011 budget. In particular, the budget largely protects from cuts essential community-based mental health and substance use disorder treatment services.

The budget plan reflects a fiscally responsible approach to the unique circumstances surrounding the stalemate in Washington over the so-called FMAP reimbursement funds, which could result in an unanticipated $650 million state budget cut. Legislative leaders established a contingency fund that would allocate FMAP funds if and when they become available.

The Legislature also established a separate Substance Abuse Treatment and Prevention Fund, which will collect all proceeds from the alcohol sales tax and dedicate the funds for addiction treatment, prevention and recovery programs that benefit more than 100,000 people in Massachusetts. This marks a significant step forward that will establish a reliable funding source for important public health services.

ABH urges Governor Patrick to sign the budget passed by the Legislature and create the Substance Abuse Treatment and Prevention Fund.

Poll Shows 58% of Public Oppose Alcohol Tax Repeal

For Immediate Release Contact: Jim McManus
617-5230038
Jim@sloweymcmanus.com

Poll Shows 58% of Public Oppose Alcohol Tax Repeal
Hundreds Rally at State House to Support Dedicated Treatment Fund
Boston, MA -- June 8, 2010 – By a wide margin, Massachusetts voters oppose repealing the alcohol sales tax, according to a poll released today by the Campaign for Addiction Prevention, Treatment and Recovery, a group of more than 125 public health and behavioral health organizations from across the state that oppose the alcohol tax repeal.
The sales tax on alcohol retail sales is being challenged through a ballot initiative supported by package store owners in November that would repeal the tax.
“Massachusetts residents clearly see the importance of using the alcohol sales tax to support public health services for youths and families,” said Vic DiGravio, and Maryanne Frangules, Co-Chairs of the Campaign. “It is also clear that people understand that the state needs revenues, and there should be no special exemption from the sales tax for alcohol.”
DiGravio is president of the Association for Behavioral Healthcare. Frangules is executive director of Massachusetts Organization for Addiction Recovery.
The poll results were released today at a State House press conference and rally to support creation of a dedicated fund for proceeds from the alcohol sales tax. In the budget for Fiscal Year 2011, the House and Senate created a Substance Abuse Prevention and Treatment Fund, which will dedicate alcohol tax proceeds to such services. The tax is expected to bring in $110 million in its first year.
More than 300 people gathered at the State House today to demonstrate support for the Fund and the services it funds. The supporters heard from Campaign organizers, Senator Steve Tolman (D-Brighton), a major proponent of the Fund in the Legislature, and individuals who are in recovery from alcohol addiction.
Robert L. Monahan, PhD., president of the Recovery Homes Collaborative, spoke at the press conference, along with Elizabeth Rodriquez of Methuen and a student from the Recovery High School in Boston, two consumers who receive services funded in part by the alcohol tax.

The opinion poll released today shows deep and broad opposition to repealing the tax. Sixty-eight percent of women and 49 percent of men said they opposed repeal of the alcohol sales tax. Six percent were undecided.
The poll surveyed the opinions of 450 Massachusetts voters from May 3-5. The margin of error is 4.5 percent. It was conducted by Anderson Opinion Research of Boston.
The poll asked voters: “If the election were held today, would you vote yes or no on a ballot question to remove the state sales tax on alcoholic beverages?”
“There’s strong support for the alcohol tax across the state,” said DiGravio and Frangules. “By using language designed to elicit voters’ attitude toward this specific tax, we were able to obtain an accurate picture of peoples’ attitudes toward the alcohol tax.”
Other findings:
· Democrats oppose the alcohol tax repeal by 72 percent to 21 percent;
· Republicans support the alcohol tax repeal 47 to 45 percent
· For the general sales tax ballot question, which would roll back the state sales tax from 6.25 to 32 percent, 55 support the rollback, and 38 percent are opposed. Six percent are undecided.
During the recent state budget debate, the Campaign supported creation of the dedicated Fund for alcohol tax proceeds. The Fund would become law when Governor Patrick signs the Fiscal Year 2011 budget.
“The Senate and the House of Representatives kept faith with the people of Massachusetts by establishing the Fund for the alcohol tax, to make sure proceeds go to public health and treatment programs,” said DiGravio and Frangules. “We urge the Governor to sign the Fund into law and create a stable funding source for these critical programs.”

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