MHID Advisory Committee Task Force

Report on Hearings

February 27, 2012

Background

At the January 12, 2012 Franklin/Fulton MH/ID Advisory Board regular meeting there was a discussion of the Franklin County Commission proposal to investigate the transition the MH/ID Administration to a nonprofit organization. During that discussion, Commission Chair David Keller, who sits on the Advisory Board, indicated that the Commissioners would welcome input from the Board regarding the viability of this transition. As a result of this discussion, a Reorganization Task Force was formed to identify issues that should be addressed as part of the development of a transition plan, should the Counties elect to go forward with it.

The following members of the Board volunteered and were appointed to the Task Force: Sheldon Schwartz, Chair, Sherry Goertz, Candace Rutherford, Dick Shoap, Becki Johnson, and Linda Carr (Fulton County).

On January 20, 2012, the Task Force held its first meeting and endorsed the following list of issues/tasks to be addressed. It is our belief that findings in connection with these issues would be important in making recommendations about the viability of the proposal.

-An indication of support by the Fulton County Board of Commissioners to further investigate the transition of the MH/ID Administration to a nonprofit organization.

-Seek County Solicitor interpretation of the IRS Code (see below) and relevant PA Codes as to whether the MH/ID Administration could be exempt.

-Public/stakeholder comments early in the process on transitioning the Administration into a nonprofit organization.

-Confidence in continuation of existing funding streams and ability to seek grants to the benefit of the Counties citizens.

-Confidence in continuation of and potential risks/benefits of quality provider/client services outcomes.

-Investigation of the experience of existing non-profit MH/ID Agencies and/or other nonprofit County organization(s) in PA.

-Evaluation of potential “County overhead” cost savings versus new/additional overhead expenses in administration, housing, employee benefits, legal fees, etc.

-Discussion of the continuing responsibility by the Franklin and Fulton County Commissioners for citizen Public Health, Safety and Welfare, if those services are administered by a private nonprofit entity, and the strategy to mitigate potential public concerns.

These issues were sent to Mr. John Hart, County Administrator for his action/information. Subsequent meetings of the Task Force with the County staff and the Commissioners led to the Task Force scheduling open public meetings for providers and consumers to gather thoughts and/or concerns regarding the investigation into transitioning the MHID Administration into a nonprofit organization.

Three open hearings were conducted by the Task Force:

-February 10, 2012 from 2-4 PM @ Human Services Building, Franklin Farm Lane, Franklin County, Chambersburg, PA

-February 14, 2012 from 3-4 PM @ Fulton County Services Building, 219 N. Second St., McConnellsburg, PA

-February 22, 2012 from 7-8 PM @ Administrative Annex, 218 N. Second Street, Chambersburg, PA

A presentation of the status of the investigation was made by John Hart, Franklin County Administrator or Claire Hornberger, MHID Administrator, at the opening of each open hearing essentially covering the following information:

a. The status of this process is in the Investigative phase of the potential proposal.

b. In the process of looking at why and how other counties in Pa. have moved to the non-profit.

c. A legal firm with experience is looking into the details of the proposed change.

d. The new entity would still be receiving the state and federal funds as well as still be under most of the regulations that currently exist.

e. The new entity would have a merit hire process.

f. Existing Federal, Commonwealth and County regulations would be adhered to.

Approximately 114 individuals (some attended all three) registered, including all of the Fulton County Commissioners at the Feb. 14 hearing. There were 4 written comments submitted, that are attached to this report, and a number of oral presentations. All sessions were recorded.

Comment Themes

The comments received by the Task Force fall into the following general themes:

Mistrust of Government:

This theme is represented by many comments regarding the lack of specificity provided as to how transitioning to a nonprofit organization would benefit the County Government(s), service providers, consumers and the citizens. There was suspicion that a decision had already been made and the transition was already in progress. Other issues raised concerned the short schedule for implementation (July 1, 2012) and concerns about vague references to “efficiencies” without hard cost-benefit data and an a priori health impact assessment. Concern was also expressed that these “transition efficiencies” also included the ability to eliminate some employees to reduce payroll and overhead expenses.

Consumers want to be involved at every level of investigation and transition should a decision be made to go forward with a nonprofit entity. It was alleged that information about the hearings and the potential for transition was not adequately noticed to those potentially impacted. What are/were the problems with the current system that necessitates this nonprofit investigation?

One commenter spoke about the need to respect each other’s position, although they may differ. Transparency in decision-making and open dialogue is necessary. He said, “Slow this thing down folks, let’s take time to do this right and do this in a systematic and planned fashion,”

Client Services

A number of commenters expressed that there would be less service and reduced quality of service if the transition took place. There was concern that no one would look after client interests during the proposed transition and after, should a new entity be created. The satisfaction with current caseworker/consumer relationships was expressed and the fear that a transition would upset long-standing care management ties because of reductions in force or reassignments. Questions on HUD housing, vocational services and client transportation were also raised.

Financial Resources

Concern was expressed as to the continuation of the current funding streams and who would provide oversight to assure quality of the program since the funds would be from the Federal Government and the Commonwealth. Since the rationale for the new entity includes the ability to apply for grants, concern was expressed that in the current financial climate grants were “drying up” and those entities that now rely on grants do not welcome the competition.

Alternative Proposals

A suggestion was made that instead of transitioning to a nonprofit organization, that the Counties bid out case management services to 2 or 3 private providers thus allowing the county to maintain a small administrative staff to manage contracts and provide oversight of the services rendered. The commenter suggested that this option could provide savings worth looking at. Another commenter supported the proposed transition although noted that any change should be considered in the context of federal health care reform measures. One reform is the creation of Accountable Care Organizations (ACO’s). These ACO’s may be funded on the premise that they provide all services for consumers including case management. They are being piloted in a few places.

Organizational Considerations

When and if a new entity is created there was a strong suggestion that the new Board of Directors include Commissioner representation from Franklin and Fulton Counties to assure organizational oversight. It was also suggested that Directors be appointed by the County Commissioners initially and as their term(s) expire. A self perpetuating Board option was rejected. The need for 51% consumer representation on all Boards was another point raised. The new entity will need liability insurance which may add to their overhead and reduce expected efficiencies.

Conclusions

The Task Force concludes that the issues raised and interest demonstrated throughout these hearings by providers, consumers and the public necessitates that the issues summarized in the five themes above be responded to by the appropriate County entity thru an open and transparent process.

Furthermore, the Task Force summarizes the various Comment Themes into three overarching conclusions:

-The Counties have discussed “efficiencies” without offering a detailed schedule or cost and benefit analysis of the proposed transition. There are both tangibles and intangibles that need to be identified, evaluated and publically discussed, with consumer involvement, before any decision is made to go forward with a transition of the Franklin/Fulton MH/ID Administration into a non-profit entity.

-An a priori health impact assessment is also needed to assure that the consumers will not be adversely impacted by the proposed transition.

-One alternative offered to transitioning to a nonprofit is to “bid out” case management thus reducing the County role to implementation quality oversight, which could be a cost saving.

Attachments

1. Memo-Michele & Larry Garnes, 2/9/2012

2. Statement-A. Kenneth Wuertenberg, ED, Mental Health Assn. 2/10/2012

3.Statement-Sheri Morgan 2/10/2012

4. Statement-A. Kenneth Wuertenberg, ED, Mental Health Assn. 2/14/2012

Generally, and this instance is no different, the reasoning given behind privatization of government services is that it has become too much of a financial burden to the taxpayers and that savings will be achieved if only privatization would occur. However, savings cannot occur with competition[1]. Competition breeds success. Privatization of any government service succeeds less or not at all when competition is not introduced. Competition breeds innovation, it breeds cost efficiencies and it breeds consumer choice. The current proposal does not provide for either competition or consumer choice in services. Consumer choice fosters both recovery and empowerment.

Every function of the public mental health system in Franklin and Fulton Counties has been privatized with the exception of case management services. It is time that this occurs as well. Privatization of case management services does not have to be a static affair- it does not have to simply be an occasion to shift the service wholesale to a single entity with a sole source contract.

Having said all that, I believe that you have placed the proverbial cart before the horse. I say that because I believe that as a committee you are asking the wrong question. Rather than asking should a non- profit be created to house case management services the question (s) I feel we should be asking should be- What do we want, where do we want it, how do we want it delivered, how will it be funded and what impact will this have on current service recipients, our community and our local government? I feel that the assumption has been made that because there is general acceptance of current case management services that they are all they could ever be. I propose to you that if you are going to make change now is the time to take the time to seriously ask these questions and more. There are too many other approaches to delivery of case management services for this to be ignored.[2]

What has been proposed is serious systemic change. This type of change cannot occur without study of the current system taking place. Privatization of government services have occurred in other places. The wheel will not need to be reinvented. There are studies upon studies out there that can be reviewed that can provide both guidance and wisdom as to the questions that should be asked and the process that needs to take place.

Slow this thing down folks, lets take the time to do this right and do this in a systematic and planned fashion.

Franklin /Fulton MHIDEI Non- Profit Hearing
Public Comments
A. Kenneth Wuertenberg, Executive Director
Mental Health Association

Managed Care guidelines require that there be two providers of services unless a second cannot be established. In these instances a waiver is granted to the local managed care entity to only utilize one provider. Currently Case Management services are only provided by the County and a waiver is in effect. This is not because no other local providers exist to provide these services. It is due solely to the desire of our county to continue a practice of providing this direct service. I believe that an alternative to what has been proposed exists and that is for our county MHEIID to get out of the business of providing direct services.

There are already local agencies who have a presence in the community who have experience in providing case management services. I propose that this direct service be put out to competitive bid. Current service levels could easily be maintained with two- three providers providing this service thus increasing consumer choice and providing a platform for new and alternative methods of case management such as Self Directed Care to be offered as a viable service option. Providing options makes our local system a more recovery oriented system than it currently is and is certainly more desirable to the end user.

Consider this, should the county restructure this department and bid out the case management services thus
getting out of the business of providing direct services, they would only need to maintain a small administrative team to manage contracts and provide oversight of services which is truly where our government needs to be involved. This option could possibly provide a level of savings to the county that is well worth looking at. This scenario would provide individuals who receive services recourse to appeal to a higher authority and would maintain a function of an impartial third party who could in an unbiased manner ensure that all services are provided in a person centered recovery oriented fashion.
An additional concern that needs study is the impact of placing a large, guarantee funded entity in the middle of the non- profit landscape. A large entity like this would skew the ability of smaller long established organizations to raise funds and receive grant monies. Smaller non- profit organizations who have been here working in the trenches for years would be at a competitive disadvantage through no fault of their own.

Promise Made – Candidate Tom Corbett promised to help Pennsylvania’s most vulnerable citizens, including individuals with mental illness and/or facing challenges of addiction.

Promise Broken – Governor Tom Corbett’s budget is recommending the most significant change and cut to the community mental health system since its inception, over 50 years ago, including:

**An additional $12.6 million reduction to the Behavioral Health Services Initiative (BHSI) and the Act 152 Drug and Alcohol Program

**A change in the administration of Community Mental Health funding – after the 20% cut, the remaining funds are put into a Human Services Development Fund Block Grant to county government. The behavioral health funding accounts for 73% of the proposed block grant total and yet there is NO commitment to ensure that counties will spend that 73% on persons with mental illness or substance abuse issues.

In addition, the budget proposes to eliminate General Assistance (GA) cash assistance and slash funding for GA-related Medical Assistance.

**General Assistance is a last-resort program providing extremely meager benefits to 68,000  ennsylvanians with no income.

**Mental health and substance use disorder clients/consumers are approximately 30% of the users of this crucial benefit. It remains unclear how the rules are going to be applied that will result in the projected savings.

The GA cuts coupled with the reductions to mental health and substance use dollars will eliminate the safety net for thousands of vulnerable people

CHIPPs Funding
Promise Made – As PA has successfully closed state hospitals, every Governor since Governor Casey promised local communities that the sins of the 60’s and deinstitutionalization would not be repeated. Pennsylvania has been a leader in its commitment to closing state hospitals, and offering a real opportunity to individuals to live full lives in the community. State hospital dollars, or CHIPPS funding follows the
individual into the community and supports their recovery and those who might have gone to the hospital.

Promise Broken – Since 1990, NO ADMINISTRATION has reduced the CHIPPs funding promised to the communities until now. Governor Corbett cuts the funding by 20% which will likely result in a return to the problems of the 1960’s deinstitutionalization including an increase in jail population, homelessness, use of
emergency rooms and a return to more costly inpatient treatment.

Nothing About Us Without Us
Promise Made – Governor Tom Corbett promised a transparent and open government. Essential to the success of the community mental health and substance abuse systems is the commitment to the motto “nothing about us without us”. Transparency, input, oversight and feedback by those who need and experience treatment, their families, advocates and providers are essential to a successful mental
health system.

Promise Broken – The biggest system change in over 40 years is being done with NO input, NO feedback, and NO oversight by those impacted by the change. The law that has governed the mental health system for over 40 years will no longer be in effect.

Take Action – Communicate the following messages to Legislators

**Oppose the Block Grant – this proposed block grant is a major shift in public policy that was developed with no stakeholder participation. While the stated goals of flexibility and better integration of programs and services, without a considered plan of action that includes input from all stakeholders, there is no
assurance that the block grant will meet these goals. The behavioral health funding accounts for 73% of the proposed block grant total and yet there is NO commitment to ensure that counties will spend that 73% on persons with mental illness or substance abuse issues.

**Oppose the 20% Cut - this cut will devastate the community mental health system. The cuts were proposed without regard to the severe consequences such as increased homelessness, elimination of life sustaining services, increased incarceration, increased use of more costly services such as emergency room visits and inpatient treatment.

**Oppose the 20% cut to CHIPP funding – As state hospitals were closed or significantly downsized, individuals and communities across PA were repeatedly promised that the Commonwealth would provide and maintain community mental health care and that individuals would not be “dumped” into the streets, into
emergency rooms or into jails. Plans at the local level were developed based on these promises. The promises and plans are being scrapped as the Governor proposes severe funding cuts under the guise of reform.

**GA benefits must be restored. It is particularly critical that people struggling with mental illness and substance use disorder who are in need of services not have benefits eliminated nor be subject to expanded restrictive criteria that will limit their access to treatment.

These cuts must be restored. The block grant is wrong and should be stopped. Promises made to consumers and to communities must be kept. The proposal for massive cuts must be rejected.

]]> http://mhaff.org/governors-budget-threatens-safety-net-drn-press-release/feed/ http://mhaff.org/christmas-in-july/ http://mhaff.org/christmas-in-july/#comments Thu, 19 Apr 2012 00:23:26 +0000 bpalmatier http://mhaff.org/?p=81 Join us on July 19, 2012 at Norlo Park located at 3050 Lincoln Way East in Fayetteville, Pennsylvania from 9:30 AM to 2 PM for our annual picnic. Fun games, good food and an interesting program. Open to all. Free. Must register in advance. Contact us at bmunch@mhaff.org

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