Vermont Council
of
Developmental and Mental Health Services

137 Elm Street, Montpelier, Vermont - 05602

Tel: 802.223.1773 Fax: 802.223.5523

Vermont Council of Developmental and Mental Health Services

Legislative Priorities for 2013

February 1, 2013

Fiscal Year 2014 Reimbursement Rate Increase

1. 3% rate increase to stabilize developmental and mental health system annually through a 3 year performance based contract.  This would require $5 million in general fund.  During fiscal years 2009 to 2012 designated agencies received cuts to base funding totaling 7.5%, while inflation continued to average 2% per year. The increase is needed to achieve mental health parity and health care goals; reduce law enforcement interventions and incarceration rates; and to fully achieve Act 79’s outcomes to replace the critical care previously provided by VSH which has been impaired by workforce challenges due to low pay and poor benefits.

2. Developmental Services Caseload: Support inclusion of adequate funds to meet all eligible individuals’ needs for service.  Research, as part of long term planning, other service models to meet the need of people with developmental disabilities that might be more cost effective

Fiscal Year 2013 Budget Adjustment Act

1. Support $3 million in additional new caseload requested for Developmental Services

2 Support $2.5 million for Severely Functionally Impaired/complex community cases for DAIL and DMH

SFI and Corrections

Many individuals at risk of incarceration or involved in the criminal justice system have challenges with mental health, developmental disabilities, addictions and other disabilities that can lead to severe functional impairments (SFI).  Designated Agencies are skilled in meeting complex needs and, with adequate resources could play an important part of the state’s sequential intercept model (SIM) system of care.  We are working actively with the Agency of Human Services and Department of Corrections to provide community placements for incarcerated individuals with SFI using flexible funding.  This initiative should be built upon to meet the diverse needs of individuals at-risk or involved in the criminal justice system, including detainees.  Improving funding for community based substance abuse and mental health intensive outpatient services will be critical to meeting needs of these individuals and reducing incarceration rates and costs. The Council is interested in working with state government to identify cost-effective options to serve individuals in the community which could include facility-based care. 

Act 87 led to a study of inmate in Vermont’s correctional facilities who have been designated as having severe functional impairments (SFI).  The Council supports the report’s recommendations :

•          To expand Integrated Treatment Courts

•          Improve screening for Traumatic Brain Injury 

•          Improve gender specific services for women 

•          Improve mental health and substance abuse treatment in correctional facilities

•          Improve the process for SFI Designation

•          Address the need for inpatient psychiatric

•          Develop a specialized treatment unit for inmates with SFI

•          Improves addictions treatment inside corrections and coordination with community providers

•          Provide a range of specific therapies

•          Coordination of Services upon departure from DOC facilities 

Health Care Reform

It is vital to include mental health and addiction services as a component of health care reform design and financing.  Sixty percent of visits to primary care physicians are for mental health and substance use disorders. Vermont will not make progress in controlling healthcare expenditures unless we develop more holistic service delivery and financing models. Collaborations among designated agencies, primary care physicians, federally qualified health centers, home health agencies and hospitals are in the best interest of consumers and tax payers. Exciting initiatives have begun throughout the state which lay the foundation for further collaborations in the future. Some individuals prefer to receive comprehensive services through their designated agency.  They should be able to choose DA’s as their healthcare home. All health reform initiatives, including the Dual Eligibles will require a significant investment for Health Information Exchanges for all providers and collaborative planning.

The Council supports the implementation of the section 7254 of Act 79. It calls for Vermont’s mental health system to be adequately funded and financially sustainable to the same degree as other health services.  And the Director of Health Care Reform and the Commissioners of Mental Health, Health and Vermont Health Access and the Green Mountain Care Board are to ensure that the redesign of the mental health delivery system per Act 79 is an integral component of health reform effort.  Specifically the following initiatives are to be coordinated and advanced:

(1) any health information technology projects;

(2) the integration of health insurance benefits in the Vermont health benefit exchange to the extent feasible under federal law;

(3) the integration of coverage under Green Mountain Care;

(4) the Blueprint for Health;

(5) the reformation of payment systems for health services to the extent allowable under federal law or under federal waivers; and

(6) other initiatives as necessary.

(b) The department of banking, insurance, securities, and health care administration shall ensure that private payers are educated about their obligation to reimburse providers for less restrictive and less expensive alternatives to hospitalization.

Unionization of Home Care and Daycare workers

The Designated Agencies support consumers who employ direct care workers to meet personal care and community support needs.  Several Designated Agencies offer childcare services, particularly Head Start programs and daycare for children with special needs.  Developmental homes provide foster care for individuals with developmental disabilities and sometimes for people with mental health conditions, these homes also offer respite services on a shorter term basis.  The Vermont Council recognizes that all of these providers deserve adequate compensation and a voice in the public policy.  We question how the unionization of independent workers and contractors will achieve this given the current funding and organizational structures.  We recommend further dialog before legislation is passed to understand the impact of redefining unions under state statute. This legislation could create expectations for increased funding for workers.  It is unclear who the union would negotiate with and how the State would address for increase costs if compensation rates for these workers are improved.

Independent Contractors

Last session, in H.762, language was developed to address outstanding concerns in the construction industry related to the definition of independent contractors.  The Council wants to ensure that the language created this session will not impact foster care services for both workers compensation and unemployment compensation.  The Agency of Human Services (AHS) also has concerns of unintended consequences and the implications in relation to foster care and other AHS services.

Public Records

The Vermont Council supports the public’s right to access public information. However, we do not support amending the law to require that organizations that contract with the State of Vermont, including Designated Agencies, be included in the law with similar requirements as state government.  Records potentially subject to this legislation would include, but would not be limited to: medical, personnel, credentialing, certification and training records, plus home provider, schools, and other subcontractor agreements. Designated Agencies need to comply with a number of federal and state privacy laws.  So, including designated agencies in the public information statutes could have the unintended consequence of increasing the difficulty and expense of sorting through the preemptive privacy laws. We agree that state government could receive and manage requests for public information about its contractors. This would streamline the process and clarify the lines of accountability.

Integrated Family Services

The Council strongly supports the vision of IFS and the ongoing work at all levels to align service delivery with its goals. In addition to improved quality of services to families, we anticipate that development of IFS will result in streamlined reporting, IT functions, business office and financial operations for both providers and AHS, as demonstrated in pilot regions.  We are experiencing various challenges to making the transition. Each entity worries that its vision, mission and culture will be overtaken by the orientation of the state administrative entity chosen to administer IFS. The administration of IFS should be the responsibility of those who have demonstrated commitment to the System of Care concepts on which IFS is based. Any plan to restructure state government should go through a thoughtful public process.  It is likely to require deconstruction of some existing boxes and changes in departmental leadership. We recommend that vetting in community forums and legislative review precede and inform the decision at AHS about where IFS lands. As IFS develops we will need to build the interface with adult services.

Changes in Children’s Personal Care Services have been a point of concern. Outstanding issues about adequate and appropriate availability of Personal Care and related services need to be resolved.