Vermont Council of
Developmental and Mental Health Services
Legislative Update for January 30, 2012
All past Updates can be found under the Library tab
House Human Services Committee Considers and Passes Mental Health Plan
The House Human Services drafted and approved a committee bill relating to reforming Vermont’s mental health system on a vote of 9:1:0. The House Institutions Committee also took testimony on this topic during the week. However, this report is only on the proceedings of the House Human Services Committee.
On Monday, January 30th, the House Appropriations Committee will review the bill. On Tuesday, January 31st, the House Corrections and Institutions Committee will review the Bill. It will be put on the House of Representatives notice calendar on Wednesday and the full House will debate and vote on it on Thursday and Friday (2nd and 3rd readings) it will then be sent to the Senate for consideration. The timeline agreed to by the Legislature and Administration is to have a bill on the Governor’s desk by February 17th.
Here is a summary of the testimony and committee discussion from the week of January 23rd.
Testimony on January 24th at House Human Services
Dr. Peter Thomashaw of Central Vermont Medical Center (CVMC) testified for more beds and a tertiary care unit at a teaching hospital for the highest level intensive psychiatric care. He sees an urgent situation and believes it is unacceptable not to have adequate resources for people in psychiatric crisis. He says we have been under-resourced for the last few years. The system was working well when Vermont State Hospital (VSH) worked as the intensive care unit for the state. He believes that we need 30 - 40 beds at the state hospital, as a center of excellence, affiliated with Fletcher Allen Health Care (FAHC). He would like to expand step down capacities as an interim solution. They said only designated hospitals should have the ability to discharge to the step down facilities.
Dr. Isabelle Dejarden, the medical director of inpatient psychiatry at FAHC stressed the need to rebuild capacity for level 1 psychiatric care. Right now FAHC is treating people with high level of need and as such cannot serve as many people. She spoke about the negative impact on the treatment environment. FAHC is declining to treat 30 – 40 psychiatric patients per month. Her opinion is that the northern part of the state needs 30 beds. She recommended a couple of interim solutions: the state should more adequately fund inpatient care and reduce regulatory oversight.
James Tautfest, nurse specialist and nurse director at CVMC, in his testimony said they have a 95% occupancy rate and do take involuntary patients. He highlighted the impact of violent patients on the treatment environment and the need to be able to transfer these people to other inpatient facilities. He explained that community mental health centers don't work on the front lines, so they do not have the same perspective on the need for inpatient care. He added that units should not be larger than 10 beds for this population and should have an academic affiliation. He raised the idea of using out-of-state facilities on an interim basis.
Dr Frankle, Tom Heubner, Jeff McGee of Rutland Regional Medical Center (RRMC) were asked about the clinical and financial feasibility of the proposed 6 bed unit. Jeff told the committee that they are going to have 23 beds in total. Financially, it will be economical he told them. They have programming all day and a full complement of staff and will be hiring additional staff to address the higher level of acuity. They confirmed their commitment to the no-reject policy and to do their part in the system of care.
Public Hearing on the Mental Health Plan on January 24
Legislators from House Corrections and Institutions, House Human Services, Senate Health and Welfare and several other legislators heard over 60 witnesses.
The Vermont State Employees Association (VSEA) was there in force to support rebuilding a large state hospital. This was supported by others, including parents and mental health professionals. This message predominated the hearing.
Karen Topper of Green Mountain Self-Advocates spoke in favor of the plan, especially peer run and community based programs. She requested that the legislature detail how the mental health needs of people with developmental services will be met. Karen Schwartz, the executive director of the Vermont Developmental Disability Council, agreed and spoke about how recent cuts to developmental services meant that many people in the waiver program lost clinical services. Several people spoke in favor of peer services including Mark Ames of Turning Point and Sarah Lunderville, executive director of VCIL. She also spoke in favor of the Governor's plan, as did Margaret Joyal, director of Outpatient Services at Washington County Mental Health Services who described the importance of outpatient services to successfully reduce the need for inpatient services. Bernard Norman, the Director of Mental Health Services for Northeast Kingdom Human Services, also spoke in favor of the governor's plan as a way to spread the benefits of the successful services provided to CRT consumers to other Vermonters. Morgan Brown spoke of his experience, the importance of having a home, and the need for homelike environments, rather than large institutions for recovery. A couple of people spoke of the need for crisis and residential beds in Orange County. Alex Forbes of the Vermont Psychological Association spoke in favor of one large hospital in centralized hospital.
January 25th House Human Services Committee Discussions
Stephanie Barrett of the Joint Fiscal Office reviewed FEMA funding options. There were questions about whether Second Spring could access these funds. The committee reviewed and revised principles as recommended by the mental health oversight committee.
During committee discussion Representative Anne Donahue spoke in favor of building enough inpatient psychiatric beds to meet the highest demand. She believes the risk of not doing that is death. She emphasized that the development of Second Spring didn't result in a reduction in the number of VSH beds occupied. Since we don't know what level of investment in community will reduce level of need for inpatient beds, Representative Donahue recommended four year contracts for RRMC and Brattleboro Retreat (BR) and building a large central VT facility with flexibility.
Representative McFaun seconded the call for a large central Vermont state hospital.
Representative Patsy French agreed, suggesting a central Vermont facility with 30 beds and an expandable design. In her opinion to create a center of excellence, you need a critical mass and right now we have FEMA money to do it. If too big use beds for something else, she added.
Representative Sandy Haas see an immediate need for BR and RRMC and is excited about building up the community services. When we see how it works, we could then have 25 - 30 beds in central Vermont. If there are 3 wings, we could include the corrections population.
Representative Tom Burditt also supported the units at RRMC and BR, as well as expanding Community services. He was less enthusiastic about a large central Vermont facility.
Representatives Lynn Batchelor supported the BR and RRMC contracts for 4 - 5 years and building a central VT facility with a minimum of 30 beds with option to expand.
Representative Mike Mrowicki said he likes the idea of the mental health system moving away from institutional care and reduction of medication. He would like the proposal starting with 16 beds central Vermont.
Chairwoman Ann Pugh spoke of her personal experience in community based services. She supports RRMC and BR moving forward quickly with renovations and expansion. She wishes there was a place for inpatient care in northern Vermont. Her concern was that 16 beds for the state hospital is not enough, 25 is her recommendation. This would allow for 45 inpatient psychiatric beds statewide, as part of a big system change, based on improved outcomes in the community. In Representative Pugh’s estimation, it will take time to retrain staff and change culture, so flexibility with short term contracts and evaluation of services is critical.
There was discussion of the Soteria house proposal and concern about the proposed appropriation of $ 1 million as a blank check. The goal of the housing funds is to secure long term stable housing. Pathways for Housing was indicated as a possible administrator for some of the money.
Rep Pugh said if we spend more on beds than the original 16-bed central VT proposal then fewer resources will be available in the community.
January 26th House Human Services Committee Discussion
The Committee discussed the recently announced Homeless Initiative of $1.5 Million and; they determined that the funds are coming from money not spent for VSH operations. On Thursday afternoon, they reviewed the operations funding and the Milliman actuarial study. Anne Donahue pointed out that the Futures plan did not bring the number of beds down. Peter Alber of BR and Julie Tessler of the Council explained that the Futures plan was not fully implemented, mental health funding was cut, and care management not implemented. Peter also pointed out that we now have new effective leadership and that the collaboration between partners has never been better. Julie Tessler and Laura Ziegler agreed, noting that we are now in the position to truly improve the system of care.
Patrick came to the committee to respond better to the current crisis situation. The state is looking to convert a section of Lamoille Community Connections (LCC) into a patient care facility, on an interim basis. They are waiting to hear back from the town, but have already looked at the facility. One option is to develop it into a hospital facility, as it is already built to nursing home code. It could have 16 beds. The secure beds could be located there on a temporary basis and it could be staffed with state employees. If it couldn't get CMS certification, it could still be viable, even if the state has to pay general funds, because we simply do not have enough beds.
There will be a separate bill on corrections and mental health. The Committees on Judiciary and Corrections and Institutions will be doing that follow up work.
House Human Services Committee Deliberations January 27th
The Committee was told that Morrisville will allow up to 8 beds at LCC without a new permit, if more are requested then the State will need to apply for a conditional use permit.
2006 Milliman Study was discussed over the phone with Dave Ogden, New sub-acute residential and crisis diversion beds were assumed. There was no assumption that secure residential beds would impact demand for inpatient care. Adequate capacity for 90% of the time is considered appropriate for planning capacity according to Dave Ogden. Rep Donahue has been advocating for building capacity for 95 to 100% of time.
Nick Nichols of DMH shared data on evidence-based practices that reduce the need for inpatient care. Julie Tessler reinforced his testimony explaining that the DAs are planning to implement and expand these services, including the STEPPS program at HowardCenter.
The Committee reviewed the language on the number of state hospital beds and Chairman Pugh made a motion for 16 beds. Only representatives Frank, Burditt and Mrowicki supported the motion. There was discussion about whether a larger facility will reduce community capacity. Representative Donahue believes health reform will address this problem. Uncertainty about FEMA and Global Commitment funds creates uncertainty about operational funding in the futures.
The Department will report to the Legislature regarding the extent to which individuals with mental health conditions receive care in the most integrated and least restrictive settings available. The Council and the Vermont Association of Hospital and Health Systems requested broad language to evaluate care. The Committee accepted language drafted by Rep Donahue and Jill Olsen of VAHHS which sets out parameters on utilization, adequacy of capacity, consumer satisfaction and clinical, social and legal outcomes.
In the end the Committee voted in favor of a 25 bed facility in central Vermont and contracts for 4 years for inpatient care at RRMC and BR to ensure they recoup their investment either by rates or capitol funding and that there would be an option to renew those contracts. The vote was 9 in favor, 1 opposed (Rep Burditt): 0 abstaining.
Ongoing Policy Issues
The Council may want to advocate for revisions in the care management and intensive residential recovery language in the bill. The full draft bill is attached. The Executive Committee of the Council will discuss it on February 1st.
This week’s schedule...
House Committee on Appropriations
Monday, January 30, 2012
1:00 PM Governor's Proposed FY 2013 State Budget
Vermont State Hospital - Representatives are by conference call
Rep. Ann Pugh, Chair, House Committee On Human Services
Rep. Alice Emmons, Chair, House Committee on Institutions and Corrections (1:30 PM)
Michael Obuchowski, Commissioner, Department of Buildings & General Services (2:00 PM)
Patrick Flood, Commissioner, Department of Mental Health (3:00 PM)
Catherine Benham, Associate Fiscal Officer, Legislative Joint Fiscal Office
Katie McLinn, Legislative Counsel, Office of Legislative Council
House Committee on Corrections and Institutions
Tuesday, January 31, 2012
10:00 AM Mental Health Bill
overview
Kasey Bryan, Legislative Counsel, Office of Legislative Council
1:00 PM Caucus
1:30 PM Mental Health Bill
Michael Obuchowski, Commissioner, Department of Buildings & General Services
Patrick Flood, Commissioner, Department of Mental Health
2:30 PM Mental Health Bill
Michael Obuchowski, Commissioner, Department of Buildings & General Services
Patrick Flood, Commissioner, Department of Mental Health
Senate Committee on Government Operations
Tuesday, January 31, 2012
1:30 PM S. 237 - An act relating to the genuine progress indicator
Jeb Spaulding, Secretary, Secretary of the Administration
Stuart Comstock-Gay, President and CEO, Vermont Community Foundation
2:45 PM Break
Senate Committee on Health and Welfare
Wednesday, February 01, 2012
10:30 AM S. 223 - An act relating to extending health insurance coverage for autism spectrum disorders
Katie McLinn, Legislative Counsel, Office of Legislative Council
Nolan Langweil, Fiscal Analyst, Joint Fiscal Office
Mark Larson, Commissioner, Department of Vermont Health Access
David Martini, General Counsel, Department of Banking, Insurance, Securities & Health Care Administration
Fred Volkmar, MD, Director of the Child Center Study, Yale University School of Medicine
Judith Ursitti, Regional Director, National Autism Speaks Organization
Amy Cohen, Clinical Director Autism Spectrum Disorder, Howard Center
Susan Gretkowski, Lobbyist, MVP Healthcare
Jeanne Kennedy, Lobbyist, Cigna Health Care
Leigh Tofferi, Director of Government Relations, Blue Cross/Blue Shield of Vermont
Senate Committee on Institutions
Tuesday, January 31, 2012
1:30 PM Waterbury State Office Complex
Respondents to State's RFI initiative
Jeff Glassberg, Renaissance Development Co.
Marty Jacobs, Systems in Sync
John Kiernan, Phelps Engineering
Bill Maclay, Architect, Maclay Architects
David Sellers, Rood and Sellers
Larry Williams, DEW Construction Corp.
Friday, February 03, 2012
1:15 PM Vermont State Hospital/Replacement of State Hospital Services Update
Site selection and other issues
Michael Obuchowski, Commissioner, Department of Buildings & General Services
Wanda Minoli, Principal Assistant to the Commissioner, Department of Buildings & General Services
Michael Kuhn, Project Manager, Department of Buildings & General Services
Becky Moore, Social Worker, VSEA
Kristy McLaughlin, Social Worker, VSEA
Joanne Hayden, VSH Sr Therapeutic Services Counselor, VSEA
Laura Ziegler, Concerned Citizen
Peter Albert, Director of Government Affairs, Brattleboro Retreat
For more information or to take action:
· Legislative home page: http://www.leg.state.vt.us
· Sergeant-at-Arms Office: (802) 828-2228 or (800) 322-5616
· State House fax (to reach any member): (802) 828-2424
· State House mailing address (to reach any member):
Your Legislator
State House
115 State Street, Drawer 33
Montpelier, VT 05633-5501
· Email, home address and phone: Legislators' email addresses and home contacts may be found on the Legislature home page at http://www.leg.state.vt.us
· Governor Peter Shumlin (802) 828-3333 or http://governor.vermont.gov/
The purpose of the legislative update is to inform individuals who are interested in developmental, mental health and substance abuse services about legislative advocacy, policy development and activities that occur in the State Legislature. The Vermont Council is a non-profit trade association whose membership consists of 16 designated developmental and mental health agencies.