COUNCIL OF THE CITY OF PHILADELPHIA PUBLIC HEARING BEFORE THE COMMITTEE OF THE WHOLE - - - Room 400, City Hall Philadelphia, Pennsylvania Monday, February 23, 1998 9:45 a.m. - - - BILL NO. 980003 - An Ordinance Adopting the Operating budget for Fiscal Year 1999 PRESENT: PRESIDENT JOHN F. STREET, Chairman COUNCILWOMAN AUGUSTA A. CLARK COUNCILWOMAN JANNIE BLACKWELL COUNCILMAN DAVID COHEN COUNCILWOMAN ANNA CIBOTTA VERNA COUNCILMAN JAMES F. KENNEY COUNCILWOMAN DONNA REED MILLER COUNCILMAN MICHAEL A. NUTTER COUNCILWOMAN HAPPY FERNANDEZ COUNCILWOMAN MARIAN B. TASCO COUNCILMAN ANGEL L. ORTIZ COUNCILMAN FRANK DICICCO COUNCILMAN RICHARD T. MARIANO COUNCILMAN FRANK RIZZO - - - VINCENT VARALLO ASSOCIATES, INC. Registered Professional Reporters Eleven Penn Center, Suite 600 Philadelphia, PA 19103 (215) 561-2220 BILL NO. 980003 832 I N D E X DEPARTMENT OF PUBLIC HEALTH Commissioner Estelle Richman . . . . . . . 835 Asst. Comm. Mark Bencivengo. . . . . . . . 858 Dept. Comm. Ellen Steiker. . . . . . . . . 851 Susan Lieberman, Dir./Maternal Svcs. . . . 878 Richard Tobin, Dir./Lead Poisoning Prev. . 883 Patricia Bass, Codirector/AACO . . . . . . 901 Dept. Comm. Mike Covone. . . . . . . . . . 895 Dept. Comm. Mike Lucas . . . . . . . . . . 923 Dept. Comm. John Domzalsky . . . . . . . . 933 DEPARTMENT OF EMERGENCY SHELTER SERVICES Commissioner Michael Nardone . . . . . . . 935 OHCD - John Kromer, Director . . . . . . . 953 RECREATION DEPARTMENT Commissioner Michael DiBerardinis. . . . . 983 Dept. Comm. Bill Carapucci . . . . . . . . 1012 Dept. Comm. Carol Rice . . . . . . . . . . 1018 Tom Fox, Maintenance Director. . . . . . . 1034 CAMP WILLIAM PENN Commissioner Michael DiBerardinis. . . . . 1086 FAIRMOUNT PARK COMMISSION William E. Mifflin, Exec. Director . . . . 1088 PHILADELPHIA MUSEUM OF ART Anne D'Harnoncourt, Director/CEO . . . . . 1131 FREE LIBRARY Elliott Shelkrot, Pres./Dir. . . . . . . 1151 Bill Roberts, Adm. Svcs. Dir. . . . . . . 1158 HISTORICAL COMMISSION Richard Tyler, Preservationist . . . . . . 1177 ATWATER KENT MUSEUM David Rasner, Board President. . . . . . . 1180 BILL NO. 980003 833 P R O C E E D I N G S
Good morning, ladies and gentlemen. This is a recessed hearing of Council's Committee on the Whole. Today we will take further testimony on Bill No. 980003, an ordinance adopting the operating budget for Fiscal Year 1999. As most of you know, we will be having hearings for about another month, and we will not have a public meeting today, but we will take testimony on a number of City operating departments, including the Health Department, the Office of Emergency Shelter Services, the Department of Recreation, Camp William Penn, Fairmount Park, the Art Museum, the Free Library, the Historical Commission of the Atwater Kent Museum. Whereas we have been formally allotted a certain amount of time for each department, we would appreciate it very much if all of the departments would stand ready so that if we get to you before or after your projected time, you will be available to testify. I'd like to mention at this time that 834 BILL 980003 the viewing and funeral services for Miss Vera Gunn, a very significant, important, civic-minded, and hard-working Philadelphian, are taking place this morning. I understand that the viewing is from o'clock till o'clock, and the services 7 are at 11 o'clock, so that there are some 8 Councilmembers not here now who are now at the 9 viewing. 10 I've spoken to Councilwoman Augusta 11 Clark. She is absent. Of course, she is at the services for her good friend. So there are other Councilmembers who may be leaving to attend these services. I will be leaving because I'm going to be going to pay my respects. So we appreciate very much your understanding. And we encourage Councilmembers, if they can, to pay their respects, but as many of us as possible, we'd like to have here so that we can continue with the hearings. Our first department today for consideration is the Health Department. Commission Richman. (Commissioner Richman comes forward.)
Good morning, BILL 980003 835 BILL 980003 Commissioner. Please identify yourself for the record. COMMISSIONER RICHMAN: Good morning President Street and Members of Council. I am Estelle Richman, Commissioner of the Department of Public Health. Thank you for the opportunity to present the Health Department's budget for Fiscal Year 1999. With me is my Deputy for Finance and Administration, Ellen Steiker. For my fourth year as Commissioner, I am happy to report that, on the whole, the Fiscal Year 1999 budget maintains service levels comparable to Fiscal Year 1998. I will note later in my testimony where we anticipate that some areas of the Department will have difficulty keeping up with the increasing demand for services. This is due primarily to factors: a series of cuts in welfare programs and termination of several demonstration grants, most notably Target Cities and Healthy Start. These cuts have had a negative effect on some of Philadelphia's most vulnerable citizens; and subsequently, on the Department's capacity to provide the array and quality of services it has BILL 980003 - DEPT. OF PUBLIC HEALTH 836 BILL 980003 - DEPT. OF PUBLIC HEALTH been providing. The Department of Public Health cannot afford to supplant benefits formerly provided by the State and federal government. However, the Department is committed to continue to meet its mission to promote and ensure the availability, accessibility, and quality of preventive and personal health services necessary to protect and improve the health and well-being of the Philadelphia community. This budget request reflects that commitment while recognizing the inherent challenges. 7 million in the Grants Fund, and $430 million in the HealthChoices Behavioral Health Revenue Fund. 9 million, or 6 percent, comes from the City tax-supported funds. The Department will support 1,337 full-time positions. The major issues facing the Department for Fiscal Year 1999 are the impact of the changes in the health and welfare system on Philadelphia and Philadelphia's Behavioral Health Managed Care BILL 980003 - DEPT. OF PUBLIC HEALTH 837 BILL 980003 - DEPT. OF PUBLIC HEALTH Initiative. In particular, we foresee continued challenges in our health care centers as well as in the Department's ability to continue to maintain its role as the safety net for many Philadelphians. For more than 30 years, the Department of Public Health has provided behavioral health care for disenfranchised, impoverished, and uninsured Philadelphia residents through the Office of Mental Health and the Coordinating Officer for Drug and Alcohol Abuse Programs. In February 1997, the provision of these services changed dramatically with the State's implementation of HealthChoices, a mandatory managed health care program for medical assistance recipients and the City's Management of Behavioral Health Services through Community Behavioral Health, CBH. The City has a unique opportunity to integrate funding streams and create a behavioral health system that helps ensure the transition of clients from higher-cost care (for example, hospitalization) to less costly treatment such as outpatient treatment without sacrificing the BILL 980003 - DEPT. OF PUBLIC HEALTH 838 BILL 980003 - DEPT. OF PUBLIC HEALTH quality and appropriateness of service. Historically, the City administered a combination of federal, State, and City funding to provide to medical assistance recipients and Medicare recipients those behavioral health services that were not covered by medical assistance and to offer a full range of behavioral health services to uninsured individuals. Providers were reimbursed directly by the State for the cost of MA-eligible treatment for MA patients. Now, for the first time, the Department of Public Health is able to manage, along with its more traditional mental health services, substance abuse program services. 1 million for OMH and $43 million for CODAAP. 7 million for CODAAP.
During 1997, Philadelphia's 400,000 MA BILL 980003 - DEPT. OF PUBLIC HEALTH 839 BILL 980003 - DEPT. OF PUBLIC HEALTH recipients were enrolled into HealthChoices in stages, and approximately 48,000 individuals have used behavioral health services in less than a year. All financial goals including the State's requirement that it establish a reserve equal to one-half of one month's capitation payment, or about $14 million have been met or exceeded. In addition, the City has established its own $5 million risk contingency funds. Although these initial indicators are very positive, it will be another several months before the City has a better understanding of the service utilization patterns for the entire population and, therefore, a clear indication of the long-term financial performance. In calendar year 1998, the first full year of operation, revenue is projected to be $344 million. In addition, CBH has made a commitment to hiring individuals previously on welfare. 1 percent (or 29 people) of CBH employees were former welfare recipients. Six years into the Rendell Administration, recent and potential federal and BILL 980003 - DEPT. OF PUBLIC HEALTH 840 BILL 980003 - DEPT. OF PUBLIC HEALTH State cost-cutting measures threaten to eradicate the progress that the City has made in providing critical health services for Philadelphians. Every entitlement program for medical assistance and Medicare to supplemental income and food stamps has been on the chopping block over the last two years. In fact, Pennsylvania has been in the forefront of welfare funding cuts nationally. There is a health care crisis in the country and in the City. Hospitals throughout Philadelphia are feeling the same effects as the health care centers: more uninsured, lower reimbursement rates, and an increasing inability to finance care. Hospitals are faced with increasing fiscal crises, resulting not only in a threat to the continuum of care in Philadelphia but to the local economy as hospitals are faced with layoffs and cutbacks to meet their own bottom line. A primary objective for the Department of Public Health is the continued provision of quality health care in the face of uncompensated demand caused by eroding federal and State financial support of America's poorest citizens. BILL 980003 - DEPT. OF PUBLIC HEALTH 841 BILL 980003 - DEPT. OF PUBLIC HEALTH The financial viability of the City's health care center system has depended on the Health Department's ability to balance the services to the uninsured with its services to the insured. The growing imbalance threatens the current level of service, and the City simply cannot afford to absorb the full financial consequences of ill-advised changes in federal and State welfare policies. The Health Department operates a network of eight community-based primary health care centers which represent the heart of the City's health care strategy. Because the health centers have always served those with little or no 16 ability to pay for care, efforts to generate revenues to help offset unreimbursed costs have been a priority. The network of centers provides comprehensive health, dental, pharmacy, and laboratory services to more than 105,000 adults and children throughout the City. Each center employs public health social workers who provide extensive health care, social service, and benefits counseling. BILL 980003 - DEPT. OF PUBLIC HEALTH 842 BILL 980003 - DEPT. OF PUBLIC HEALTH Moreover, the centers offer uninterrupted service delivery as patients move in and out of health insurance status and between health plans, which makes them particularly attractive to patients whose health care coverage is subject to change. The solid performance of the eight centers in this area is particularly remarkable when viewed in light of the volume of patient visits they attract. Total visits went from 277,000 in Fiscal Year '94 to 324,000 in Fiscal Year '97, an increase of percent.
And the 14 Department of Public Health projects that the 15 number will grow to 330,000 in Fiscal Year '98 and 16 335,000 in Fiscal Year '99. 5 million from Fiscal Year '98. The termination of general assistance for Philadelphians cost the health centers 1,000 managed care enrollees between July and October of BILL 980003 - DEPT. OF PUBLIC HEALTH 843 BILL 980003 - DEPT. OF PUBLIC HEALTH 1996 and reduced the centers' revenues by $250,000 annually. Federal cuts in HealthChoices cost the health centers 3500 enrollees and $750,000 annually. The loss of potential revenue was $1 million. The effect of these changes is already plain. 8 percent) since Fiscal Year '95 is the fact that those visits are being made increasingly by people who are less likely to have insurance. In Fiscal Year '94, only 45 percent of health care patients were insured. That rose to 58 percent in Fiscal Year '97, and 59 percent in December of 1997, and it is expected to reach 61 percent in Fiscal Year '98, an escalation in uninsured visits of more than 30 percent from Fiscal Year '96 to Fiscal Year '99. In fact, DPH estimates that the number of visits by patients with some types of insurance is actually projected to decrease almost 20 percent from Fiscal Year '96 to Fiscal Year '99. As a result, the unreimburseed costs of care, those costs that are fully supported by BILL 980003 - DEPT. OF PUBLIC HEALTH 844 BILL 980003 - DEPT. 7 projected for Fiscal Year '99. While increases in waiting times have not affected all services and patients as yet, the Department of Public Health does not believe that has seen the end of the ever-growing line for service. Should waiting times continue to increase, the health centers may very well become less desirable places for insured patients, jeopardizing health center third-party revenues, and placing mounting pressure on limited City resources, creating an ever-downward spiral. In addition, while appointment availability within three weeks has reached 89 percent by Fiscal Year '96, increased service demand, primarily by adults whose medical assistance benefits have been cut, lowered that to 76 percent in Fiscal Year '97, and a projected 74 percent in Fiscal Year '98, and a projected 72 percent in Fiscal Year '99. Despite this, appointment availability at the health centers is competitive with the BILL 980003 - DEPT. OF PUBLIC HEALTH 845 BILL 980003 - DEPT. OF PUBLIC HEALTH private sector, especially as three-week availability for prenatal care remained at 100 percent, and the longest appointment wait is four weeks. In addition, as I mentioned earlier, the Department continues to feel the effects of cuts and reductions in federal demonstration grants; specifically, the Target Cities Program and Healthy Start. These grants were for federal demonstration projects, which were one-time funding from the outset. Healthy Start was a federally-funded demonstration project aimed at reducing infant mortality and improving maternal and child health in west and southwest Philadelphia. 5 million in Fiscal Year '99 and the remainder of the project. Target Cities was a federal grant to improve the substance abuse treatment system. 2 million in Fiscal Year '98. A remaining 600,000 is expected BILL 980003 - DEPT. OF PUBLIC HEALTH 846 BILL 980003 - DEPT. OF PUBLIC HEALTH through Target Cities in Fiscal Year '99. The Health Department is aggressively pursuing ways to offset the losses incurred with the termination of these two grants. Services provided by the HMOs through the HealthChoices Program will provide some Healthy Start services for those clients who are MA-eligible. Those clients served through Target Cities will receive services through the Behavioral Health System.
I conclude my testimony by stating that while the issues that I've discussed will be difficult ones for the City and the Department to grapple with in the coming year, I believe that with the additional investment contained in our Fiscal Year '99 budget request and continued advocacy for policy and practical changes in welfare reform, we can continue to protect our most vulnerable citizens. I want to again thank you for the opportunity to give testimony today, and I will now take questions. )
Thank you, BILL 980003 - DEPT. OF PUBLIC HEALTH 847 BILL 980003 - DEPT. OF PUBLIC HEALTH Commissioner. I would like to discuss, if I may, the Philadelphia Nursing Home. I believe it's costing the City $3.3 million? COMMISSIONER RICHMAN: That's correct.
And I remember the day it was costing us well over $8 million or close to $9 million. Can you tell me, how long is the contract for Episcopal Hospital for the nursing home? COMMISSIONER RICHMAN: The initial contract was a three-year contract, and we are within the second one-year extension of that contract.
All right. And the census presently is. . . ? COMMISSIONER RICHMAN: The current census is 450 people. The capacity of the nursing home is 500.
So I assume from the census, that we have opened that wing that had been closed for quite a while? COMMISSIONER RICHMAN: No. 25
We have not? BILL 980003 - DEPT. OF PUBLIC HEALTH 848 BILL 980003 - DEPT. OF PUBLIC HEALTH COMMISSIONER RICHMAN: Six West, which is the one wing of the nursing home, remains still closed, and there are several reasons for this. The first one is that we have an outside monitoring team that does review the nursing home on a quarterly basis, DePaul. And they have found two deficiencies that we've been seeing over time: one is infection control and the other is housekeeping deficiencies. And in their last report, which happened -- in the survey in January of '98, they still found that these deficiencies still existed, although they were significantly better than they found in other surveys. So we are continuing to keep our eye on these two to make sure when we do open, we don't put ourselves at risk again at a licensing level for the State. The other issue has been staffing. Staffing problems have persisted for several years. In fact, in my last visit to the nursing home, which was about two weeks, it was the first time they've had unit managers on all ten units. So for the first time, we're actually reaching BILL 980003 - DEPT. OF PUBLIC HEALTH 849 BILL 980003 - DEPT. OF PUBLIC HEALTH full staffing. We will be reviewing -- I have just received another request from Episcopal again requesting the opening of Six West. In light of the fact that they are at full staffing now and the deficiencies are showing improvement, we will again review in detail with Episcopal the possibility of opening the unit.
I also note in your testimony that you say that the City is assessing appropriate strategies related to the future of the Philadelphia Nursing Home. Can you elaborate on that? COMMISSIONER RICHMAN: Yes. As we have worked with the nursing home over the past four years, one of the most consistent problems that we've heard, both from our subcontractor, ELTC, and the State, is the physical setting, the building. The building is old, we have frequent systems breakdowns, and the size of it makes it difficult sometimes to both supervise and hire staff for. So we have been looking at the possibility of what other things we can do with BILL 980003 - DEPT. OF PUBLIC HEALTH 850 BILL 980003 - DEPT. OF PUBLIC HEALTH the nursing home that would possibly either have us use a different site, be able to split to different kinds of sites, but looking for, as we project to the future and look at this contract, what are other possibilities that might be open to us.
It should be interesting. Commissioner, would you mind referring to -151 of the operating budget? COMMISSIONER RICHMAN: 151?
There is no 16 indication as to what the cost for personal services would be. What I would assume is that they are the providers. COMMISSIONER RICHMAN: I'm --
It's the contract between CBH and the providers. COMMISSIONER RICHMAN: I'm not quite sure I'm looking at the --
There's no list of who the providers are. BILL 980003 - DEPT. OF PUBLIC HEALTH 851 BILL 980003 - DEPT. OF PUBLIC HEALTH COMMISSIONER RICHMAN: Providers for CBH?
Mm-hmm. COMMISSIONER RICHMAN: I have that information and can easily get it to you, if you would like.
Would you, please? COMMISSIONER RICHMAN: I can tell you since I do have a list of providers here that there are 242 providers for CBH. That includes 30 hospitals.
Can you tell us how many employees CBH has? COMMISSIONER RICHMAN: Yes. CBH has 188 employees; that's full-time. And there are another 14 part-time.
Can you give us a detailed budget for CBH? DEPT. COMM. STEIKER: We can provide that. That's no problem.
And when can we expect to see that? COMMISSIONER RICHMAN: Probably within BILL 980003 - DEPT. OF PUBLIC HEALTH 852 BILL 980003 - DEPT. OF PUBLIC HEALTH five days.
Thank you. Since we have a rather lengthy schedule today, I thought it would be best if each of the Councilpeople had five minutes for questioning, and then we'll have another go-around if necessary. Thank you. The Chair recognizes Councilwoman Fernandez.
Thank you, Madame Chair. Let me follow up on some of the questions about CBH. I was reminded again yesterday morning when I went to the local 7-Eleven to get a newspaper, and there were two people panhandling. Again, I'm not a professional, but I wondered if drug- or alcohol-abuse might have been a part of the picture. And so I'm really -- again, I thought of CBH and thought about how important it is that it will be to the City's best interests to provide not just quicky-fix kind of care for people to get them in and out as soon as possible, but really to BILL 980003 - DEPT. OF PUBLIC HEALTH 853 BILL 980003 - DEPT. OF PUBLIC HEALTH try to help people deal with serious drug and alcohol problems and mental health problems. And certainly, as far as I'm concerned, with all of the cuts coming from the federal level in terms of welfare changes and stuff, probably having CBH in place is probably one of the most important positive steps and sort of safety net that the City might have. Could you review for the record what kind of savings or -- I don't know what the exact word you use is -- I think it's "profits," but basically savings that could be reinvested from CBH? I know there was some discussion that was one of the testimonies about -- is it 500,000 or $1 million that will be reinvested if Council so approves outreach services for the homeless? But where I'm leading is, I'd like to know what the level of savings has been that would be available for reinvestment, and then what some of your plans and thoughts are for that reinvestment. Because my goal would be that I would be able to say to people panhandling at the BILL 980003 - DEPT. OF PUBLIC HEALTH 854 BILL 980003 - DEPT. OF PUBLIC HEALTH 7-Eleven or downtown, or when I saw someone in trouble, I'd be able to say, Here's a card, there is help, go get yourself help so you aren't out here asking me to support your drug or alcohol habit. Or if there's someone with serious mental health problems, there would be, again, a place to turn. Could you review that for us, please. COMMISSIONER RICHMAN: Let me try to break that up in a couple ways. First, in our end-of-month report with our month ending in November, we had $19.7 million in savings and are projecting $21.6 million for December, but the December one is still an estimate as we're in the work of closing the books for December. Of that $21.6 possible dollars, $14.2 million is for the Risk and Contingency Fund set by the State. The other $7.4 million would be a Risk and Contingency Fund for the City. And with that Risk and Contingency Fund for the City, we were hoping to allocate $1 million at this point for reinvestment. And let me take this opportunity to BILL 980003 - DEPT. OF PUBLIC HEALTH 855 BILL 980003 - DEPT. OF PUBLIC HEALTH apologize to Council. The Health Department did make a commitment last year that before any reinvestment dollars were used, that there would be a resolution before Council for the usage of those dollars. In our hurry this year to do some investment in the homeless system, we failed to do that. Those resolutions are -- will be -- the language for some of those will be presented to Council hopefully sometime this week. So we would like to again apologize for not forming the procedure that we said we would be in, and we hope to be partners with Council from this point on, to make sure that you're aware of any planning that is going on with reinvestment dollars and have an opportunity to review that before any commitments are made. We have identified for this year approximately $1 million that were to be available for reinvestment; $500,000 for the homeless initiative and approximately $500,000 to work with children at risk within the School District on a partnership basis.
And then what about the other money? If you say there's about BILL 980003 - DEPT. OF PUBLIC HEALTH 856 BILL 980003 - DEPT. OF PUBLIC HEALTH we have, 14 that the State asked you to set aside, what about the other million, what might 4 that be used for? What would be the process? 5 COMMISSIONER RICHMAN: At this point, 6 the first thing we would like to do is engage in a full planning process to involve as many stakeholders as we can in the system. And, certainly, that would involve Members of Council and their staff as we begin to create a plan for how State dollars would be used. We also would like to create our own Risk and Contingency Fund. As you know, this is still a new program, and we are still trying to make assessments on what kind of dollars we'll use, what kinds of risks may still be out there. So we would like to continue to develop a Contingency Fund for the City as well as a reinvestment Fund. And, as we work through what those planning efforts should be and what should be in each fund, we will keep Council involved and very aware of where we're moving in that activity.
What time -- how long -- BILL 980003 - DEPT. OF PUBLIC HEALTH 857 BILL 980003 - DEPT. OF PUBLIC HEALTH
That will be your last for the time being and then we'll do another go-round.
Right. What now is the waiting time if someone says, I am willing to get some drug treatment help, I'm ready and willing to go, how long is -- what's the wait time now? COMMISSIONER RICHMAN: I believe that someone can be placed in a program immediately. There should be no wait whatsoever for any drug and alcohol problem -- program at this point if somebody is willing to go into a program. And that includes both our CBH initiative and our BHSI initiative.
If you did see someone on the street who looked like they needed help -- not that you'd try to -- COMMISSIONER RICHMAN: Right.
Where would BILL 980003 - DEPT. OF PUBLIC HEALTH 858 BILL 980003 - DEPT. OF PUBLIC HEALTH you tell them to go? Where would someone refer them to? COMMISSIONER RICHMAN: Now you're a little bit too technical for me. Mark? (Assistant Health Commissioner Mark Covone comes forward.) ASST. COMM. BENCIVENGO: I'm Mark Bencivengo. I'm the Assistant Health Commissioner for the Coordinating Office for Drug and Alcohol Abuse Programs. What we in the office have been telling people when they call seeking help is there are two phone numbers. If they are on an HMO and, therefore, a part of HealthChoices, that they call the CBH 1-800 number or 1-888 number. If they do not have insurance, then we give them the number of the Behavioral Health Special Initiative for the people who are uninsured. They call either one of those two numbers. And, as the Commissioner said, placement is virtually immediate to whatever level of care that they might need.
I would BILL 980003 - DEPT. OF PUBLIC HEALTH 859 BILL 980003 - DEPT. OF PUBLIC HEALTH suggest you get those numbers around to us so we know -- I'd really like to know what they are. ASST. COMM. BENCIVENGO: We'll be glad to make those forms available to Council.
Thank you, Madame Chair. Commissioner Richman, could you please give us an update on the Needle Exchange Program, the status, increased number of needles, decreased number of needles, how much we're spending with Prevention Point? And also, could you please provide the Chair some of the literature that Prevention Point is distributing to the community? COMMISSIONER RICHMAN: We'd be very glad to provide that information to the Chair on all of the information provided by Prevention Point. And Mark will specifically answer the question. ASST. COMM. BENCIVENGO: Prevention BILL 980003 - DEPT. OF PUBLIC HEALTH 860 BILL 980003 - DEPT. OF PUBLIC HEALTH Point is distributing approximately -- will distribute approximately 850,000 syringes this fiscal year. I believe that the Commissioner's testimony, there was some tables in the back, and it indicated that 97 percent of the syringes distributed by Prevention Point are returned. That's one of the highest return rates of any of the 72 cities that currently have syringe exchange programs. And the Department is currently allocating approximately $203,000 to Prevention Point.
Commissioner, in your opinion or legal -- or in the Law Department's opinion, this program, do you consider it a legal program? Do you see any violation of State law at all in this program? I know the Mayor's executive order established this program, but I understand that the Attorney General said it is an illegal program. COMMISSIONER RICHMAN: At this point, the Mayor's executive order has not made it BILL 980003 - DEPT. OF PUBLIC HEALTH 861 BILL 980003 - DEPT. OF PUBLIC HEALTH illegal in the City of Philadelphia. The State Attorney General, I believe, at this point, still hasn't ruled on the program and has remained quiet.
He has publicly stated that it is not legal to distribute needles. COMMISSIONER RICHMAN: I think that they've tried to remain silent on the program, rather than having a specific ruling on the program.
With regard to CBH, are the subcontractors generally satisfied with the general contractors? We've had some complaints regarding the service. COMMISSIONER RICHMAN: In general, I think that people have been very satisfied with the program. We do regular surveys of consumers who are using the services, and those consumer issues have always come back resolved and very positive. The providers, I think, are at different stages in terms of their contracting and their ability to adjudicate claims appropriately. We have long lists of issues that have to be BILL 980003 - DEPT. OF PUBLIC HEALTH 862 BILL 980003 - DEPT. OF PUBLIC HEALTH addressed with the State, as to what it takes in terms of information submitted to have a claim successfully adjudicated. An adjudicated claim is what happens when you get paid. And we work with providers individually in provider meetings. And probably for most of those providers that are having problems, we are probably meeting with them practically once a month to help them resolve any claims issues they may have.
Commissioner, on of your testimony, you explained that the Health Department revenue initiatives have contributed $8.2 million. You also explained that cost savings initiatives have $10.8 million. Can you explain these initiatives? DEPT. COMM. STEIKER: Good morning. This is Ellen Steiker. I'm Deputy Health Commissioner for Finance and Administration.
Can you turn on her microphone, please. DEPT. COMM. STEIKER: Good morning. This is Ellen Steiker. I'm Deputy Health Commissioner for Finance and Administration. BILL 980003 - DEPT. OF PUBLIC HEALTH 863 BILL 980003 - DEPT. OF PUBLIC HEALTH The initiatives are laid out in the five-year plan in some detail, but the revenue initiatives include improved billing and eligibility at the district health centers, fees for asbestos control programs, environmental user fees, increased revenue for dental services, increased revenue for pharmacy improvement, and making some changes to the County Health Act that would improve the revenue that comes from county health. And those total initiatives, as we said earlier, were $8.8 million -- $8.5 million in FY '99. On the cost side, when the Rendell Administration began, there were a number of initiatives that were put into effect to contain costs. Most of the cost initiatives have been really implemented already and are part of our base budget. They include implementing the EPSCT program and MHMR that allowed reduction in program-funded dollars, the privatization of Riverview, the privatization of PHN, and some cost reductions in the General Fund when we moved some BILL 980003 - DEPT. OF PUBLIC HEALTH 864 BILL 980003 - DEPT. OF PUBLIC HEALTH of those funds to grant-funded sources. Those were the major expenditure savings. And they were worth $10.8 million in FY '98; and the same, $10.8 million, in '99.
Thank you. Finally, Commissioner, could you give us the status of Love Park? It's been closed now for the winter. And hopefully by spring, the restrictions for people to use the facility for recreation, for lunch, hopefully, it will reopen in the spring. COMMISSIONER RICHMAN: We are certainly working towards looking at this as a possible reopening. Just for your information, last spring, when we closed the park for the summer, there were 80 active rat burrows. We now -- it's down to about 5. So it was 80 when we closed, it's down. We do think -- these were rats with a very large size. Some of them looked more like squirrels we do believe now that because of the bathing and the rat-proofing and the landscape changes, that we really do have that under control. We are working with Fairmount Park and with the other departments of the City to assess BILL 980003 - DEPT. OF PUBLIC HEALTH 865 BILL 980003 - DEPT. OF PUBLIC HEALTH what it's going to take to reopen the park. One of the things we do know is that rats multiply more frequently in the spring, so we want to do it a little bit slowly so we don't have a sudden surge in the rat population again, which created environmental and health problem. But starting now, we will be meeting with Fairmount Park to put forth a plan as to how we should move. And our hope would be to certainly, at least on a pilot basis, while we track the rats and the borrows, to see whether we can get it reopened.
Thank you, Councilman. The Chair recognizes Councilman Nutter.
Thank you, Madame Chair. It just never ceases to amaze me what sometimes we end up talking about in here. Good, morning Commissioner. COMMISSIONER RICHMAN: Good morning.
Let's go back to of your testimony, back into what is BILL 980003 - DEPT. OF PUBLIC HEALTH 866 BILL 980003 - DEPT. OF PUBLIC HEALTH affectionately known as "CBH World." In response to a question asked by one of my colleagues, you said that there was no wait for drug or alcohol treatment in the City; is that correct? COMMISSIONER RICHMAN: That's correct.
Okay. Do you have any information with regard to drug and alcohol treatment in our prison population? Do you provide those services, or does the prison provide those independently? ASST. COMM. BENCIVENGO: There's a program in the Philadelphia Prison --
Before testifying, please identify yourself for the record. ASST. COMM. BENCIVENGO: Assistant Health Commissioner for CODAAP. There is a program in the Philadelphia prisons called "Options." It is not run by the Philadelphia Department of Public Health, but we do have a close relationship with the Options Program. BILL 980003 - DEPT. OF PUBLIC HEALTH 867 BILL 980003 - DEPT. OF PUBLIC HEALTH And individuals who have been identified as eligible for the Forensic Intensive Recovery Program, which the Department does operate, are referred into the Options Program so that we assist them in making them treatment-ready so that when they leave prison, then they can go into community-based treatment. But the Department does not operate the program behind the walls. So I can't speak to the issue of, Does it have the capacity to see everyone who want to go into it? That would be something that the prisons would have to answer.
Okay. You're anticipating my next question. Did the Health Department ever operate the program? And is Options relatively recent? ASST. COMM. BENCIVENGO: No, the Department, to the best of my knowledge -- and I've been around for quite some time -- has never operated that program. Options is not a particularly new program. It is, I believe, run by a woman by the name of Deb Ratta (ph.) within the prison system. BILL 980003 - DEPT. OF PUBLIC HEALTH 868 BILL 980003 - DEPT. OF PUBLIC HEALTH
Okay, I'll save that for the prisons. Commissioner, in response to Councilwoman Verna, you told us that CBH has 188 full-time employees and part-time employees; is 7 that correct? 8 COMMISSIONER RICHMAN: That is correct. 9
Okay. In addition 10 to the information that the Chair asked, could you 11 add to that an organization chart now that you 12 have all of these employees on board? 13 And there was a question back when we 14 were dealing with the larger issue of creating CBH about who these people were, were they Philadelphians, were they outside Philadelphia? Could you also provide information with the list to indicate who's in Philadelphia, who may not be in Philadelphia? COMMISSIONER RICHMAN: Yes, we will be able to.
Okay. In your testimony, it seems to indicate that you're asking for a $90 million increase in the budget for CBH. If I'm reading this correctly in your testimony, BILL 980003 - DEPT. OF PUBLIC HEALTH 869 BILL 980003 - DEPT. OF PUBLIC HEALTH FY '98, $341 million for CBH; FY '99, $430 million for CBH. It's about a $90 million increase. DEPT. COMM. STEIKER: Ellen Steiker, Deputy Health Commissioner for Finance and Administration.
I can't -- I'm sorry, it's not your fault. Can we check and make sure that microphone's on? I cannot hear her. DEPT. COMM. STEIKER: This is Ellen Steiker, Deputy Commissioner for Finance and Administration. The increase is a large increase, we realize that. The basic reason is that we're being fairly conservative in the way that we are budgeting because of very unknown factors. If I were to break this down for you, I would say that revenue for FY '99 could be in about the range of $380 million, so that's about a 40 million increase from where we are now, although that's high. But, again, it depends on the number of enrollees, and it depends on what category of aid they're in, which will determine the rate that we get paid. And some of these factors are not BILL 980003 - DEPT. OF PUBLIC HEALTH 870 BILL 980003 - DEPT. OF PUBLIC HEALTH known. So we are budgeting conservatively, which means we're asking for appropriations to make sure that we have enough. Secondly, we get revenue in one year. We may not spend it in the year that we get it. There are timing issues. And, particularly, there are delays from the time that services are delivered until when a payment is made. And so we're taking into account some of those timing differences, which, again, are sometimes hard to anticipate. So we have another $46 million put aside for the combination of those timing differences and any reinvestments that we want to do from prior years' savings.
Madame Chair, I know I got the buzzer. I'll come back.
Good morning. Commissioner, I have a couple of questions. After I ask my questions, I'm going to leave to attend the funeral. I have others, but we'll talk later. We talk about the number of uninsured BILL 980003 - DEPT. OF PUBLIC HEALTH 871 BILL 980003 - DEPT. OF PUBLIC HEALTH people who are on the increase because of the cutoff in the welfare rolls. What impact will that have on the City? And have we seen a significant impact to date? COMMISSIONER RICHMAN: We are seeing -- can you hear me? Okay?
Thank you. COMMISSIONER RICHMAN: We are continuing to see significant increases for the uninsured. In Fiscal Year '96, the number of uninsured clients we saw was about 49 percent of the people who came to the district health centers. As of Fiscal Year '99, we're predicting that number to be 61 percent. That's a 30 percent increase in three years. The impact that it's having is to extend waiting times so that when people are calling for an appointment, rather than pretty reliably getting an appointment within three weeks, it is dropped to about 76 percent of the people get an appointment within three weeks. And that's for basic adult care. Pediatric care and prenatal care tend to be a little bit better, but they ultimately BILL 980003 - DEPT. OF PUBLIC HEALTH 872 BILL 980003 - DEPT. OF PUBLIC HEALTH will be affected. But it's the single adults that seem to be coming off the welfare rolls at this point that are being affected most dramatically.
Will we have to increase the staff at the health centers to deal with this increase? COMMISSIONER RICHMAN: If we wanted to impact the waiting time, we would need to hire more docs in the health care centers more specifically, and some of the support for those doctors, which would be the other staff. At this point, the budget request that we have to Council is to increase our hospital contracts and our pharmacy contracts primarily, which are ones that are impacted already by the increases we've already seen. So we have not at this point requested additional staffing for the health care centers.
Would the Chip Program cover the children? COMMISSIONER RICHMAN: The Chip Program will cover the children. But, again, with the Chip Program, one of the major issues is finding the children, getting them registered, and making BILL 980003 - DEPT. OF PUBLIC HEALTH 873 BILL 980003 - DEPT. OF PUBLIC HEALTH sure people know about the program. In those outreach efforts that are going on with the Chip Program, we usually find about 50 percent of the children are actually eligible for medical assistance, and 50 percent are eligible for Chip. But the Health Department is supporting efforts by both PCCY and Choice, which is a subcontracting agency, to help find those children and get them registered. But that will add revenue, yes.
I don't know if I'm reading this correctly, but in the budget, on page -- where is it? Page-something, I had it here. There was -- it seems to be a decrease in the number of MA enrollees for '99? COMMISSIONER RICHMAN: That's correct. As people come off medical assistance -- as they come off welfare and consequently in some cases as they come off medical assistance, we're anticipating a drop in medical assistance enrollees.
But will it BILL 980003 - DEPT. OF PUBLIC HEALTH 874 BILL 980003 - DEPT. OF PUBLIC HEALTH increase the uninsured? COMMISSIONER RICHMAN: In many cases, it will increase our uninsured. In some cases, obviously, some of these folks, as the ones who are working for CBH, will have full medical coverage. But that's probably more of an exception than a rule. As people go into their first job, as they transfer from Welfare-to-Work, many people, if not most, are not going into jobs that are paying them full health benefits for their families.
Which leads me to a question. I have the proposal here, the Welfare-to-Work proposal for the City of Philadelphia. And one of the areas they're concerned about is the number of people -- individuals who have mental, physical abuse and drug abuse, substance abuse. Are you tied in with this Welfare-to- Work Program in terms of the drug and alcohol program being upgraded or expanded to provide for the -- to cover this population? COMMISSIONER RICHMAN: Because this BILL 980003 - DEPT. OF PUBLIC HEALTH 875 BILL 980003 - DEPT. OF PUBLIC HEALTH particular population is still on welfare rolls, yes, we are involved. Most of these folks are members or will be members of CBH or they're receiving treatment -- or they can receive treatment through BHSI. The Health Department and CODAAP and the entire Behavioral Health System is preparing to screen about 40,000 people and looking at as many as 50 percent of those who will probably be requiring some level of drug and alcohol treatment. We believe that many of these folks are currently in the system, and many of them probably are currently -- or have currently received that treatment. So we are in the process of gearing up for that and are working with the Mayor's Office of Policy and Planning to try to prepare for this massive transition of folks by indeed looking at our delivery system and looking at our provider system preparing them. The problem -- the key point for us is making sure we have enough providers that understand the relationship of domestic violence as we do that counseling and substance abuse BILL 980003 - DEPT. OF PUBLIC HEALTH 876 BILL 980003 - DEPT. OF PUBLIC HEALTH treatment.
When the Partners for Progress go into a neighbor, such as they did in West Philadelphia with the drug sweep, are there facilities and resources for people who want to get long-term treatment? Are they available, and do we have enough facilities to provide long-term treatment? COMMISSIONER RICHMAN: At this point in time, we really -- it appears that we do. I hesitate a little bit because we haven't seen the massive number of people come in at the different points in time that we have anticipated. Certainly, when -- anytime anyone presents for a drug or alcohol treatment, they have to be screened with a State instrument, that is the Pennsylvania Client Placement Criteria, PCPC. And that tells us whether or not they need a long-term treatment, a short-term treatment, inpatient, community-based, what kind of treatment they need. At this point in time, we are managing to treat people who come and present for treatment. Now, if we get 20,000 new people or BILL 980003 - DEPT. OF PUBLIC HEALTH 877 BILL 980003 - DEPT. OF PUBLIC HEALTH 10,000 new people that we haven't seen before and that are brand-new into the system, I'm sure that will stress the system. But at this point, we haven't seen those kind of overwhelming numbers that we can't handle.
I notice you talked about the contract at the prison. How's that going? The health services contract. COMMISSIONER RICHMAN: The health services contract, our role -- we no longer, as the Health Department, hold that contract. The contract is held by the prison. What we do do is monitor the contract. So we monitor the contract for quality. And we send in DePaul, which is our quality assurance monitor, once a year to look at those services.
One other question. The Healthy Start Program, I know that it's in Northwest Philadelphia. Do you have any plans to expand that program to North Philadelphia? Certainly I understood there was some discussion, particularly to expand it to the Latino community. BILL 980003 - DEPT. OF PUBLIC HEALTH 878 BILL 980003 - DEPT. OF PUBLIC HEALTH COMMISSIONER RICHMAN: As you know, the Healthy Start Program itself is ending as a federally-funded demonstration project. The concepts within that program are lay home visiting and early identification within prenatal and are concepts we hope to continue. However, the general amount of dollars for maternal and child health in this City have decreased because of the ending of Healthy Start and the change in funding from the State. But let me have that addressed by Sue Lieberman.
Hi. I'm Susan Lieberman. I'm the Director of Maternal and Child Health. And we've lost in the past two years, counting the loss of federal funding for Healthy Start and some federal Title 5 block grant money, which comes through the State, close to $7 million, which is about 50 percent of our maternal and child health budget. So we are struggling to reassess what we have and to become more efficient. We've asked the managed care companies BILL 980003 - DEPT. OF PUBLIC HEALTH 879 BILL 980003 - DEPT. OF PUBLIC HEALTH to pick up what they acknowledge is their responsibility, and we've also looked at some different ways of delivering services. So we've moved from general outreach into education programs where we provide parenting skills, and we provide different kinds of education to groups. But $7 million is $7 million. And no 9 matter how mightily we try to make up the difference, we're not going to be able to make up the difference, even with different ways of providing the services.
The Healthy Start Program was a federally-funded program, and it was a demonstration project. I imagine at the end, there was an evaluation to determine the need for the program, but the federal government decided that there was no need for a Healthy Start Program? COMMISSIONER RICHMAN: I think that the federal government determined there was a need for the Healthy Start Programs, and it would be a good idea to continue them, but they declined to be the funder of them.
Typical, typical. BILL 980003 - DEPT. OF PUBLIC HEALTH 880 BILL 980003 - DEPT. OF PUBLIC HEALTH COMMISSIONER RICHMAN: And the last two years of the grant are spent in what are called "sustainability discussions." In other words, how can these grants be sustained without federal dollars. And one of the primary recommendations that came out of many of those discussions is the use of managed care or mandatory managed care, or MA managed care, to transition these programs or the concept of these programs into. When you look at the HealthChoices RFP and what the HMOs are mandated to do, many of those services are indeed there. The HMOs are being paid by the State to provide lay home visitation, transportation to and from clinics, nutritional and other counseling, and specific outreach to MA-enrolled clients, as well as all the EPSDT services that are normally requested and needed by infants. So many of the services are there. And if you were to ask the HMOs if they provide these services, they would all unequivocally say yes, they do. In our opinion, they do some of them, and they may not do them all BILL 980003 - DEPT. OF PUBLIC HEALTH 881 BILL 980003 - DEPT. OF PUBLIC HEALTH in the same way that we wanted to see them done within Healthy Start. And we continue to work with the HMOs, all four of the HMOs around these services, to make sure they're there. With our dollars, we've tried to target the most isolated, the most at-risk, and particularly the non-English speaking clients for the services that we do because they needed to be so much more intensified, and we didn't feel they were being reached as effectively as the more routine population. But, indeed, the federal government has said yes, it was a good service; yes, it met many of goals; but, no, they were not going to continue funding it.
One other question. Some time ago, years ago, one of the issues of the Health Department was the billing for services at the health centers. Do you now bill the HMOs for services? And if you do, how up to date are you in that billing? COMMISSIONER RICHMAN: At the time that was a discussion, it was shortly before, I think, BILL 980003 - DEPT. OF PUBLIC HEALTH 882 BILL 980003 - DEPT. OF PUBLIC HEALTH the current administration came in. The health centers did not actively bill the fee-for-service system in medical assistance, and neither did they have strong contracts with the HMOs. At this point, when we became a federally-qualified health center, we were able to begin billing the State fee-for-service system very effectively. And when we have transitioned now into Medicaid, we have contracts now with all four HMOs, and we're capitated by them, so those dollars come in on a very regular basis. So capitation means we're paid before the service. What hurt us the most, though, was in the transition from a voluntary system to a mandatory system. You may have heard in my testimony last year that the State misassigned many people, and we lost about a thousand clients at that point in time. And by the loss of those clients, it lost us about $1 million. So that was -- and we're still working with the State and with the benefits consultants to try to find out if many of those clients would like to return to the health care centers and any BILL 980003 - DEPT. OF PUBLIC HEALTH 883 BILL 980003 - DEPT. OF PUBLIC HEALTH other activities that we can do to increase the number of people using our health care centers that are currently part of the mandatory managed care system.
One final question, Madame Chair. Could you tell me if we have a good relationship with the landlords and correcting lead problems in the housing? COMMISSIONER RICHMAN: Oh, the Lead Program?
The Lead Program. I'm sorry, I went from one to the other. Here's my guy . COMMISSIONER RICHMAN: We are currently actually working very well with the people in the Lead Poisoning Program. I think there have been some major gains this year. And the task force that we're working through is a joint one with OHCD and the Health Department. And I'll have Rick update you on some of those positives.
My name is Richard Tobin. I'm the Director of the Childhood Lead Poisoning BILL 980003 - DEPT. OF PUBLIC HEALTH 884 BILL 980003 - DEPT. OF PUBLIC HEALTH Prevention Program. As Estelle has said, we are working very closely with landlords across the City in the task force. We have worked well with them in the past year. There are problems, of course, whenever you issue -- whenever you have an enforcement agency issuing orders, and there will be complaints. And I would ask anyone who gets them to please refer them to us directly. We are also working currently with the Commonwealth. The Commonwealth of Pennsylvania recently passed regulations requiring certification of abatement contractors and inspectors. This is going to change somewhat what is being done and how it has to be done in terms of remediating lead problems, but I think we can work through all of these issues very nicely.
What is the -- do we see a decrease, a decline in the number of families who are being threatened with eviction or evicted because they filed a complaint against a landlord for lead paint?
We seem to be seeing a BILL 980003 - DEPT. OF PUBLIC HEALTH 885 BILL 980003 - DEPT. OF PUBLIC HEALTH decline in that. We have set up procedures to enforce the Council regulations and to protect tenants in these cases. We also have a program working through the Office of Housing, which can provide money for private landlords who are renting properties. And there are HUD funds available to do some of the hazard remediation work in the form of forgivable loans and low-interest loans. And that seems to be working nicely.
Thank you, Madame Chair. Following up on Councilwoman Tasco's questioning, on Healthy Start. Ten years ago, we had probably one of the highest infant mortality rates in the country, north and east of Broad, Philadelphia. And we also had a very big one in West Philly. But, really, the problem that we had in Broad Street and in the African and the Latino communities were of third-world country BILL 980003 - DEPT. OF PUBLIC HEALTH 886 BILL 980003 - DEPT. OF PUBLIC HEALTH statistics. And it concerns me in terms of the cuts that we're having because, one, we didn't expand the Healthy Start into the rest of the City. And two, the HMOs are not picking that up in terms of the poorer communities. The third factor is the cuts that are coming down on welfare. And the people that will be left are the ones that will need the greatest need and will probably have the less education. So we are in a situation in which the greatest danger perhaps that children and infants will face in the City will be the lack of medical services. And I wonder what has been the progress during the last few years in reducing the infant mortality rate in terms of north and east of Broad, Philadelphia, and in the other parts of the City where we had the problem. COMMISSIONER RICHMAN: Let me start off by saying that the reduction in infant mortality actually happened in both parts of the City.
Right. COMMISSIONER RICHMAN: And part of the controversy about the success of Healthy Start is BILL 980003 - DEPT. OF PUBLIC HEALTH 887 BILL 980003 - DEPT. OF PUBLIC HEALTH that they didn't see a dramatic drop just in Philadelphia because there was a drop also in parts of North and Central Philadelphia also. So they said if there were a drop in both, the plan couldn't have been effective. In our opinion, there were drops in both. And part of the reason for the drop in Southwest Philadelphia, we think, was Healthy Start. And part of the drop we believe we saw in the North Philadelphia areas were because there was some active outreach by HMOs. We did have a Healthier Baby Initiative there, and there were drops there. Neither drop is sufficient. So I don't want to --
No, no, I understand that, because we had hearings with Dr. Clifford, and we had -- Council held hearings that dramatized that. And then the City began to put some more money into the health centers in terms of education. The Mom Mobiles came into being. What I wonder right now is -- because we just cannot say, Well, the federal government is not going to fund it, that we're just going to BILL 980003 - DEPT. OF PUBLIC HEALTH 888 BILL 980003 - DEPT. OF PUBLIC HEALTH leave infants and children in terms to essentially die and go back to a situation where we were ten years ago. And I'd like to see what it is that we're planning to begin taking care of the problem so that we don't slip back to our ten-year situation.
Hi. I'm Susan Lieberman, the Director of Maternal and Child Health. And some of what we've tried to do in this past year is also prepare for the end of Healthy Start by doing some different types of activities and by moving to some different kinds of services. So, for example, we have created for the Latino community -- we were one of the first partners in the Women's Center at Congreso. So we know that healthy women have healthy babies, and so we're also looking at extending the continuum to make sure that we have healthy women who can then have healthy pregnancies, who then can have healthy children. So we've looked at extending the BILL 980003 - DEPT. OF PUBLIC HEALTH 889 BILL 980003 - DEPT. OF PUBLIC HEALTH continuum in larger ways and for smaller amounts of money to serve that population. We have asked the Mom Mobile to keep at a hundred-percent-funded their outreach services to the Latino community. So we have looked at -- we've done a lot of educational materials in, actually, Puerto Rican. And what we've done is trained outreach workers to go and to do training. We've done a lot of sensitivity training, but --
What I'm asking -- we were -- we were in trouble ten years ago.
We have a problem right now in terms of funding -- the poverty population in Philadelphia has started decreasing. The problem will grow when the welfare reform has an impact. If we're cutting out Healthy Start and we didn't expand it to other areas of the City, and I know that we did have and we generally put forward a series of programs across the City that brought some prenatal postnatal education to the population. But if we're having all of these costs, BILL 980003 - DEPT. OF PUBLIC HEALTH 890 BILL 980003 - DEPT. OF PUBLIC HEALTH what is it that we're doing in terms of the health centers? And what are we doing in terms of the Health Department across the City and specifically in North and Central Philadelphia, where these statistics have always been higher, in order to begin programming for these cuts, so that in a year and two years from now, we're not here and we're taking about infant mortality rates that we have seen in the City because it is still high. And I'd like to have those statistics across the City to be sent to the Chair. But what are we doing in terms of programming or diverting funds? Or if CBH has that other funding that should be redirected, what are we doing in terms of putting some monies into programs that prevent us from sliding back to third-world figures? COMMISSIONER RICHMAN: Okay. Part of what -- in looking at the Healthy Start Grant, some of the things that we determined were most effective coming out of that grant were lay home visits and being able to visit mothers hours 24 after babies, they got home, and making sure those home-visiting teams stayed in contact for the BILL 980003 - DEPT. OF PUBLIC HEALTH 891 BILL 980003 - DEPT. OF PUBLIC HEALTH first year. We tried to make sure that mothers got back and forth to clinics. Everything that we did within Healthy Start didn't come out looking effective. We tried to narrow down what really worked and what really didn't work. The Mom Mobile was effective, lay home visiting was effective, transportation because many times, moms couldn't get to the clinic because there were other children or other factors. Getting them to the clinics for their prenatal visits was effective. Making sure there were appropriate nutritional counseling and nutrition in the home was effective. Many of these projects are in different formats, and we'll either continue to push the HMOs to do them or if we can do within the district health centers. We do say -- and one of my statistics was that we are at a hundred percent of seeing people who come into the district health centers who are coming in for prenatal visits within that three-week period of time. So we are encouraging and are also still putting money into Latino Mom Mobiles BILL 980003 - DEPT. OF PUBLIC HEALTH 892 BILL 980003 - DEPT. OF PUBLIC HEALTH specifically and in other North Philadelphia places to do the outreach. So many of those services still are being covered, but they're not being covered in the depth that they were originally, and we do track those numbers very carefully. And we'll be glad to share them with the Chair for every part of the City that we've been involved in, to make sure that don't get back to those infant mortality rates that we saw before. One of the criticisms of Healthy Start is that not all of the projects that were funded were as effective in reducing that rate. So it's looking at where the programs were effective and not trying to re-fund programs that the HMOs are currently being funded to do, but to work with the State and to work with the HMOs about making sure they do the job that they've already been paid to do.
Thank you. The Chair recognizes Councilwoman Blackwell.
Thank you, BILL 980003 - DEPT. OF PUBLIC HEALTH 893 BILL 980003 - DEPT. OF PUBLIC HEALTH Madame Chair. Commissioner, the Needle Exchange Program was listed, which we totally support. But if we have a community that doesn't want it -- COMMISSIONER RICHMAN: I'm sorry?
The Needle Exchange Program, if we have a community who doesn't want it, can we use those resources someplace else in the district who does? COMMISSIONER RICHMAN: If I get the question, if there are communities in the City who would not like a Needle Exchange Program and there are parts of the City who would very much like the Needle Exchange Program, can we shift some of the sites?
(Nods.) ASST. COMM. BENCIVENGO: Mark Bencivengo, Assistant Commissioner for CODAAP. The quick answer to your question is yes. In fact, we have worked with communities that are not supportive of the exchange, and we have made some moves there. And there are neighborhoods and communities that would like to see that. They BILL 980003 - DEPT. OF PUBLIC HEALTH 894 BILL 980003 - DEPT. OF PUBLIC HEALTH should certainly have some representative contact my office, contact me personally, and we'd be glad to have those discussions.
All right. I will be in touch with you. One of my captains has spoken with me. I'm sure he's been in a dialogue with the Department, but I will make that known to you. Commissioner, what's CBH's relationship to the Access Program? And I assume Access, due to their own funding source, would pay for whatever clients they have. Am I correct? COMMISSIONER RICHMAN: Let me have Deputy Commissioner Covone answer that. But while he's coming up the Access Program is another demonstration project of the federal government that does come to an end. Some parts of Access Program, not all of the dollars, but some of those dollars pay for case managers. For those dollars that pay for case management, that piece of it will probably be transitioned to CBH in terms case management. I'll let Mike address the rest of the program. BILL 980003 - DEPT. OF PUBLIC HEALTH 895 BILL 980003 - DEPT. OF PUBLIC HEALTH (Deputy Health Commissioner Mike Covone comes forward.) DEPT. COMM. COVONE: Mike Covone, Deputy Health Commissioner for Mental Health and Mental Retardation. As the Commissioner said, one of the advantages of CBH and having an integrated behavioral health system is the continuation that Access was a five-year program that ends, I guess, next summer. And we are going to be able to continue through Community Behavioral Health that case management component as a covered service and afford the sustainability there. We're going to look at the other components of that Access Program over the course of the next year to see if there are other components that can be transitioned on that as well. But the decision on that hasn't been made yet. COMMISSIONER RICHMAN: The reason that wouldn't fit so well is that the clients within Access are Medicaid-eligible clients, and the case management is an in-plan service that they would be doing anyhow. So it makes for a natural BILL 980003 - DEPT. OF PUBLIC HEALTH 896 BILL 980003 - DEPT. OF PUBLIC HEALTH movement between the two.
Thank you. The Philadelphia Child Guidance Center, we continue to hear rumors about them, and I know we need them, especially the residential component that they provide. Will that service be ongoing? And hopefully -- I just don't know what's going on with the organization, and I'm hoping that it will survive intact, but what do you hear about that? COMMISSIONER RICHMAN: Let me not talk too much for Child Guidance itself. But, as you know, Child Guidance as completed a merger with CHOP, and they're involved in some major changes right now, both programmatically and physically. And they did work with us around some of the format of those changes. And they have relocated their inpatient beds at the Kirkbride Center for the next year, I believe. And for their outpatient services, they are continuing to work. We are trying to keep an eye on them and make sure they survive these transitions. But we really do hope that they come up with a BILL 980003 - DEPT. OF PUBLIC HEALTH 897 BILL 980003 - DEPT. OF PUBLIC HEALTH stronger, more diverse, and more responsive program. And I've been assured by their leadership that that's their goal also.
All right. And, finally, I'm just reminding you, in terms of Mr. Bencivengo, to keep us updated in terms of that drug money that we've been fighting so hard about for clients who need these services, that money coming from the State. COMMISSIONER RICHMAN: The BHSI, Behavioral Health Special Initiative dollars?
Yes, the BHSI dollars. COMMISSIONER RICHMAN: Yes, we will keep you up to date on where we are with our negotiations on that. We still have concerns about Fiscal Year '99 and we will certainly make you aware as we hear more about the Governor's budget and where that seems to be going.
Finally, just a comment. The infant mortality issue, that was really, really severe in West and in Southwest Philly. I was just talking to Bernard Brown, BILL 980003 - DEPT. OF PUBLIC HEALTH 898 BILL 980003 - DEPT. OF PUBLIC HEALTH and we have people like Virginia Brown who are all so very, very committed in this area. And certainly, we just ask that you just continue to work with them too. And we don't want to lose the focus on our area, so that we continue to make a difference in terms of infant mortality. COMMISSIONER RICHMAN: The struggles with infant mortality, both in South and Southwest Philadelphia as well as in North Philadelphia have been fought, and the gains have been slow but steady. And we certainly don't want to lose any of those. So this will be an area that we will continue to work; whether it is continuing to sort of pound on the State government to work with the HMOs, but also to find some ways to make sure the investments we made in both areas aren't for naught and we can continue to decrease infant mortality and not see it rise again to those third-world levels where it was ten years ago.
Thank you. The BILL 980003 - DEPT. OF PUBLIC HEALTH 899 BILL 980003 - DEPT. OF PUBLIC HEALTH Chair recognizes Councilman DiCicco.
Thank you, Madame Chair. Good morning, Commissioner. COMMISSIONER RICHMAN: Good morning.
Before I get to my question, I would just like to take this opportunity to address the question that Councilwoman Blackwell referred to concerning the Needle Exchange. Your department has been extremely helpful in addressing some of the concerns that one of my neighborhoods in my district had as to the location of the Needle Exchange Program. They were not necessarily opposed to the Needle Exchange Program; it was the location which was in close proximity to a school and the district. And your Department has really helped me work through that process. I believe we've relocated the Exchange location, and everyone is happy, I'm glad to say. And, again, I want to publicly thank you for your cooperation. COMMISSIONER RICHMAN: Thank you. And we will continue. BILL 980003 - DEPT. OF PUBLIC HEALTH 900 BILL 980003 - DEPT. OF PUBLIC HEALTH
There are no numbers that I can find in this book when we get into the budget parts, so I'll try to describe where I am. It's the area that's -- the types of services that we're speaking to is HIV prevention, surveillance, and care services. And at the bottom of that page, HUD Construction Services as it relates to William Way Center. Again, there are no page numbers. I can't figure out where to get you. You could borrow this if you'd like. COMMISSIONER RICHMAN: Okay, I see it, yes.
There was $300,000 in '97, and I don't see any obligations for 1998. My question goes to: What is the HUD Construction Services? COMMISSIONER RICHMAN: This was actually money that was given to us on a grant through Senator Foglietta.
Congressman, Ambassador Foglietta, the former Councilman. COMMISSIONER RICHMAN: Former, thank BILL 980003 - DEPT. OF PUBLIC HEALTH 901 BILL 980003 - DEPT. OF PUBLIC HEALTH you. As a one-time grant for this specific purpose, let me see.
I'm Patricia Bass, Codirector of AACO. And the Commissioner's correct, that was one-time dollars that were allocated to the program.
Thank you. I mean, they do a wonderful job in the gay and lesbian community, and they're in need of additional funding for an elevator, which would really help their program. So I was looking to see if we can get some more money in it. I guess we'll have to speak to the next congressman in the First Congressional District. COMMISSIONER RICHMAN: Hopefully, the next congressman will be able to help.
Well, if it's who I think it's going to be, I certainly believe he will help us. COMMISSIONER RICHMAN: Okay, thank you.
The other question is the following page with the Ryan White Formula Services. Under that heading, there are a number BILL 980003 - DEPT. OF PUBLIC HEALTH 902 BILL 980003 - DEPT. OF PUBLIC HEALTH of agencies that provide outpatient health and support services and case management and comprehensive treatment services. My question is, there are about or 6 13 agencies that are performing that. Are they 7 selected through an RFP process? And why is it 8 there are so many of them? And I'm really getting 9 to one issue, it's the third one on the list, 10 South Jersey Council on AIDS. 11 COMMISSIONER RICHMAN: Okay. 12
Excuse me. Could you please pull the microphone closer to you because the stenographer is having difficulty hearing you.
As you probably know, the EMA for Philadelphia is for Philadelphia as well as the PA suburbs and the New Jersey suburbs. And so the South Jersey contract is, in fact, a contract that we are engaged in to provide BILL 980003 - DEPT. OF PUBLIC HEALTH 903 BILL 980003 - DEPT. OF PUBLIC HEALTH services in South Jersey. COMMISSIONER RICHMAN: "EMA" means "eligible metropolitan area." And Philadelphia receives funding for nine counties; five counties in Pennsylvania, and four counties in New Jersey. And Philadelphia controls funding for all nine counties.
Are there any City dollars -- COMMISSIONER RICHMAN: No. 12
-- involved in that at all? COMMISSIONER RICHMAN: No, no City dollars, no match. It's a hundred percent federal dollars, and it's called "The Ryan White Care Act," and Philadelphia receives it for the nine-county metropolitan area. Almost all of the dollars within Ryan White go to metropolitan areas. We are one of those metropolitan areas.
Okay. And the same would apply to the bottom of the page where it says "Supplemental Services?" It's the same thing? BILL 980003 - DEPT. OF PUBLIC HEALTH 904 BILL 980003 - DEPT. OF PUBLIC HEALTH COMMISSIONER RICHMAN: Right.
I'm not familiar with this. That's why I needed to know -- when I hear of firms outside of Philadelphia, I generally panic. COMMISSIONER RICHMAN: Right. Approximately 70 percent of the dollars are earmarked for the City of Philadelphia, percent 10 for the Pennsylvania suburbs, and 15 percent for 11 the New Jersey counties. 12
Again, my concern 13 was there was no City dollars, right? I want to 14 clarify that. 15 COMMISSIONER RICHMAN: No City dollars.
Okay, thank you. I have no further questions, Madame Chair.
Thank you. Commissioner, I'm going to sneak in a question. Do you mind, Councilman Nutter? I see you smiling. Can you tell me what guidelines exist concerning the placement of special-needs homes in residential communities? BILL 980003 - DEPT. OF PUBLIC HEALTH 905 BILL 980003 - DEPT. OF PUBLIC HEALTH I had written you a letter making such inquiry under date of February 10th. I never received a response. I had a member of my staff call your office on Friday, and I still have not received a response. I'm going to a meeting tonight, and I would like something in writing from you, if I may. COMMISSIONER RICHMAN: I apologize. I was out of town on Friday afternoon, and I did receive the message that your staff had called this morning. There is no City policy that governs strictly notification for residential programs. We do notify the Chief of Staff's Office at the point that someone is requesting to move in, and at that point, he will approve whether we should continue with the process or not. We have done that in this case. We notified that office that there is an agency that is looking for property in that particular area of the City. For the area that you are specifically asking about, the six clients in question BILL 980003 - DEPT. OF PUBLIC HEALTH 906 BILL 980003 - DEPT. OF PUBLIC HEALTH currently live in that area. In fact, they live about four or five blocks from the area they're going to move into. They have lived in the Korman Suites for about ten years. The agency's looking to build or construct --
Actually, there would be clients. 9 COMMISSIONER RICHMAN: I didn't -- are 10 there 12 clients? 11
Mm-hmm. That's 12 what the proposal's for. COMMISSIONER RICHMAN: Two homes, six clients each.
I thought there were four homes, three clients each. COMMISSIONER RICHMAN: Okay, sorry. I will let Mike answer. DEPT. COMM. COVONE: Mike Covone, Deputy Health Commissioner of Mental Health and Mental Retardation. I think, based on some of the feedback we have received and some of the discussions that we have had with the organization, that the grouping of the homes were only two on the particular street that were in BILL 980003 - DEPT. OF PUBLIC HEALTH 907 BILL 980003 - DEPT. OF PUBLIC HEALTH question last week and not four on -- I believe it was --
How many clients? DEPT. COMM. COVONE: Six clients. And I believe that's the information that we sent over to the Mayor's Office as well.
Well, once the Mayor's Office receives this information, what's the next step? DEPT. COMM. COVONE: It's generally just a notice to proceed. What they've been trying to do centrally is not to have various organizations within the City who are developing housing trip over one another so that mental health or mental retardation wouldn't be developing a home without some central clearing point, that also there could be an AIDS home being developed or a homeless facility on the same block. So they've tried to serve more as a central clearinghouse to notify departments that, did you know something else was in the same particular area? It hasn't been an approval process; it's more of a clearinghouse function BILL 980003 - DEPT. OF PUBLIC HEALTH 908 BILL 980003 - DEPT. OF PUBLIC HEALTH that they serve. COMMISSIONER RICHMAN: Evidently, there has been a lot of activity with the neighbors around this particular home and this particular site. We would be glad to provide to you all of the backup information about the meetings that have taken place and the current status of all of the activities currently going on with this particular residential site.
And when would you get me that information? The meeting is this evening. COMMISSIONER RICHMAN: I will get you that information today as soon as the hearing is over.
I'd appreciate that. The Chair recognizes Councilwoman Fernandez.
Thank you, Madame Chair. On of your testimony, there was a reference to a $200,000 additional amount of BILL 980003 - DEPT. OF PUBLIC HEALTH 909 BILL 980003 - DEPT. OF PUBLIC HEALTH money for the Animal Control Program, and it added that you have a new vendor contract. I couldn't figure out why we needed more. Like there were more rottweilers running wild or -- and why a new vendor contract would require additional money. Maybe I'm misreading it. DEPT. COMM. STEIKER: This is Ellen Steiker, Deputy Health Commissioner. Actually, in the FY '98 budget process, the Environmental Protection Division came to us and said the current vendor hasn't gotten an increase and is not covering costs. There was a negotiation, and the result was a two-year increase that, I believe, was about $500,000. I will get you the exact number. And it took place in two parts. This is the second of two years. But the idea was that this particular vendor couldn't provide its current level of services unless we increased its contracts, and we went through a negotiation process and did agree to some increases over a two-year period. COMMISSIONER RICHMAN: But this is not a new vendor. This is the same vendor we've had BILL 980003 - DEPT. OF PUBLIC HEALTH 910 BILL 980003 - DEPT. OF PUBLIC HEALTH for the past several years.
Who is that? COMMISSIONER RICHMAN: The SPCA. And basically, what they do is pick up stray animals, and we've had an ongoing contract with them. We have not upped the amount of that contract in several years. They said they had been losing money on it for several years and were willing to eat that cost and found that they could no longer do that and requested a fairly large increase. We were able to negotiate that we would do that increase with them over two years, and this is the second of the two years.
As long as they get all those rottweilers running around. COMMISSIONER RICHMAN: Yes.
The second issue is, you mentioned a lot about the Mom Mobile and said how important that is as one of the strategies to deal with -- in terms of reducing, you know, infants at risk and children at risk. I looked in the budget, and I was puzzled as to why in '97, 304,000, almost 305,000, BILL 980003 - DEPT. OF PUBLIC HEALTH 911 BILL 980003 - DEPT. OF PUBLIC HEALTH was spent. But now, it's only like 25. And I'm wondering, is there some additional money somewhere else? COMMISSIONER RICHMAN: Yes. As I look at it, we've moved money from -- the General Fund was funding it at 305. Next year, the Title 5 will be at 322,000.
Good, okay. And following up on the discussion of, you know, the funding from Healthy Start being cut back, and you said you're really trying to work with the HMOs, the four that have the contracts in the State. What kind of actual leverage do you have? I mean, is there anything more than gentle persuasion? Or who does really have a hammer over these HMOs if they don't produce the kind of -- essentially, I call them almost "softer services." It would be if someone comes bleeding to the hospital, you know, it's very evident. But if it's the kind of stuff that's more prevention and really doing the aggressive kind of outreach, it might be harder to track and monitor. BILL 980003 - DEPT. OF PUBLIC HEALTH 912 BILL 980003 - DEPT. OF PUBLIC HEALTH Who monitors? And then, what kind of hammer is there? COMMISSIONER RICHMAN: In fact, the Philadelphia Health Department doesn't have that level of leverage with the HMOs. What we do do is try to push them, to shove, to try to be not nice sometimes in terms of letting them understand that they have a contractual obligation to the State to provide these services. The State does have the responsibility to monitor the services and to monitor the contract. And these are all contractual services for the HMOs to provide for women who are receiving medical assistance. What we try to do is to push the HMOs as much as we can as well as help the State if people are not meeting what we feel are their contractual obligations. Some of the discussions -- and, obviously, we would like this to be as black and white as we can get it, and it probably isn't. The HMOs will say that they are providing these services; and, to some extent, they are. Are they providing them at the same level of depth BILL 980003 - DEPT. OF PUBLIC HEALTH 913 BILL 980003 - DEPT. OF PUBLIC HEALTH and breadth as we would like? We don't believe that. But we are continuing to try to work with them to let them know where we see the gaps, and to push them as much as we can with as many other advocacy groups as there are in the City in terms of service, what needs to be done, who's at risk, and where we think they're actually missing.
Thank you, Madame Chair. Commissioner, I'd like to go back to an area where Councilman Ortiz was. When we talk about the Healthy Start Program and some of the other projects that are grant-funded and then the funding drys up. I received this report last year. It's the "Annie Casey Foundation, City Kids Count" BILL 980003 - DEPT. OF PUBLIC HEALTH 914 BILL 980003 - DEPT. OF PUBLIC HEALTH report. I assume you're familiar with that? COMMISSIONER RICHMAN: No, I'm not.
Okay. Annie Casey does an annual report, apparently, on various data on the well-being of children in the 50 largest cities in the country. And you may not necessarily have answers right now, and that's okay. I'd like you to get back to us with some information. But in the most recent report done in 1997, in the category of percent low birth weight babies in 1994, Philadelphia ranked 43rd of the top cities of the country. In infant mortality rate, the City ranked 41st out of 50. In the percent of births where the mother who received late or no prenatal care in 1994, Philadelphia was 48 out of 50. In the percent of all births to females under age 18, in '94, the City ranked 40th out of the top 50 cities in the country. My question is: In light of either Healthy Start funds being cut or other potential funding cuts that affect us either at the State or federal level, what are we doing over time to get our numbers down in whatever anyone might consider BILL 980003 - DEPT. OF PUBLIC HEALTH 915 BILL 980003 - DEPT. OF PUBLIC HEALTH to be a more acceptable rate? Or at least out of the 40s, possibly into the 30s or the 20s of these top 50 cities across the country? COMMISSIONER RICHMAN: I'm not familiar with the report. Sue Lieberman is familiar with the report, so I'll have her address it.
I think one thing that I need to restate is that when we go from 11 million to 7 million, no matter how much we try to 12 do, we're not going to be able to make up that 13 difference. And we have looked at some other 14 sources of funding, we do have some grant requests. And some of what we're trying to do is use our current money more effectively and more efficiently and to leverage money in a better way. One of the things we've done is, this year, we've looked at smoking and pregnant women. And we know that one of the two highest causes of infant mortality really relates to pregnant women smoking. And we also know that programs that help pregnant women stop smoking are relatively cost- BILL 980003 - DEPT. OF PUBLIC HEALTH 916 BILL 980003 - DEPT. OF PUBLIC HEALTH effective. They already exist in this City. And so we try to work with managed care companies to say, you know, If you put some money into this and we will leverage some of our money, let's put together a systematic approach to try to help pregnant women cut down on their smoking because we know in the end, that's going to have a much better result. So some of what we're looking at is how can we take the money that we have and leverage it and use it to convince managed care companies to do some things and then to work with us. We've also looked at things like breast-feeding. We know breast feeding is going to have a very significant impact on the health of children and infants. And so we've also done some work to say to managed care and to actually cost out for them how much, if they promoted breast-feeding, it would help and how much money it would save. So we're looking at that kind of program.
Well, I guess my question is, do you believe that by looking at all of these programs or pursuing these various BILL 980003 - DEPT. OF PUBLIC HEALTH 917 BILL 980003 - DEPT. OF PUBLIC HEALTH efforts that in a fairly comprehensive fashion, all of those efforts will lead to better indicators over some time? I mean, what's the goal for next year or what's the goal over the next five years? Where is this going?
Well, I mean, I think part of where it's going is, hopefully, less babies dying. But as I've said, there's also some other indicators that I think are really important measures of health. And those are both women's health because, as I also said, if we had healthy women --
-- we would have healthy babies. Because healthy women who -- women who don't have high blood pressure when they get pregnant, women who don't have diabetes, women who are well nourished will have a much healthier pregnancy. And so part of what we want to look at is, how can we get those women into care and get them healthier so that when they get pregnant, they're going to have healthier infants. BILL 980003 - DEPT. OF PUBLIC HEALTH 918 BILL 980003 - DEPT. OF PUBLIC HEALTH One of the other things that we really want to look at is the other side of the continuum. Once we have a healthy baby, that we make sure that that baby stays healthy, so that we don't just say, Okay, well now we've had this healthy baby, and in two years, that baby will be back in the DHS system or in the mental health system or in some other system, in the emergency room, because we didn't do something for that baby. " It is for children who have some kind of health care need. But they're not the kids that DHS will see now, they're not the kids that managed care is going to see now. But they're those children that we all know that if we don't do something, they're going to be in the hospital emergency room or they're going to be in DHS in two years. And so what we've tried to do is put BILL 980003 - DEPT. OF PUBLIC HEALTH 919 BILL 980003 - DEPT. OF PUBLIC HEALTH some of our resources into those services so that we have prevention so that we're going to be bringing down the negative kinds of indicators. But it's going to take a little while. And, frankly, I mean, we can do a lot of group education because that's one of the things we've moved to now. We've moved to a lot of -- instead of doing a lot of in-home education, bringing women together on sites and doing group education. And we can do a lot. But, as I said, there's only so much that we can do with what we have. COMMISSIONER RICHMAN: Let me also add to that. Not only are we interested in making sure that the infant mortality rate not get any worse in this area, and that all those numbers in the 40s get into the 30s, these are also the primary areas that the State is tracking for the medical assistance clients here in Philadelphia and tracking the outcomes of the HMOs. This is one reason that gives them some impetus to work with us because we're both being judged on the same statistics. If those outcomes don't improve, then the State has to judge whether BILL 980003 - DEPT. OF PUBLIC HEALTH 920 BILL 980003 - DEPT. OF PUBLIC HEALTH or not they're doing their job with the capitation dollars they're receiving. Our focus with them is to make sure they know as much as we know about the research that we've been doing and the results from Healthy Start. We know that smoking is a cause, we know that no prenatal care is a cause, we know that not doing enough outreach to make sure we can connect with mothers with care is a cause. Once all those things are done and as we continue to monitor them, those numbers in the 40s should begin to get into the 30s. Certainly my long-term plan would be to very actively watch those outcome indicators and very actively see whether or not the programs we are investing in are making a difference. And if they aren't making a difference, being ready to change them and to continue to force both the State's hand and the hand of the managed care providers to make sure that they are also using their dollars in the most effective way. We chart that very carefully so that we are aware if the numbers aren't changing. We know right now, for example, that our immunization BILL 980003 - DEPT. OF PUBLIC HEALTH 921 BILL 980003 - DEPT. OF PUBLIC HEALTH numbers are going way up. That should have an impact. We know that both Annie Casey and several other foundations are willing to invest in Philadelphia to help us to continue to track these dollars and the outcomes of them.
You're welcome. The Chair recognizes Councilwoman Miller.
Thank you, Madame Chair. Good morning, Miss Richman. COMMISSIONER RICHMAN: Good morning.
I too just want to express my advocacy, interest, and support for funding regarding Healthy Start. And having worked for the former Chair of the Pennsylvania Health and Welfare Committee, then I know the influence and impact they can have on helping you to get what you need. I know things have changed now, but I just wanted to express that. COMMISSIONER RICHMAN: Thank you.
I'm going to ask BILL 980003 - DEPT. OF PUBLIC HEALTH 922 BILL 980003 - DEPT. OF PUBLIC HEALTH a couple questions regarding Health Center No. 9. And you and I have had this discussion once or twice. Health Center No. 9 is one of the oldest health centers in Philadelphia, but I don't think that this fiscal plan has been changed to keep up with the demand now, particularly with the number of uninsured patients that are coming there. And it's my understanding that they're serving more uninsured patients than any other health center in the City. And I know that there's a -- the Capital Office right now has an RFP out for the purpose of, I guess, planning design. And we're really glad that that's going on. I just wanted to talk about time lines or deadlines. COMMISSIONER RICHMAN: Okay. The two health centers that we're working on now are 2 and 10. And the renovations in those centers should be completed by July of '98. The two centers after that are 9 and 3. And, as you were told, that planning effort is going on now. You're also correct in that District BILL 980003 - DEPT. OF PUBLIC HEALTH 923 BILL 980003 - DEPT. OF PUBLIC HEALTH Health Center has a high portion of the uninsured. And, again, the uninsured tend to be working poor and not people on medical assistance. These are people who are actively working but don't have health insurance coverage and, therefore, use the district health centers as their base of health care. That's why the health centers were designed indeed. And they have seen an increase in that as more people have been taken either off medical assistance or, for whatever other reason, don't have appropriate health care. I will let the Deputy Commissioner address some of the time lines and other issues with the health center renovations. (Deputy Health Commissioner Michael Lucas comes forward.) DEPT. COMM. LUCAS: My name is Mike Lucas, Deputy Health Commissioner. As the Commissioner said, the next two centers which are under design and which expect to be completed by the end of this calendar year to mid this calendar year are Health Centers 3 and 9. Health Center 9's renovations are principally to BILL 980003 - DEPT. OF PUBLIC HEALTH 924 BILL 980003 - DEPT. OF PUBLIC HEALTH make it a better-looking center and a more functional center, concentrating on the first floor.
Okay, thank you. COMMISSIONER RICHMAN: And it's expected to be completed in August or September of '98, so within this calendar year.
Okay, good. Also regarding Health Center 9, I understand that there are some vacant staffing -- we want to talk about staffing. There's some vacant positions that haven't been filled in more than two years? DEPT. COMM. LUCAS: At any given time, there will be vacancies at each of the health care centers. Each of the health care centers have a particular staffing level. If Health Center 9 is down two or three staff members, which I believe they are right at this point, it's simply a result of the positions being tested for and hired within the City's civil service system. The two or three which I think you're probably referring to are expected to be filled within the next month or two months. BILL 980003 - DEPT. OF PUBLIC HEALTH 925 BILL 980003 - DEPT. OF PUBLIC HEALTH
Okay. One other question regarding the way that the community advisory boards operate with the Department. It's my understand that the community advisory boards are to be a part of the budget planning process, and they have an authority to approve budgets. It sounds like -- well, first of all, is that true, due to legislation? Can you explain the actual role the community advisory board has as it regards to the budget, budget approval? DEPT. COMM. LUCAS: Certainly. As the Commissioner said earlier, the health care centers became federally-qualified health centers in 1993. And one of the stipulations to become an FQHC was to have a community board. The community board has a variety of responsibilities, but if you look at the bylaws of the board and the memorandum of understanding, which we would be happy to provide to you, there are two items in which the City cannot relinquish responsibility: that is in financial matters and in personnel matters. There are civil service and other budgetary matters which supercede the BILL 980003 - DEPT. OF PUBLIC HEALTH 926 BILL 980003 - DEPT. OF PUBLIC HEALTH responsibility of the board. That is clear in the memorandum of understanding and the bylaws, which we can make available.
Okay, I'd like that, plus I think the community boards need that information to be really clear on it. COMMISSIONER RICHMAN: We will try to clarify it. I know that the boards themselves have been told that they don't have fiduciary responsibility, and they don't have responsibility for personnel, but I think sometimes the boards feel that so much of the activity relates around those two things, that they would like to have input on that. But we will explain it to them again and try to make it clear as possible.
Okay, I have one other question. In my district, and it probably will be happening in other districts too, we seem to have an influx of blackbirds. People were calling my office -- calling lots of places, saying they felt like they were in Alfred Hitchcock's movie "The Birds." The birds were everywhere, in trees. And it was -- this year, it was unlike past years. BILL 980003 - DEPT. OF PUBLIC HEALTH 927 BILL 980003 - DEPT. OF PUBLIC HEALTH Did you get any other calls? I was driving through North Philadelphia one day and I saw this same situation, birds lined up on the telephone wires, like hundreds in a tree, which is something very unusual. COMMISSIONER RICHMAN: I am not aware of an influx of blackbirds at this point. However, we will investigate and get back to you as to whether --
You know, I'm very serious. The people were very scared. The first time we got the first couple calls, we sort of sat back and said, Oh, well, we have these birds, but then we had more and more people talk about the birds flying around in flocks and messing up streets and all kinds of things. Okay, that's the only questions I have so far. Thank you.
During a previous session, Commissioner, I raised with you the question of what it would take to give all Philadelphians minimal but adequate health care BILL 980003 - DEPT. OF PUBLIC HEALTH 928 BILL 980003 - DEPT. OF PUBLIC HEALTH and as to how it kind of would be structured and what the cost would be. COMMISSIONER RICHMAN: Yes.
Have you been able to do anything on that? COMMISSIONER RICHMAN. Yes. I guess I'm a little surprised you haven't received that correspondence yet, but we have been able to do that, yes.
And are your conclusions going to be in writing or oral? COMMISSIONER RICHMAN: Yes, the conclusions are in writing, and we give you a range of different kinds of insurance and what we thought the costs would be. In other words, the per capita rate can vary between the very minimum to a little bit more than that. And we did give you a range of dollars that would cover the uninsured. The hardest part of that exercise, actually, was trying to get a basis of what is the percentage of uninsured in Philadelphia. We reached out to several national research organizations and basically came in with a BILL 980003 - DEPT. OF PUBLIC HEALTH 929 BILL 980003 - DEPT. OF PUBLIC HEALTH percentage of somewhere between and percent of people in Philadelphia are uninsured.
Well, I don't want 5 to put the President of the United States in an 6 embarrassing position, but his Saturday radio 7 address, I think, probably went beyond my request 8 in his Saturday address. And I would like to 9 suggest that my question be tailored to fit in 10 with the President's. 11 He said, as I think everybody knows by 12 now, that there are intolerable differences that 13 exist between the health care of whites, blacks, 14 Native Americans, Hispanics. And he set forth the 15 need over a ten-year program. 16 In my impetuosity, I would like to have 17 it cut to five years, but maybe ten years allows a little more, you know, working time. He said that that difference has to be eliminated. Now, tailoring my question to that presented by the President, how in Philadelphia do we guarantee that all Philadelphians, regardless of their background, receive adequate, affordable health care -- whatever that may mean, based upon their economic circumstances, but adequate health BILL 980003 - DEPT. OF PUBLIC HEALTH 930 BILL 980003 - DEPT. OF PUBLIC HEALTH care? And so, therefore, I suggest, as you're putting together the final thoughts, you try to tailor what would a Philadelphia model be of that because that's essentially the same question that I've raised. I think it's intolerable that in the United States, we ought to be satisfied with adopting City policies. I understand the imperatives that push us in that direction, but we have City policies that help put people on the streets of Philadelphia, that counter other efforts to take people off the streets. And we excuse it on the grounds of finance, and I would suggest that finances cannot be any reason in the United States for permitting any differentiation in the adequacy of the health care of each Philadelphian or each American ought to receive. And I think you would probably agree and you're working toward that end. But could we have a model for Philadelphia presented? Or would your answer fit that category? COMMISSIONER RICHMAN: We will try to BILL 980003 - DEPT. OF PUBLIC HEALTH 931 BILL 980003 - DEPT. OF PUBLIC HEALTH make sure our answer fits the scope of your question. And since we've already started it, we will continue to develop the model we have now and try to address those types of individual differences.
Because there's going to be federal money that will be coming, you know, to those groups that are prepared to adopt the President's model, and I think we ought to be ready to advance that and to be the first major city which can really boast about the health care of its citizens. Thank you, Madame President.
You're welcome, Councilman. The Chair recognizes Councilwoman Fernandez.
Thank you, Madame Chair. Despite all the tough questions you've gotten -- maybe it's because the Health Department is such a large and important department -- I just wanted to end by saying that you and all of your staff deserve an incredible amount of credit for BILL 980003 - DEPT. OF PUBLIC HEALTH 932 BILL 980003 - DEPT. OF PUBLIC HEALTH all that you have done, having dramatically increased child immunization, having what's described as the most effective lead poisoning prevention program in the country, for all you've done to improve the quality of care at health centers, including having evening and weekend hours at least in one. And the child care facilities for parents as they wait for their kids, I think that's a great addition, and then all of the progress you've made in terms of reducing infant mortality and low-weight babies, not to mention CBH. And I noted in your testimony that there was one other good indicator that you may or may not be responsible for, and that was having our air quality be improving. And I'm wondering, what do you feel the Health Department's been doing to improve the air quality? COMMISSIONER RICHMAN: Actually, we do have -- air management is a main part of the Health Department. John will describe that. But we've also been very active in working to identify those places that are BILL 980003 - DEPT. OF PUBLIC HEALTH 933 BILL 980003 - DEPT. OF PUBLIC HEALTH violating our Air Management Act and to try to stay on top of any of the discharges to the air that would endanger our health. DEPT. COMM. DOMZALSKY: I'm John Domzalsky, Deputy Health Commissioner. The Commissioner is correct. A large part of the improvements in our air quality, particularly going for the number of poor-quality to good-quality air days which, incidentally, is reported daily in the weather section of The Philadelphia Inquirer. And through using our air-monitoring data, which --
The Philadelphia Inquirer and The Daily News or just The Inquirer? DEPT. COMM. DOMZALSKY: And the Daily News. And a large part of that has to do with our implementing at the local level all of the provisions of the Federal Clean Air Act and working closely with our industry to ensure compliance with those regulations.
So it's not just an El Nino effect? BILL 980003 - DEPT. OF PUBLIC HEALTH 934 BILL 980003 - DEPT. OF PUBLIC HEALTH DEPT. COMM. DOMZALSKY: (Laughs.)
Okay, thanks again for your good work, and continue the careful monitoring. Thank you, Madame Chair.
Are there any other questions or comments from Members of the Committee? (No further questions or comments at this time.)
At this point, I would simply like to invite Mr. Covone into my office before he leaves the building. Thank you. Thank you very much, Commissioner. COMMISSIONER RICHMAN: Thank you. - - - (Council President returns to the Chair.)
May I have your attention, please. Office of Emergency Shelter Services, Office of Emergency Shelter Services. (Members of Panel from Office of Emergency Shelter Services come forward.) BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 935 BILL 980003 - OFF. EMERGENCY SHELTER SVCS.
Good morning. Please identify yourself for the record, and proceed with the summary of your statement. DEPT. DIR. NARDONE: Good morning, Council President Street and Members of City Council. My name is Michael Nardone, and I am the Deputy Managing Director for Special Needs Housing. I am joined today by Sally Fisher, Acting Director of the Office of Emergency Shelter and Services; and Richard Shaeffer, Administrative Services Director of OESS. I'm pleased to offer this testimony on the homeless services budget request for FY '99 and the significant challenges that lie ahead. 7 represents grant revenue funds. I do not need to tell you that there is perhaps no other problem as complex and challenging as homelessness. And the numbers who are homeless or at risk of being homeless threatens to increase with the enactment of a BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 936 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. series of welfare reductions affecting thousands of victims and families throughout this City. At the same time, we have witnessed a reduction in resources available to Philadelphia from federal and State governments for emergency shelter and services. 4 million reduction in federal and State assistance. Despite an FY '98 increase in homeless assistance funds, the amount of State and federal support remains significantly below prior year levels. Unfortunately, despite the real human impact of these external funding decisions, the City is not in a position to replace dollar-for- dollar cuts imposed at federal and State levels; nor can the City allow decision-makers in Harrisburg and Washington to walk away from their responsibilities and shift costs to City government. As a result, for the past two years, the Administration has made the extremely difficult decision of imposing shelter restrictions to ensure sufficient resources to provide shelter beds during the winter months. BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 937 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. Even with these restrictions, the Administration has had to come before Council to seek additional funds to cover emergency shelter costs. 3 million requested for OESS in FY '99 will support 2,150 year-round shelter beds, with an additional 100 children's beds supported through the Department of Human Services. We received some good news in December when HUD announced restoration of 828,000 in federal dollars for emergency shelter under the McKinney Homeless Assistance Act. These dollars reverse prior-year federal reductions and will support an average of 300 winter beds, freeing up resources to allow for an increase in year-round shelter beds from this year's level of 1950. And, fortunately, while Washington has decided to reverse past funding reductions, the Governor's budget does not take a similar step. For FY '99, the Governor proposes only a 2 percent increase for the Homeless Assistance Program, an increase of approximately $136,000 in HAP funds over this year's level. While any increase is obviously appreciated, this proposal still leaves the City BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 938 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. $700,000 to $1 million short, compared to prior- year levels. It also falls far short, given the potential fiscal impact which welfare may have on the homeless service system. The Administration has chosen to direct the limited new resources at our disposal to increase the number of shelter beds rather than undertake new initiatives in the FY '99 budget. At the same time, we have taken great pains not to drain resources from other critical ongoing investments in the homeless continuum of care; for example, homeless prevention.
But the State's failure to step up to the plate and provide sufficient assistance to fund homeless services likely means that we will again be required to impose some manner of restriction as we prepare to enter the next fiscal year; unless, we of course, are able to -- unless we are successful in persuading the State to provide additional assistance. But the news is not all bleak. The inclusion of $3 billion in federal Welfare-to-Work dollars in the 1997 Balanced Budget Act will help to mitigate some of the impacts of welfare BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 939 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. reform. Philadelphia expects to receive some $50 million over the next two years to help TANF recipients move successfully into work. As the Administration develops its plan, I have been working to ensure that TANF recipients residing in shelters and transitional housing receive priority for service within components of the Welfare-to-Work Program. We are we are also exploring enhanced case management, life skills, job preparation, and computer-literacy training, including development of shelter-based computer labs for TANF recipients in the homeless service system. OESS is complementing the Welfare-to- Work initiative with a major employment and training initiative targeted primarily at non-TANF recipients who will not benefit from the new Welfare-to-Work funds. With the help of FY '98 and proposed FY '99 general funds as well as dollars recently made available by the Private Industry Council, we hope to be able to support at least a million- dollar program over the next 15 months, devoted to the employment training needs of these recipients. BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 940 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. These initiatives will not fully counter the impact of welfare reform. However, it is the Administration's goal to use those dollars as efficiently as we can to assist those within the homeless service system achieve independence and economic self sufficiency. We are also working hard on a number of other fronts to improve the continuum of services provided to homeless individuals and families. With the appropriation of an additional 250,000 in General Funds, the Administration has been able to significantly expand and revamp the City's homeless prevention efforts. Beginning in FY '98, OHCD will contract with two nonprofit organizations to provide community-based prevention services, including cash assistance for delinquent rent and utility payments, case management, and employment assistance to households at risk of becoming homeless. The Members of City Council deserve a great deal of credit for their support of this expanded homeless prevention program. Our success is attracting federal dollars for housing BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 941 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. developments and support services for homeless individuals also continued this year. 1 million in 8 the previous fiscal year. 9 All told, these projects will support 10 about 220 housing units, serving approximately 550 11 homeless individuals and families. They are in 12 addition to the estimated 380 housing units in the 13 pipeline which may be completed at the end of the current calendar year. Finally, in collaboration with Community Behavioral Health, the Administration is putting in place, as part of this year's winter bed initiative, a set of new services targeted at homeless men and women with serious mental illness who require on-site mental health support and are not adequately served in the typical housing shelter setting. Despite the significant strides we are making, however, there is little doubt that difficult days lie ahead. A big part of the BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 942 BILL 980003 - OFF. EMERGENCY SHELTER SVCS.
Administration's legislative agenda will include advocacy aimed at increasing support for homeless services and plugging some of the gaping holes created in the social safety net. Though a relative newcomer to City government, I am well aware of the hard work done by the Members of City Council under Council President Street and the Mayor to restore the economic health and welfare of the City. Among your many accomplishments, you have helped this Administration develop a range of services for homeless individuals and families that seek to transition them to independence and self-sufficiency. However, the impending impact of welfare reform threatens to unravel much of the progress made over the last several years. In light of our limited resources, we must work together, building on the opportunities at hand to mitigate the serious human consequences that welfare reform may entail for the City. Thank you very much for this opportunity to testify, and I'd be pleased to answer any questions you may have.
The Chair recognizes BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 943 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. Councilwoman Blackwell. I'm sorry. Oh, Councilman Cohen, I'm sorry. I thought it was Councilwoman Blackwell's light; it was Councilman Cohen's. The Chair recognizes Councilman Cohen.
Mr. Nardone, I read your statement, and it looks kind of warm and friendly, and then I go back a second and a third time, and I'm not sure that the sentences are quite as clear and the paragraphs have as much meaning as I first thought or maybe hoped they had. So let me start. First I read in the first paragraph, "As presented to Council, the proposed FY '99 budget for the Office of Emergency Shelter and Services is $29,300,000 roughly, of which 12-1/2 million represent City General Fund dollars, and over 16-1/2 million represent Grant Revenue funds." And then I go to your last page, which contains the operating budget of the City, and I'm looking for where I am going to find this 29 million or at least the 12-1/2 million representing City General Fund dollars. And all I BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 944 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. can find is a statement which talks, at the most, about $4 million. And I wonder, do I have a defective copy? Or, if I don't have a defective copy, is there some other explanation? DEPT. DIR. NARDONE: Well, I think the -- I don't know if the number you're referring to is the service-level statement that's at the back of --
I'm referring to what is furnished to us. DEPT. DIR. NARDONE: Right. The $4 million that I think you're referring to is a service level related to meals. But in terms of the --
Is there any other document I should have? Am I missing a or. . . DEPT. DIR. NARDONE: There is a budget number that I could make --
I have an eightwritten statement. DEPT. DIR. NARDONE: Right.
And I have one BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 945 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. single page with the front and back having budget figures on them. Now, am I short on that? DEPT. DIR. NARDONE: Yes. I think that we need to make sure you have the budget numbers and --
No, no, I'm only talking about what was distributed to us as your advanced statement; I'm not talking about the other budget books. Do I have the completed statement that you had distributed? DEPT. DIR. NARDONE: That is the complete package that I distributed.
Well, then, can you tell us -- you know, I had trouble understanding. I've never felt that the City, considering all the funds, ever invested anything like $30 million in shelters, but it's a hopeful sign that maybe we are taking it seriously. And then when I look for the confirmation of it, I come up with $4 million. DEPT. DIR. NARDONE: The $29.3 million in the statement refers to both City general funds and grant revenue funds. And the amount of -- I apologize that BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 946 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. you don't have -- that we haven't provided the information that we need to, but the amount of General Fund dollars is $12.6 million, and the amount of anticipated grant fund revenues is 16.7. And those are the numbers that --
Why did you furnish us only with the budget document showing $4 million? DEPT. DIR. NARDONE: Those -- my understanding -- what the testimony -- what's affixed to the testimony are the service-level impact numbers. And I was -- I thought -- and that was the package in addition to the testimony that I was provided.
I'm having a great trouble understanding. DEPT. DIR. NARDONE: I'm sorry. The service --
Can you furnish the source? DEPT. DIR. NARDONE: I think it's been the practice -- I'm new to City government. But it's under my -- I understand that the package that we usually provide includes both the overall BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 947 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. statement as well as there's been a practice of providing the service-level impact statements. And that's what that two-page document is. It's not an attempt to -- it's not an attempt to give you the budget numbers; it's an attempt to provide you with some indication of service levels through the Office of Emergency Shelter and Services.
Well, basically, the reason I raised those was, my staff member working on budget matters for me is indicating to me what is contained in the regular book furnished to us. But, generally, these statements are supporting statements by the officers in charge of the department, that when they give us budgetary material, they give it to support what's in their written statement. And I'm suggesting that I find it difficult to deal with that. And I'm troubled because I'm worried about these shelter restrictions. I worry about beautiful language like "shelter protocols," which you use in this statement, giving a kind of dignity to the concept of forcing people to sleep out on the streets of Philadelphia. I find that a BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 948 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. very undignified thought, people sleeping on sidewalks. But, you know, shelter restriction, shelter protocols sound as if it's a really humane approach, when I find it to be a very inhumane approach. That's the reason I'm raising the question. And then to talk in terms of these large sums of money supported by documents which show anywhere from 1/3 to 1/6 or 1/7 of the amount of money you say is very troubling. Let me go on to another statement of yours that I find very difficult. On , you talk about the federal funds provided through the HUD Initiative Cities Grant and some other things. Your office, which, you know, now operates -- you weren't there at the time -- placed more than 475 homeless clients into full- or part-time employment. Let me ask you, how many of those folks are still employed now? DEPT. DIR. NARDONE: I do not have -- I'd be happy to provide that information to you. I don't have that available right now, but I'd be BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 949 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. happy to provide that for you.
All right. In a fashion so that we could check it out? DEPT. DIR. NARDONE: Certainly.
Because my experience over the years is that by this time, if the job promises we were told every time we participate in giveaways to businesses at various levels, this City would be teaming with maybe 2 million more additional workers, and our population would be maybe closer to 3-1/2 million instead of 1-1/2 million. So I'm very suspicious of these numbers, and I would really like to be able to track them down. DEPT. DIR. NARDONE: There's no 18 question that particularly with the population and the efforts that we've garnered away, that it's very difficult to continue employment over a period of time. One of the things that we're trying to do with the new initiative or the expanded initiative that we're putting in place is to track very carefully what are the results after six BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 950 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. months and one year of time.
Well, we would like to see it so we could know what it means. If you have, in fact, placed meaningful jobs with income sufficient to support a small family, and jobs have a major permanency, say a year or more, we can understand that. But we're told by suburban employers that they're very lucky if out of ten referrals at the end of six months, if one still remains working with them, for a lot of different reasons none of which I attribute to the fault on the hands of the people running the program. There are just economic problems that exist: transportation problems that exist, levels of skill problems that exist. But we'd like to be able to, you know, weight these figures in a meaningful way and see if it's 475 that got jobs, and three weeks later, after each one got a job, they were no longer working, that kind of thing. Thank you, Mr. President. And I'd like to pass this round and continue on the next round.
Thank you very much. BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 951 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. The Chair recognizes Councilman Nutter.
Thank you, Mr. President. Mr. Nardone, I just really have one question. I've read through the testimony. And in light of the recent announcement by the City Administration, I was somewhat surprised that there was no mention of the potential impact of the elimination of the homeless preference at PHA in the Section 8 Program and what impact that might have on your agency, which, I assume there would be an impact on your agency. But in the eight pages of testimony, there's no mention made of that. DEPT. DIR. NARDONE: You're correct, there is no mention in the statement about the Section 8 policy. One of the things that -- although the homeless preference is eliminated, the --
Has it actually been eliminated? DEPT. DIR. NARDONE: No, I believe it has to go before the PHA Board, and I'm joined by John Kromer, who might be able to provide some BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 952 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. additional details in that regard.
Okay. DEPT. DIR. NARDONE: But one of the things that that policy envisions is not the elimination of the homeless preference -- I mean, it envisions the elimination of the homeless preference, but that does not mean that no 9 homeless families will receive Section 8s. What it means is that there will be an allocation process put in place between Tier 1 and Tier 2, the Tier 1 being those who are homeless or who also -- there are also a number of other categories in that, but primarily, that's the homeless category. The intent of that is to have some flexibility in terms of the allocation of those units so that we can closely monitor what is the impact on the system and, therefore, rearrange policies as we proceed forward if we are seeing an impact. We also continue our investments with respect to transitional housing and also -- that are presently in place, which we will be able to move some of the folks out of the shelter into the BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 953 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. traditional housing units. And, John, I don't know if you have any additional -- (John Kromer comes forward.)
Yes, I'm John Kromer, Director of the Office of Housing and Community Development. Just three points which may be helpful. First, the Mayor has asked his staff to draft a resolution for the PHA Board to consider. The homeless preference has not yet been ended, but a resolution is being drafted for consideration by the Board. Secondly, it's not yet clear how much of an impact that change might have because an assessment has not yet been completed of the availability of Section 8s during the coming fiscal year. Last year, our understanding and the Housing Authority's understanding was that Section 22 8 certificates would be very scarce. And then, without warning, the Housing Authority had several hundred new certificates made available by the federal government. So that assessment needs to BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 954 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. be completed. And then, finally, the resolution, if enacted by the Board, would give the Board discretion to allocate between Tier and Tier preferences. And I just wanted to say that the families in the Tier 2 category are not middle- class families. These are people that are seen every day by the Tenants Action Group and the Tenants Rental Assistance Corporation, people that are just hanging in there. And part of the purpose of this change would be to provide support to those families as a way of preventing homelessness and preventing them from entering the shelter system in the first place.
Well, let me go back to my original question. Are you anticipating any impact on OESS as a result of the proposed change in policy? DEPT. DIR. NARDONE: It's very difficult to answer that question because I think that it's difficult to know with a great deal of certainly, first of all, how many Section 8 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 955 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. certificates will be available in the upcoming year to begin with.
Well, I understand that. I mean, that may be, you know, one of the great questions of the universe. But if we go by past history, there was a homeless preference in the Section 8 Program, and if that means that homeless people had a preference for the certificates and therefore they were getting them and moving into neighborhoods and subsequently, at least by some accounts, causing great havoc throughout the City, which is not particularly a view shared by myself, but that's another argument for a different day. If homeless people were getting the certificates, and if the policy is changed so that they won't, or that there's no preference, what happens?
It's not clear at this point whether that change would have any impact at all on the system. For every Tier person who does not receive a certificate, there may become available a Tier 2 household that is helped maybe prevented from entering the system in the first BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 956 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. place. It really is too early to tell, but there may be no impact at all on the system.
Well, you know, one, I find that hard to believe but, you know, we'll see what happens. Mr. Nardone, is it correct that your office provides a variety of social services to people while they're in your care or in your custody? DEPT. DIR. NARDONE: That is correct.
And is it also true that if a person leaves the system, should they, under the current policy, be fortune enough to get a Section 8 certificate, do they then lose those services? DEPT. DIR. NARDONE: The services -- we have so many families that fill in the gap behind them, that basically the services do not follow the families into Section 8 housing, that's correct. One of the things, however, that --
Is that a financial question, is that a policy question? And why BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 957 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. wouldn't the services follow the person? They didn't all of a sudden have some epiphany and everything just got better for them, did they? DEPT. DIR. NARDONE: I mean, there is -- I mean, there is -- I mean, there is the need to continue services to folks in Section 8 housing. And the policy that the Mayor's Office has released tries to address that issue through the provision of some $1 million in support services funds to folks moving into Section 8 housing.
IS this the million dollars coming off of the Section 8 administrative fees -- DEPT. DIR. NARDONE: Yes.
How would it be funded? DEPT. DIR. NARDONE: We do -- there are -- in addition, there are -- one of the things we have added under John's direction is support services that follow individuals into traditional BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 958 BILL 980003 - OFF. EMERGENCY SHELTER SVCS. housing as well as people who are leaving the shelter to move to transitional housing. And we do have a pilot program that's in place when individuals and families move from transitional housing to Section 8, that the services do follow the clients. But we need to do a much better job, I think, in providing social services to individuals in Section 8 housing.
Okay. Well, to the extent that you can keep us informed should there be a change in policy, what you think the impact may be or at that point in time is, I think all of us would greatly appreciate it. And I guess lastly on that same point, I'd like to get that information prior to what I anticipate will be your appearance before us in about six to nine months for transfer ordinance 19 for OESS as a result of the impact on your department. DEPT. DIR. NARDONE: Yes, Councilman.
Thank you very much. The Chair recognizes Councilman Kenney. BILL 980003 - OFF. EMERGENCY SHELTER SVCS. 959 BILL 980003 - OFF. EMERGENCY SHELTER SVCS.