That probably is the most important thing that people want to do.
How well are you managed?
In your experience, how important is it for the senior management team to have a strong background and a track record with a substance use disorder residential facilities before they launch a brand new facility?
So residential facilities are one of the more complex of all the facilities that you can operate. So you do need the expertise. I mean, you can go online and Google what a residential program is. That would not give you the ability to run such a complex operation.
Let's focus on the specific proposed substance use disorder residential treatment center at 508 Moore Street.
Right. What kind of specific what specific kind of facility is being proposed here?
They're proposing a three one, which is is in in Pennsylvania would be considered a halfway house, halfway house, meaning it's a non-hospital residential treatment facility licensed as a treatment facility, but also has the ability to allow people to go to work on a daily daily basis or go to school.
And it's for people who have been stabilized to the point where they can leave the facility and get back to the facility without harming themselves or others.
So when you say in Pennsylvania, it's called a halfway house, is that because Pennsylvania designates these facilities with different names or different codes than other states?
So up until about three to four years ago, Pennsylvania had its own state criteria.
We were the first state in the nation to actually fund through Medicaid the residential treatment.
So they had their own standards.
And then about three years ago, they crosswalked that with ASAM, which is the American Society of Addiction Medicine.
So there's a transition. And what the state did is a crosswalk to show how their past past licensing standards, which haven't been changed. So you got to know that these are licensing standards that have been there for a very long time. And then what they did is they crosswalked into it to use ASAM, which is really a placement criteria. It's not necessarily licensing criteria at all. So the licenses in Pennsylvania are different than they are in other states.
Okay. We've also heard the number 3.5 for a facility. What is the difference between a 3.1 facility and a 3.5 facility?
Yeah, it's an intensive facility.
Mr. Chairman, I will have to object to that because our application, we've always stated 3.1. That's the project that we're proposing.
Well, Mr. Chair, at the community meeting that the applicants attended, Mr. Bovey was not at this particular community meeting, but I was there.
And there was discussion of the potential for this to be operated as a 3.5 if they weren't able to successfully operate as a 3.1.
So I wanted to put that in the record.
Okay. So subsequently, we sat down with the councilman and our community benefits agreement says no more than a 3.1.
Okay, good. I would say I'm going to allow the question and see what the expert would response.
So the license for a 3.1 and a 3.5 in Pennsylvania are the same, so you know.
So they are the same.
They are both non-hospital residential treatment facilities.
So they have the same licensing.
So the 3.1 and the 3.5 are different in regards to the types of clients that they take.
Is that helpful?
Well, when you say it's different with the type of clients,
Well, when you say it's different with the type of clients, is there different levels of care that are required?
is there
And is there different types of clients that are in each of these facilities?
Yes. So for 3-1, you're looking at people who would probably step down.
When I say to use the word step down, would usually have been stabilized in another level of care so that this level of care would be appropriate.
For example, Cadenzia operates many 3.1s and many 3.5s, and most of our clients that are in 3.1 have been in a 3.5 before they get there.
So you see what I mean? So that the more intensive treatment has been done before they get there.
um so that's so when you say that it's the same state license for a 3.1 and a 3.5
what um what would what would stop a facility from from being able to change from from one
to offer one level of service to a different level of service but they have to get they'd
have to apply to the state if they said they were 3.1 and they're going to be a 3.5 they'd
have to communicate with that state of Pennsylvania. That's about it.
Just give them notice that they're changing their treatment modality?
Right. They wouldn't need to change their license because they'd already have the license,
but they're changing their... Is there another form of residential treatment center that's also
encompassed in that license? Yes. If you had a non-hospital detoxification program,
but that's a separate license but the the two two levels of care that are in asam that have one
license is the three one and the three five and there's a three now there's a three seven which
is for people that are severely um uh mentally ill or have other problems that are accommodate
with this problem so you that same license but and and is is the same license is there's something
called a recovery house is is that is that included in this in the state licensing just
recently a couple years ago they came up with standards for recovery houses that are uh which
is a different license altogether okay much more um uh is really for for living it's more of a
housing program okay um covering how recovery housing not necessarily treatment
so the emphasis in recovery house is on the housing and not on the treatment part right
okay um going back to this proposed 3.1 facility who is the defined target population
from your from from your review of and i think you you've heard all of the testimony before
right so what i did is i reviewed all the documents uh from uh the meetings all the
meetings that were had anywhere where there was a document I reviewed it and then I researched
looked at wherever there was a uh a name or a person I went online to see what their their
background was where I didn't have it if I had it I I looked at it and I evaluated based on that
I can kind of I can give you a list of all the things I mean Mr. Chairman I I I think I have
to object to this because the question he's being asked is speculate what kind of clients
we would have and i i don't think that's that's that's appropriate um because simply he he's
he's not a consultant to us he's not uh and and our plans to to populate
uh is it necessarily set in stone the way he's going to describe it so for i think that that's
that's going a little bit too far out into sea just to say hey what where is he going to get
the where will the applicant get their get their patients from and for him i can reframe the
question, Mr. Chair. All right. Mr. Harrell, in the course of your leadership of Gadenzia,
did you ever, were you ever the leader when your agency expanded and opened up new 3.1
facilities in Philadelphia? Yes. Okay. And as part of that leadership of the agency during that time,
do you have an understanding of the population that is typically served by 3.1 facilities in
Philadelphia? Yes. And is the population that was served by your facilities at Godenzia,
is there any reason to believe that it would be different from the population that would be
served at 508 Moore Street? No. Okay. So what is the targeted population for 3.1 facilities for
for 3.1 facilities for people who are residents of Philadelphia.
people who are
residents of Philadelphia.
So I wanted to clarify that I did not assume that.
I just read the documents that said specifically that the target population would be males in Philadelphia, okay, that are on Medicaid.
That's what it said.
Now, I can tell you that if you're not dealing with people on Medicaid, that you probably would have a problem financially, but that's a different discussion.
But I just went by the information that I got from the meetings that they stated their target population and who it was.
Are you referring to that question and answer, I think, 10-page document that Councilmember Scuola read at that meeting?
Okay. So when you're saying that their target population is males in Philadelphia who are eligible for Medicaid, where would this facility, where do you believe, what is the likely sources of referrals at this facility?
In order to bill for Medicaid in the city of Philadelphia, you would have to be an approved provider for that level of care with the Community Behavioral Health Managed Care Company in Philadelphia.
CBH, which is a quasi-government agency, right?
Right. And do you have an opinion on the likelihood that this new facility would qualify for Medicaid funding with CBH?
That's really up to CBH, but CBH at this point has said that they're not looking to open up new programs.
So that's based on their most recent discussions.
including at the
one of the community meetings that was held on this project
exactly it was in the documents that you proposed to me
so usually what they do
the city of Philadelphia would do is put out a request for proposals
to open up the network
so the way you're saying
the way CBH works is they put out an RFP
there's an RFP process
Well, they don't have to, but they usually do.
They'll put out if they're looking to expand their services.
For example, recently they put an RFP out for 3-1 and Gadenzius actually got one of the awards before I left.
So, and then they closed it back up again.
Well, you left about three years ago?
So when you say recently, it was kind of more than three years before now?
Probably three years.
probably i've been going for two and a half something like that all right in your in your
opinion um if this new facility does not have a contract with cbh or medicaid funding will they
likely get funding from other insurance companies they could they would have to get um places like
independence blue cross or some of the other insurance companies that in the some of the
different insurance companies but i can tell you that most of the folks in philadelphia that need
this level of care probably don't have it the reason they're there is to get back into the
workforce and get a job you know what i mean and the fact the idea that they would have insurance
to pay for this is probably not likely but it could be well in your experience with opening
up and running 3.1 facilities in philadelphia have were were you aware of of any sizable
uh number of of of clients who came into your facilities that had private insurance no
were there any clients that came into your facilities with private insurance okay so
what would you say in that level of care usually in the more intensive levels of care like detox
residential treatment not not in the 3-1 which is really a halfway house most insurance companies
don't like to pay for halfway houses matter of fact they don't usually like to pay for treatment
so well if you're if you have private insurance and you need treatment how do they how do they
say no to you uh you have to you have to be certified you have to go through a process you
have to be a provider one of their providers in their network and their network sometimes have a
managed care company that you would just like cbh that you would have to be approved by i see i see
And then that you'd have to meet criteria for admission.
And some of them use ASAM, some of them do not.
So if this facility, this new facility at 508 Moore
so if this facility this new facility at 508 more was going to take private insurance they
would have to be in network for all of these insurance companies they could be at a network
and and the individual could be billed to themselves and then they have to work it out
with their insurance company but that that's a that's a real steep hill to climb there
does the location i'm going to switch now to to talking about location for this facility
Does the location for this facility impact whether it can be a successful self-pay facility? In other words, are facilities located in South Philadelphia? What kind of success rate would they have with operating with self-pay, with having people bring their own insurance?
Most self-pay programs are out are sometimes outside of the city or in locations that are many of the ones that are either in the suburbs of Philadelphia or in the rural areas.
so you know i just i i don't know of any uh there might be outpatient programs that that operate in
the city that operate off insurance and there are many actually but but not residential treatment
programs it's it's unusual so right now patients in the city where it could happen but this may
not be one of them but your testimony is that right now you're not aware of any 3.1 facility
in philadelphia that has uh self-pay uh private insurance well they may have some people but you
know but i don't know any that operate strictly off of that level okay um i want to turn now to
your evaluation of the leadership and the staffing for this new facility
um did you do any background searches on the development team yes okay how would you describe
their background and experience? Well, I think that
the big area is that none of the people on the team, many of them had never operated 3.1 or
even designed or ran a 3.1. That's number one. And if they did, they might've done some consulting
work for one, but not necessarily the startup or the actual operation of one. And particularly in
where there was some interaction, they weren't in Pennsylvania and they definitely weren't in
Philadelphia. So there was no expertise in opening a program in Philadelphia or opening up a program
in Pennsylvania that's a three-one. So that was kind of, that was very obvious. And there was
limited expertise outside of Philadelphia. There was other expertises, mental health, other
expertises, but not the kind of expertise you would need to design and implement a program in
philadelphia why is it important that uh the leadership uh the leadership team in a new
facility have experience specifically in philadelphia for a 3.1 facility well with i mean
they could have similar experience uh that transpires but philadelphia is a pretty complex
place they have their own managed care company so you'd have to you would have to deal with cbh
You know what I mean? You would be in a situation where all the other city and state organizations like criminal justice system, probation and parole, all the other systems in Philadelphia, you would have to have some ability to interact with all those.
The health department, you know, I mean, it's a it's a you know, the city itself is a complex part, although and the state is as complex also, but not as much as the city of Philadelphia.
It would be like opening in Baltimore or New York City.
What did you discover in your background review on Revive Consultant?
Yeah, they had very limited expertise in doing this at all.
I mean, I can tell you, I can give you more detail if you need it.
Yeah, I'd like a little more detail.
uh the program that they described by the way they described the program and i looked at that
program and i looked at the expertise of the people operating to run the program that they
described okay so um the project developer and the team had no document experience
administering a similar project and no expertise in operation of any similar program is evident
than anything I read, okay?
The Revive consultant has a very limited experience
in assisting with startups in Maryland
In assisting with startups in Maryland and no experiences with 3-1 in Pennsylvania, which are licensed and financed differently than Maryland.
and no experiences with 3.1 in Pennsylvania.
I know that because I operated in Maryland.
Revised consultant has no history of actual program administration.
They did consulting work, you know, for very specific things for them.
um the other there were seven other consultants listed who had no history of program administration
at all of um of that would be necessary for this um seven of the people there was one or there was
one person who had drug and alcohol background i had operated a drug and alcohol program in
pennsylvania but not in philadelphia and it was an outpatient program is that are you referring to
the american treatment center yes right okay well that's talking about chris um devaney because he's
i added i added him because he's actually works at the american treatment center so right so but
he's not the designer of that program in order to open it so i just wanted to make that clear so
but he has philadelphia by the way it's in pennsylvania it's right it's not in philadelphia
so well this american treatment center is is not residential is that correct
right is it basically a methadone clinic well they provide outpatient services beyond just
methadone but that's one of their largest populations that look you know that's i'm
looking at their own website and what they've operated but they operate they also do mental
health counseling they do other counseling there but it's not a it's not a three there's a much
different than what a 3-1 would be it's all like an out on an outpatient basis in a different
license okay um chris devaney though he was part of some residential treatment program in uh
delaware is that correct yes and uh he came in later because none of this he was not a part of
any of the teams that that were given to uh to me so he came in much later um he does he has
background in operating programs in Delaware and he worked in Pennsylvania, but there is no
expertise there for a 3-1 in the state of Pennsylvania or in Philadelphia. And I don't
think he has any experience from his resume that he gave to provide any services like that in
Philadelphia, but he has more expertise than the rest of the team. He's the one person that has
enough expertise to actually
you know
guide some of the things but