Councilwoman, we don't have that information with us today, but we can prepare it for you and submit it to you.
Do any other members of the Committee have questions? I want to take a break.
You said in your testimony that today available is 121 beds. What is the breakdown of that because we all have heard that 121 beds is not necessarily 121 beds depending on the classification? Again, going back to what we're saying that a bed is a bed, let's just get them in, how does that break down? What beds are available out of 120? What levels of care, how many of this care can you do, how many of that care can you do a day? What is the actual breakdown?
When we say beds, those are substance use disorder treatment beds. And Amanda I think has some additional information.
So for the 3.5 beds, we had 77. For 3.7, medically-monitored intensive inpatient services we have 10. For 3.7 WM, we had 30. The ACM 4.0, medically-managed intensive outpatient, this morning we had 1. Now, we have 12 I got a notification on. And then ACM 4.0 withdrawal management is 3.
So with that being said, 77 beds that are 3.5, right? What's the difference between 3.5 and 3.7 besides the 2 percentage points or tenth percentage point?
Hi. This is Andrew Devos from Community Behavioral Health. Those are -- so Pennsylvania implemented the American Society of Addiction Medicine or ASAM level of care system. And part of the reason they had to do that is really to maintain their 1115 wavier that they have to pay for substance abuse treatment through Medicaid. That was really the deal with CMS to do that. And what that does is lays out -- and we do have some handouts that we can give you and we can talk to you more over time about how those lay out, but they really line up with how they're staffed and what is kind of the focus of the bed. So 3.1 is a halfway house. 3.5 is your typical rehab. When people say they're going to rehab, they don't have major medical problems. They may some wounds. They may have some other things. And 3.7 is really moving into high psych and/or high medical need. And then the Level 4 that we've talked about, those are very medically-intensive beds. Those are people that have chronic medical. They're going to need 24/7 staffing. And it really aligns with the staffing. That's part of what some of the medical professionals this morning were talking about, making sure somebody with a PICC line can go into a place where they're going to be able to get that kind of treatment and have doctor care 24/7. So it's a continuum of care, kind of less intensive to more intensive.
It kind of baffles me because I see these poor individuals every day and by my layman diagnosis of looking at them and interacting with them, they're all 3.7 to 4.0. So why are we even messing around with the other stuff, you know what I'm saying? Let's make them all 3.7 and be done with it and get everybody into treatment. I just don't --
And you guys are the ones that actually do the intake stuff, so you guys are the ones that put down, all right, they need this care. How does that come about? I'm trying to get a grasp on what beds. I just don't get it. Common sense would dictate that if you have an individual who's ready to go into treatment, let's get them into treatment.
But I would also say that most of these people out there are on the high end of needing multiple services. So why are we playing around with the other ones. Let's just get into that and start helping people.
I would agree that we're trying to catch up to that and move to that. I'm very interested, we're very interested. I loved your idea about when somebody's ready we need to get them into a bed. So we are talking about some providers just developing something that would be an engagement and triage center just to get them in --
What I'm saying is we're dealing with this. This is an everyday thing of dealing with these people. We know what we're dealing with. We know what their issues are, you know what I'm saying. They all have basically the same issues, homelessness, open wounds, mental health issues. So my thing is why are we even bothering with the other stuff. Let's just make them all 3.7, 4.0 and send them. If the beds are there, just send them all in.
Well, I think that's something to talk about with the people who licensed the DEDAP(ph) around how to do that. Part of it is the change in the drug supply has really driven medical wounds -- remember, we were dealing with the pandemic, just trying to get providers through the pandemic. So 2021 into 2022, we had -- some of our rehabs would have 80 people out at a time with COVID, so really just trying to keep things staffed and up. During that time is really when the drug supply changed over the last five years when we started seeing these wounds. And I would agree we need to accelerate that. We need to look at how to get those beds. We have been talking to providers. We've had providers like the Behavior Wellness Center at Girard who's open to wound care. We have the Level post-acute, which really took a lot of work, as the Jefferson people talked about this morning. Engaging with the medical units who didn't know how to kind of get and refer and set people up to go into rehab, engaging the physical health managed care organizations who pay for the medication to say we need to streamline the way it can go from, say, somebody in a Jefferson Medical Unit to be paid for an equal bill for the same medication. So I would say we're catching up to it. We share your passion and concern.
There's a crisis in Kensington. There's a crisis in Kensington. We've been talking about the crisis for years. You all have $1.7 billion in a budget, $1.7 billion. There's a crisis in Kensington. Y'all have the capacity in this department -- and, Dr. Williams, I'm rooting for you. I'm rooting for you.
I need us to recognize that there's a crisis in Kensington.
We can't keep coming to hearings -- we cannot keep coming to hearings and not have any information. Commonsense answers to very commonsense everyday questions that we have asked multiple times. All of these questions, all of these questions I asked during the budget hearings. These are common sense. We need to respond to the crisis that we have. We have talked about the barriers that we have. Why haven't we responded to them because they don't seem difficult to me. They don't. We have providers. How many providers are here? Who's getting the money? Who are they responding to? Are we responding to 1,000 people, to the 976 people that we say or are the same five providers responding to the same 200 people? And if they are, then let's shift the money. I can't understand why are we making it so difficult. This community deserves to restore their quality of life. (Applause.)
I don't think that we are asking for anything that is difficult. And I think that it is this department that holds that key. You guys are the people that contract these services out, right. Your workers are the ones that are out in this community every day. And I want to say to those workers that are out there, we appreciate you. We appreciate your work. (Applause.)
We know that it is not easy. We know that there are challenges. We know that the people out there that are suffering from addiction are sometimes not friendly because they are in pain. We get it. But we cannot continue to come to hearings, to meetings, to town halls and keep saying we don't have the information because I call bullshit on that. I call bullshit. You know why, Dr. Williams? Because I know we have the numbers, because I know that we can respond. Because when we're writing out the contract and we're asking for money at the federal and state level, we have to provide that information. We have to. We have to be able to tell people who's getting the money and what are they supposed to be doing with it. And we have a responsibility to this community to be able to respond to that. And we asked this same question at budget hearings. We asked the same question a year ago, right. I expect more. I hold you to a higher level than I held your predecessor. And you know why. I don't have to tell you that. You know why, right?
So I expect us later on this afternoon to be able to have those numbers. Because before we leave today this Committee needs to have some type of a roadmap to be able to say we're going to fight for your department, we're going to fight for those outreach workers that are out there every day and we have to get them more funding. If we have to shift how we're giving people money to be able to provide services, then as a Committee we need to be able to do that. We can't do it if you're not being transparent. And so, I want to for the life of me -- I don't want to have a heart attack up here today. But I want to make sure that people that come up here today -- we're recessing, we are going to recess and we're going to come back. We're going to recess for 30 minutes. But I don't expect people to come up here to tell me you don't have the information. You've had a year, a year to respond and find the information. I know you don't. I know you haven't had a year. And I recognize that there are people in this Administration that have not been in their positions for a long time, but you knew what the issues were coming in. You know what the issues are coming in. And you've also worked in government long enough to know what the questions were going to be when you were coming here. There is a crisis in Kensington that we must respond to. We have to change and restore quality of life in this community. And this is not about elections. This is not about votes. This is not about anything other than the people that are trying to raise their families in this community. (Applause.)
Council colleagues, I think we're going to call for a recess.
So I can appreciate your passion and your frustration. We had a conversation about this in April. And what we intended to do was talk about how the department looks at barriers and the things that we do every day, every week, every month for years as you've been saying to reduce those barriers. So that's what we prepared today. In terms of the financials, the rates, the providers and how much money they get, we hadn't prepared that for you today, but we're not saying we can't prepare that for you. So it's not a matter of being transparent. It's a matter of intending to have another conversation today about the multi- layered problem, the multi-tiered, multi-interagency approach. So we also feel like needs to happen, yes, behavior health holds a part of the key --
A part of the key, right. But this is a big problem and it's not just about behavior health and treatment services. It's going to take all of us to really get together and not be siloed in our understanding of how to approach the problem to actually bring a solution to the problem.
And we talked about that. We talked about that a year ago that there were silos. And the assignment when people left the room at Conwell was, we are no longer working in silos but breaking those down and we need to do something different. And my ask is what have we done differently, who are the people that you're funding, what is their responsibility, not just to the contract but to the people that they're serving and the people whose community these people are living in. And so, I get it, I get it. But we need to be better- prepared. We need to be better- prepared. And that is all a part of the conversation. We can't figure out where the beds are or how many beds we need if we don't even know how many people are out there.
I got the number for our last count. Our last count was on May 15, 2024. And there were 828 people in Kensington.
But I will also go back to what I was saying in the beginning and make the point about the number of people versus the number of people who need treatment and who are ready for treatment and who are going into treatment. So we can get that number for you, but it doesn't mean tomorrow that we're going to need 800 beds. We have to make sure that we have a number of beds ready for the people who present themselves at a specific moment in time and we have had that. We not only have these 121 beds, but we have out-of-network beds and we have surge beds. We're waiting for this big surge and making partnerships and contracts with people for that time to come. So I want you to understand that we're thinking about it in the same way that you're thinking about it and holding these spaces for the time that will come. But I think it's faulty to think that if you have this group that they're going to need that number of beds in that same day.
There's a crisis in Kensington and we need to figure out how we get people from living unsheltered in the streets of Kensington.
We need to figure out how we get 1,303 people into whatever service it is they need --
-- and out of our streets. Because if they are hurting the quality of life in this community, then the goal for us is not for them to move to another community to ruin that community. So we need to figure out how are we responding to the crisis in Kensington.
On that note, I'm going to break for recess for 30 minutes. We'll be back at o'clock. Thank you. (Lunch recess.)
We're going to get ready to begin and continue our hearing. This public hearing of the Special Committee on Kensington is regarding Resolution 5 240510. Before we begin, I'd like to recognize that Commissioner Kevin Bethel has joined us. Thank you so much for the work that you do every day. Thank you. I'd also just like to note that if there's anyone here that would like to sign up for public testimony or public comment, there's a table back here. Sarah from my office is in the back there to my left and she's happy to sign you up. We are going to have the Clerk call the folks that are on this panel again just so that we're clear with who we're starting it up with, and then I'll open it directly to my colleagues for questions, follow-up questions for DBHIDS. Will the Clerk please share who the members of this panel are.
Yes, Madam Chair. We have Commissioner Marquita Williams, David Holloman, Deputy Commissioner Pedro Rosario, Noelle Foizen and I'll get the other two names for you shortly.
Deputy Commissioner Amanda David and Andrew Devos, COO of Community Behavior Health.
Thank you. And then we have a representative from the PAD program as well.
Thank you. Right before we recessed we had very specific questions that we needed to find answers on. Commissioner Williams gave her testimony. My colleagued didn't have an opportunity to ask questions. And so, I'd like to recognize Councilmember Dr. Nina Ahmad to proceed with her questions.
Thank you, Madam Chair. Good afternoon. Thank you for being here.
This is a very important issue and I thank you all for -- I know you all are working hard. We just have to make it work smart to make sure what work you're doing results in making Philadelphia a safe and healthy city. And so, I thank you for that. I just had a specific question about first you mentioned an 800 number in the most recent count in May. What was that number, 800 and --
28 in realtime count on that one day in Kensington. Do you have a sense of the 828 people where they fit in the -- so first of all, do they have SUD? I don't know if all 828 have them or not. Are they assessed in any way during that count or after or any way to asses? What is this population of 828? Are they people with addiction disorder? And if they are, where are they on the spectrum? Meaning, you said there were beds available, treatment beds available but not recovery spaces, if I understood you correctly. And to my colleague Councilmember Harrity's point, most of them and what we see with our own eyes are probably 3.7s. But apparently a lot of 3.7s are really assessed at 3.5, so there's a different level of services that go because of the way that they're identified. So I wanted all of those interconnected questions to be answered. One, about the population you're serving when you do a count; two, about where they are in the continuum of needing care; and three, is it true that people get their status changed in order for less resources a spot in recovery?
Hi. Amanda David, Interim Deputy Commissioner at DBHIDS. So when we do the count, we count any individual who appears to be homeless. That person could be bedded down, sleeping potentially in a tent. If there are tents, we count those individuals and anyone else that we believe to be homeless. It is actually just a 1, 2, 3, 4, 5 kind of count where we really get into meeting people and understanding what their challenges are through the engagement that I talked about earlier. We would assume that most of the individuals in Kensington do have a substance use disorder. The homeless count, we assume that they have a substance use disorder, but we couldn't tell you who would assess at a 3.7, at a 3.5 and those types of things.
And the next piece about 3.7s being reclassified as 3.5, this is anecdotal feedback that people are assessed at lower levels of needing care. I'm not sure of the motive, but I hear that's a practice and I wanted to know if there's any truth to that?
Councilwoman, I don't know that there's any truth to that. What I do know is that people are continually assessed in whatever level of care they are with the goal of moving them down to less acute settings and moving forward with their recovery. The way that you're describing it I haven't heard that.
Okay. We'll have to get more evidence about that, if it's actually true because this was all about a reimbursement model. That's where that was coming from. I just want to go back to that realtime count. Is there a follow-up for us to know what is the population we are dealing with to know what the services are needed. If we just leave it at a count and don't know anything beyond that, then how do we know who needs treatment beds, who needs recovery? And to Jimmy's point, I think mostly they would be probably treatment beds. And if they're substance use disorder, I can't imagine we're going to send them to a halfway house situation. So I just wanted to know what you're doing to follow up to really assess the population, what their needs are and how we're meeting those needs. If you don't collect that data, how are you going to deliver the care?
Yeah. Thank you. The way that we do follow-up to that is through our everyday outreach engagement. So we have the DBHIDS homeless outreach teams with the contracted group of providers that provide those services. We also have the Community Wellness Engagement Unit that does connections with individuals to find out what their needs are. And then we also have the mobil outreach and recovery services that is able to do assessments with individuals who are seeking treatment on the spot and be able to move them into, get them into the right space for the level of care that they're appearing to assess at. And then once they get to that treatment program, they would then need to go through an ASAM assessment to determine the actual level of care. We also have connections with the PAD group that Joelle here is representing and the AR-2 team through the Fire Department.
And my last question before I yield is do you have in the teams that do the assessment, is there medical personnel there who are doing the assessments in this team?
For the teams that DBHIDS oversees, the outreach teams do not have a medical person. Some of the teams have clinical behavioral health staff who can see what the needs are for the individual and then move them to -- either they can transfer them to the MORS team who can do an assessment on the street or they would take them to a crisis response center depending on what the individual's need is.
The reason why I think having some medical personnel in that team, early team, would be because all of our medical professionals here said MAT is needed, medically-assisted treatment is needed, right. And I think to reduce the time involved of one person doing this, the next person doing another assessment, by the time we lose the person who is ready to go into treatment, we've had three layers of doing things. So if we can reduce the time and condense what we have to do and have an assessment, then is where I think we could have our hospitals and all of those who get reimbursed by Medicaid, have a capitation program there, could look to see how they partner with you -- so we need to rethink what I'm saying -- to partner with you on the ground so they know who's a real 3.7 and who needs to go where right away instead of putting three, four layers. And by that time, the patient was looking for the next time they're not in detox, they're going to go off somewhere. So we need to get people the minute they are ready without increasing that time to get into actual treatment. So one of the things I want to look at is how do we make our hospital or whoever is doing that in-bed-with-treatment, at that point of engagement so we can have a much faster, better way of giving our folks the treatment that they need. Thank you, Madam Chair.
Thank you. Before I recognize Councilmember Harrity, before we went to break, there were a series of questions that we needed to get responses to. And the questions were questions that we've also asked during budget hearings. We've asked them and been asking them over a course of a year. And the reason why I feel it's appropriate to ask those questions because many of you on this panel that represent DBHIDS have been in those conversations, right. And so, can you please provide us the responses to who's in Kensington that is a partner provider, what is their responsibility, how much are they getting? If you don't have that information, where can we find that information? When can we have that information? I think it's important that those very basic questions are answered because like all of you, we on this Committee have a responsibility to respond to community residents, right. And if we're going to town halls, if we're going to community meetings and people are consistently telling us this is a good provider, that's a bad provider, this is a provider that's not really doing what they say that they're doing and they're continuing to receive contracts, it becomes a problem, right. It becomes -- there's a sense of distrust that we as electeds who are put in these positions to be able to respond to people, they feel like they can't trust us. And I think that part of we have been doing over the course of the last few months, right, with this new Administration is change how community residents feel about their government, right. This community for the last eight years lived under an Administration -- and I'll say it here, I'll say it tomorrow, next year, next month in front of whomever -- they've lived under an Administration that was not responsive to them, right, and for a lot of different reasons. And I'm not going to even try to make reasons up as to why the past Administration wasn't able to respond the way this community deserves to be responded to, right. I'm not going to make that up. I'm not going to go there. But we all know, we've all been here long enough to recognize that the Administration was not and did not do their due diligence when providing basic quality-of-life services to this community, right. Can we all agree on that?
And so, these are questions that this community has had for a long time. And I need to know that you know who your providers are who are here, that you recognize that they are your providers, that you recognize how much money you're paying them, that you know the services that we expect them to be delivering to the people of this community. And that if you realize that they are not providing these services, that we create mechanisms that will allow us to redirect those dollars. And it shouldn't matter to us who the hell that person is connected to, who they know, how long they've been in the system, right. It shouldn't matter to us. What should matter to us is that we are using tax dollars, people's money, to be able to receive a basic quality of life, right. We should know that this is not acceptable in anybody else's neighborhood, in Society Hill, Drexel Hill, Chestnut Hill. None of the Hills of this City would this BS be permitted, right. And so, we have people who are saying to us we're paying attention and you guys are killing us. You're destroying our community. Our children see this every day. Our children cannot be expected to be successful contributing citizens to our great city if we continue to traumatize them every day, right. (Applause.)
So together, we're going to do this together. We are going to figure out who these clowns are, right, that are saying they are supposed to be doing some type of service but are not. And we are going to figure out together who are those really amazing providers, even if they're the small ones that are really doing some impactful work in our community. And we're going to figure out how do we provide them with additional resources. It's that simple. (Applause.)
I want us to be a government that is doing business and we're using some basic common sense because we would not allow this in other neighborhood. So, Dr. Williams, I'm going to allow you to respond to all of those questions that we had before because I don't want -- I want to stop. I want people to not see me walk into a room and say holy shit. I don't want that. That's not who I am. As an individual, that's not who I am. I want you to understand that I'm going to hold you accountable. And I want to be held accountable too. I do, right. I don't want people to be freaked out when I walk into a room because I'm going to ask them a question that they don't know an answer to. Yes, you do. You know I'm going to ask. You know because I've asked before, right. And you know because we have a responsibility to the people. We have a responsibility to change what has been happening here for a really long time. And so, I want to do this together. I never want people to feel like I got them because I don't want to have you. That's not the kind of business that I want to be in. But I do want you to know that I'm going to hold you accountable, that this Committee up here is going to always hold you accountable. And that if we ask you a question today and you didn't have the answer, that's okay. But we're going to expect the answer because you got to come back in front of us, right.
You got to come back. You're not going to be able to hide. You work for us. We work for the City. We work for you. We're supposed to work together. We need to figure this out. So the goal is to become partners and recognize that what has been happening here is not what should be happening here because it wouldn't happen anywhere else, and that we are not going to be here 12 months from now having this same conversation. So I'm going to allow you the floor. Thank you very much.
Thank you, Councilwoman. We appreciate that. And I appreciate your passion every time I see you, right. We want the same things. We wanted the same things yesterday. We want the same things today. In our plight to make sure that we're doing things better, we're doing many of the things that you're talking about, looking at our providers, making sure the ones that are bad actors are out of our system, looking at the small providers that maybe don't have the capacity and infrastructure of some of the larger ones but they're doing great work, they have great outcomes. And we've been looking at ways to bring them into our system. There are a number of things that CBH has been doing to make it a lot easier to become a provider as well as that DBH has been doing with BIPOC providers. And so, I wanted to let you know that we hear you and we're right there with you. In terms of some of the things that you asked for around providers in this area, we have that. And Andrew Devos is going to give you that information and talk to a little bit who they are and what is happening. But I do want to say all of the information that you asked for in terms of the financing, we were not able to pull together in the last 30 minutes. But we will pull it together for you. We're happy to have a meeting with our finance team and look at what we're doing with CBH and with your office to look at how we can answer these questions in a fuller way but also create a different solution we have had up to this time. So I'm willing to do that with my team and your team.
Hi again, Councilmembers. Andy Devos from Community Behavior Health. We've broken it out by the two zip codes that we think of usually as Kensington, 19134, 19125. We also have 19124, which is kind of adjacent, if you would like that as well. But here in 19134, we have APM which as both a substance use outpatient program and a mental health outpatient program. We have Beacon Point Recovery, which has 120 SUD beds and broken out by 90 of them are 3.5 and 30 of those are 3.7 WM, withdrawal management which used to be known as detox. COMHAR, which is really kind of centralized here, has a number of services. They have mental health case management, mental health outpatient. Within that mental health outpatient, they do have the ability to do suboxone treatment. And then they have a day program for people with serious mental illness called a Community Integrated Recovery Center. We have Esperanza, which is a federally qualified health center. They also do medication- assistive treatment there. Very small mental health outpatient program called Get Well, which is really just one psychiatrist. Hispanic Community Counseling which has three mental outpatient locations here. And finally in 19134, PHMC has Pathways to Recovery which is the substance use disorder partial hospital program that has 60 slots. That's where people can go up to 20 hours or more per week. In 19125, COMHAR has another mental health outpatient program. We have a mental health outpatient provider called Emilio Medical Group. And then one of our largest providers in our network which is Temple Episcopal which has as well as -- they have the Temple faculty practice plan, which is kind of the doctor group like we said with Jefferson this morning. They also have a mental health outpatient clinic. They have the crisis response center, a large acute inpatient psychiatric program. Then they also have something called an Extended Acute, which is a psychiatric program for people who need longer term --
Extended Acute. And then finally, they just recently opened a substance use disorder outpatient program on the grounds of Episcopal as well. So those are those two. Would you like 19124? It's kind of towards -- going up toward the Boulevard?
Best Behavioral Health, which is a mental health outpatient provider. COMHAR, which has something called a long-term structured residence, which is really for people with serious mental illness where they can get treatment and also with longer term. Friends Hospital, which is a large hospital in our system, nearly 200 beds and they also have a crisis response center. That's all acute inpatient psychiatric care. GPHA, which is the federally-qualified health center. Northeast Community Center for Behavioral Health, they have mental health outpatient. They have mental health case management, and they have three of the day programs for people with serious mental illness that are called Community Integrated Recovery Centers. Northeast Treatment, which has two substance use disorder outpatient clinics in 19124. They also have some services for children called Intensive Behavioral Health Services. That includes ABA, which is specifically for kids with autism as well as their regular IBHS. And they have family-based services, which is also a mobile service for children and families. Also in is Resources for 19 Human Development that has New 20 Start II, which is one of the 21 Journey of Hope rehab programs that 22 we talked about for people who 23 qualify under the chronic homeless 24 federal definition. And finally, we have Wedge Medical Center which has one mental health outpatient program and three substance use disorder outpatient programs in the 19124. We can get those to you as well.
So we have about 20-plus providers that provide services within a very specific area or walking distance. And so, I'd like follow-up from you around how much do they get, what's their commitment, who are they providing services to, right? Are they providing services to 200 individual clients? Are they providing services to the same 200 clients, right? How often are these clients frequent flyers? And do you even do an assessment of these individual providers? And if so, give us a report back on how is that assessment, what do you assess, how do you make decisions to shift dollars. I want to know everything you know about these individual people, right. If they provide beds, if they're responsible for beds, how many beds are they responsible for? What are the challenges that they're experiencing when people are reaching out to them to get people into these beds, what are the challenges? And, hey, I'm even excited about give me some success stories. Tell me, tell me how great they are, right. And why we should continue to trust in them as a community, right. Because this is not about us. This is about the people who live here trusting that provider and making sure that that provider is really providing the services that they're getting paid to provide. The Chair recognizes -- thank you so much for getting the information to those follow-up questions. Yes?
And just to let you know, those are all the Medicaid-funded CBH providers.
Okay. Thank you. Thank you for that. The Chair recognizes Councilmember Harrity.
Thank you for being here again today. So my colleague Dr. Nina Ahmad was hinting toward some things. So you know we're being told from the providers that we talk to that they'll assess somebody at a 3.7 and then when they call to get them placed into something, the person on the other line or whoever they're dealing with tells them, oh, no, they're a 3.5. Who is in charge of that? Where does the buck stop when it comes to who's making the decision of what bed a person actually needs, you understand what I'm saying? We're getting feedback that they'll call and they'll say, oh, I reassessed this person and he's a 3.7 and meets the other comprehensive thing and the person on the other end of the line or whatever says, no, we believe they're a 3.5. What can you tell us about that and who makes that decision? Who is the ultimate person that says, no, this person is 3.5 or this person is 3.7, this person is 4.0 or whatever?
So at the place where the individual is assessed those folks are trained in how to administer an ASAM and what goes into the ASAM level of care assessment. Through a set of dimensions they determine what level of care a person is assessed at. They then make the referral to a treatment provider that is that level of care to move them into that space to find a bed and get them into that space. We do not condone dropping or changing the level of care. If the individual is assessed at a 3.7, they should be referred to a 3.7.
Well, apparently that's not the case. That's not the -- sorry. Apparently that's not the case. Apparently what is happening is they're assessing about one thing and then somebody along the line is changing that assessment to say, oh, no, we believe that this person is 3.5. Whose decision is that? You're telling me that they're doing it in the assessment on the street is what you're saying or in the intake center or wherever they're at, wherever they go to get the services?
Yes, wherever the person gets the assessment. So it could be at the Crisis Response Center -
Who do they report to? Who is the one that ultimately makes a decision on what bed is what and what a person is able to go into? So if they assess it at 3.7, why and who is the person saying, oh, no, they're only a 3.5? How is that decision made? If somebody else has already looked at them and he's right there in front of them and they can see what they need physically, but somebody else along the line is actually making the decision on whether that person gets the 3.7 care or are demoted to a 3.5, that's what I'm trying to figure out?
We had talked earlier about certain levels of care, that CBH has no prior authorization. That's the 3.5, that's the 3.7 WM, which will be detox. For the 3.7 and the Level 4, the clinical information is called into CBH. It's reviewed by a clinical care manager. That's the first person who would make the determination. Most often they do agree and authorize it, but if there's a clinical opinion that doesn't meet the medical necessity --
They review it with a physician, but I understand your concern.
Absolutely ludicrous and this is quite frankly bullshit, you know what I mean. We're talking about families here. I don't care what it is. If the person on the ground says this should be a 3.7 and somebody else is changing it to a 3.5, that is not right. The person who is physically in front of the person should be the person making that decision. And I'm not saying that this is you --
-- I'm saying who is it that I have to go after in order to get this situation rectified? Now, is it the insurance companies because they don't want to pay that extra money for care? But most of these people are on Medicaid, so who actually is making this decision?
Just to finish what the process is, the care manager would then review that with a physician at CBH. They would make the final determination, but again they are not --
They don't know what the immediate physical needs are.
It's so much bull, you know, to navigate the system. What people aren't getting is that these people don't have that (inaudible) -- UNIDENTIFIED SPEAKER: Can't hear.
I said this is a decision that's going to affect their whole lives from that point on. The fact of the matter is do they get the care that they deserve and need or do they get the care that some bureaucrat said they need. I just want to figure out who I have to go after to hold responsible for this and how we change it, because the bottom line is this has to changed. It can't be done like that. There's no way somebody can make an assessment over the phone not even looking at a person, seeing what the physical condition that they're in is and then make an informed judgment of their treatment should be cut down from 3.7, 3.5 when they haven't had a chance to observe the person in person. That's not acceptable.
Thank you, Councilmember. The Chair recognizes for the record that Councilmember Mark Squilla has joined us. And I'd like to recognize you for a comment or for a question.
I want to ask a question real quick because I know -- I missed the part where you said you have plenty of beds. I'm sure you said that. The question is too on the assessment process, is there data that shows all the people who are being assessed and then what assess level of care they're assessed to? So you have data that says all of the people who were assessed and then what level of care were they sent to?
We do as far as if they're going to a bed-based level of care.
Ultimately, aggregate we have that. On an individual basis, like a Crisis Response Center is able to do an assessment. If they see a person needs like an IOP level of care, they'll just make that referral directly.
But you have those numbers like how many people came in?
Yes. So we can link together between the Crisis Response Center evaluation that we get billed for and then what's their next level of care.
The reason why I'm asking that question is we have people who are unhoused and people who have told us that they have nowhere to go, yet they will be assessed as IOP, MAT. And we don't see how that is possible for that person to get the successful care that they need in order to get the help that they need. So we want to understand why they're being assessed at that level knowing what their situation is and then how we could help to change that. And I know we have available beds so it's not because we don't have enough beds available, right. So what is the reason why it seems like these folks that really have nowhere to go are still being assessed at that level?
I think that's where we should engage with our provider partners to talk through, especially the Crisis Response Centers, about what they're seeing in that moment that would make them think about that assessment.
All right. I'd like to see if we can get that data to the Chair too on those individuals --
-- so that we can then look at those numbers also to help with the providers and you and all of us because we're not the experts. We're only hearing from the people who are on the street that are telling us this. So I think if the providers are doing that to them, then maybe we need to change what their assessment process is.
And I don't want to speak for the providers, but I do think sometimes when they see that somebody has completed a rehab treatment recently and then come within days back, that's probably the most often -- it could be that they do need to go back into rehab. There are people -- we're going to get the unique number of people served by provider for the Councilperson. I think it would also be good for us to look at how many people -- because we have over 8,000 people who were in bed-based substance use services. But that just represents the unique people that have that service. Some of them might have been in three times in the year. So I think that's compelling information.
Correct, yep. But some of them may have been in more than one time.
We're not counting them -- in that 8,000, those are unique individual people, right. Some of those unique individual people though may have been in -- it doesn't then change the total. So it could be 12,000 treatment episodes with 8,000.
Correct, yeah. And I think that's worth looking at too because that's a question to find out too. What is it that the people -- we've talked a lot about housing. We've talked a lot about things on the backend. We --
And we can probably decipher some of that information from some of those numbers.
And one of the things as a managed care organization we're measured on that we really pay close attention to try to do what we call warm handoffs is linkage to the next level of care, because really the long-term recovery and some of the Councilpeople even talked about, the rehab really sets the stage, but the rubber meets the road when the person walks out the door.
And when you do that warm handoff, there's a process of following that person through the next phase, right?
So do we have those numbers, like when you do the warm handoff?
To see how many people do follow up through the next level, yes.
Because if they're successful through the first phase and then they go to the next level of care, are they successful in that next phase, right. And then we can determine what other resources we need, do we need additional resources in that second phase if it's not working or how we can do it because it helps us help you help our providers make the best decisions.
And I think that speaks to the why we need to know who the providers are, who they're serving, what level of services and have the capacity to be able to be redivert if we find that we're not getting what we need, right. It's because of reasons as basic and as simple as those that the Councilmember has just finished describing, right. And so, getting us that information is extremely important for us to continue to be able to do the work that we know to need to do in order to improve quality of life for those who are suffering in addiction and the people of this community. So thank you so much. We look forward to receiving that information.
And we talked about that, right, providing resources for them to continue on their road to successful healthy living. I'd like us to, Mr. Clerk -- are there any other questions for DBHIDS?
I don't know if this is the right place to ask this question, but you all obviously will be involved in this case. I wanted to ask about the issue of (inaudible) and what's your role in that and what is the outcome for patients who are (inaudible). So I don't know if this is the right panel to ask this. So through your disaggregating of data, do you have this type of patient who involuntarily is taken in and subjected to (inaudible)?
So we were talking -- Councilmember Harrity and I were talking briefly about drug and alcohol inpatient treatment which is just in the process of being kind of framed out and potentially enacted. So right now involuntary commitment is really on the mental health or psychiatric side. In fact, drug and alcohol issues can kind of preclude people from being --
Yes, depending on the situation. There are people with serious mental illness who also use substances and may need to be involuntarily committed. On the CBH side, that's an automatic for us. We also don't prior authorize acute psychiatrics. So just to try to help, it's seen as an emergency admission. They just flow right in. As far as the process itself, that's on the county side. There's a group called the Philadelphia Crisis Line. They are certified as mental health delegates, which is really a state title. They're the ones who look at the criteria of an involuntary commitment. It has to be witnessed by the person who's called the petitioner of the involuntary commitment and it has to be within the last 30 days. It has to be eyewitnessed. There's some that are automatic which are a two-physician 302 or a police officer 302. So we're just going to set those aside for now.
And that's what I was getting at, the police officer 302. Is that something that they encounter or is that something they will encounter?
For psychiatric, oh, absolutely. Both police and SEPTA police are often involved.
So does that intersect with SUD at all or will there be a future for SUD?
The Mental Health Procedures Act doesn't allow involuntary commitment for substance use disorder at this point, those are the rules that we follow. It just doesn't allow it, unless there's psychiatric.
So there's been some concern around that and that's why I'm asking. Is that on the horizon?
That's not something we can speak to. State laws will have to be changed.
Because there is a state bill about that. That's why all the questions are outlined. And I don't know the status of the bill, but there has been a bill already.
That's what I was talking about with the Councilmember. We're watching that. We're thinking about how the implementation of that could look, see if it will mirror. There are other ways that aren't involuntary commitments historically and it just depends on kind of the City's Administration and really the District Attorney's Office. In the past there was a lot more court- ordered treatment, which isn't involuntary commitment but it was court-ordered.
And so, just -- it's very clear we need this aggregated data and we need follow-up to see what exactly is happening for all the different treatment modalities we have out there, and we need to know to put this much money in this individuals who are treated, this is they are being tracked one year out, six months out, whatever the case. We need that data. We just need to know what is happening with patients that you're treating because that should determine how you're awarded contracts to these providers. But you must have that data, am I correct, that you are tracking their progress and who they're treating and what the outcome for those patients are. You have that data?
We have data on the recovery process, long-term recovery process.
So how do you decide who you're going to give a contract to, based on what? How do you renew people's contracts? Is there an outcome- based approach to this?
We have something called value-based contracting and we have pay-for- performance, which kind of ranks out our provider network. And then we have a quality review process that --
There's not result-based review that determines whether this organization will get another contract?
They typically stay in the network unless there are -- I mean, there are providers who have had to leave the network because they are not performing.
How do you know that? What tells you unless there's an incident? So you don't have a normal tracking. So if I were going to do a contract, multi-year contract which is renewed every year, I would like to know at the end of that year how is your performance, how many people you treated, what is their outcome and then I'll decide, yes, I'll renew my contract with you or not. I'm amazed that you don't have that process already in place that will tell us before we had to remove them what were the things that would alarm us or make us happy. It should be a report.
A profile of the provider of their number of critical incidents, the number of complaints.
There's also a review that happens based on the provider's performance the last time they were monitored. So it's called -- our NAIC team goes out and it's the Network Improvement and Accountability Collaborative. They do a multi-level review for all of our levels of care, and it assesses the provider where they do a clinical tour, they do a clinical record review, staff file reviews, conversations with individuals receiving services. They do a living review with talks to the indiv -- they review the record, they talk to the individual, they talk to the individual's counselor, they talk to the individual's counselor's supervisor to make sure all the information matches. And then a credentialing status is determined by that along with whatever's happened with them related to quality and compliance, so there's a --
So providers can receive a status of six months if they're not doing well, one year, two years and three years.
So you keep giving them money to do the work if they don't have a clean bill of health?
They get corrective action plans in order to improve, and then they work with the provider to help them improve. And then the provider also has to show that they're improving. And we continually go back and monitor those providers.
I would like to see a status report on every third-party provider that you contracted, what is their status, like do you give them a number, this is a high-performing one, this is a medium-performing one. This is on probation, whatever it is. I want to see that report and how we are rewarding them and what is the outcome, because that 8,000 number should be all going down if these are all high-performing spaces, right. So there has to be some kind of assessment and equation has to be balanced in some way. I would like that data. Thank you, Madam Chair.
For the record, we're going to ask DBHIDS to please provide a provider assessment report to us for the providers that receive funding for the very specific services in this community. Just as a follow-up to Councilmember Ahmad's question, what would cause a provider not to receive a contract renewal, right? You've given them a corrective action plan, how many stripes do they receive before they have been kicked off of the contract list? Andrew Devos mentioned that they typically stay, they typically remain providers. So tell me what would cause DBHIDS or CBH to say, you know what, this is not a good provider, we've given them 5 different action plans and they've 6 not responded or we gave them three 7 or we gave them one. What's that 8 process? 9 And then I want us to wrap 10 up with DBHIDS because I want to 11 move on to the opposite side of 12 those that actually do the work on 13 the ground and I want to hear from 14 them what are some of their 15 challenges. I'm going to start 16 with Police, then OHS, MDO and the 17 PAD program. I want to hear from 18 them and I want to be respectful of 19 people's time as well. But if you 20 can --
And there are incidents that put providers out of the network more or less immediately if there are critical incidents that happen with a provider. But each provider's unique as far as their size, ability to engage. So we really try to put them on corrective action and move the needle towards quality. We have a group that can do technical assistance with them to help support them in that. But after you've applied technical assistance, often times it's through either the documentation that you see of the provider or through the NAIC process where we have people going out and reviewing with providers.
I want you to be really honest because I think that what I am hearing, right, Councilmember Lozada, Chairperson is hearing they really never get kicked off of becoming a provider, right --
-- unless there's something extremely serious. And what I want people to understand is that this is a new Administration, this is a new day and I don't care who you know and who you don't know and how long you've been a provider. If you're not handling your business in this community, then you shouldn't get a contract, right. It's that simple. (Applause.)
I think we need to understand that we have to do things differently and we have to recognize as government -- and it's not just your department, right. As government we've never been able to hold people accountable and assess and adjust or remove those who don't provide the services that they commit to giving us, right. We're really great at, oh, this is a problem, everybody is an expert at identifying the problem, but we never can figure out how do we remove this individual from our system and from our process if they're not doing what they say they're going to do and the problem persists or get worse. And so, this Committee as I've mentioned before is committed to doing things differently. And we want to work with you to figure out, you know, I hope that that report that you're going to share with us will show us who are those providers that you've had to put on corrective action, what is their response to that corrective action plan, have you done a re-assessment of that plan and how have they progressed, right. I think that's the expectation --
-because we want to be able to say you're no longer going to be a part of our system and you're no longer going to line your pockets on the backs of poor people. Not going to happen anymore.
Oh, absolutely. And we only want quality care for the citizens of Philadelphia. We can get you information on what that process looks like. It starts with a corrective action plan and it escalates. It goes, you know. And there's a review that happens. That review can go to the CBH Board. Anybody at CBH who sees a concern with a provider can call a provider teaming. And then there are things that automatically happen with providers that cause a teaming, certain critical incidents. A teaming is when a cross-departmental group from CBH comes together. There's immediately -- there's a list of actions. We can get you that too when we have a teaming. There's a list of actions that you can take that are kind of like 0 to 60. Sometimes somebody hits in the middle and then it progresses. You're on our watchlist at that point. There's a lot of work that starts being done with the provider. We try to invest in the providers to try to make them better. Many of our providers are grassroots providers that are from the community, we really want them, but there are absolutely deal breakers right out of the game. And we want the same thing that you want. We really do want the quality of care. We don't want it to be less than.
Thank you. Are there any additional questions for this particular part of the panel? There being none --
One last question I guess. How many people from our PAD program enter the treatment services, do we know?
We're going to probably be able to respond to that on this part of the panel, but DBHIDS -- are there any additional questions for DBHIDS?