I'm working on it.8 As I think I've said as clearly as I can,9 I don't want to close a health center, and10 I think it's not wise to close a health11 center, and we are doing everything that12 we can possibly do to inform people why13 it's not good to close a health center.14 But if things are terrible, we15 have to do something. If you pass a16 budget that tells us that we have to close17 a health center, I have to be prepared, so18 I'm gathering --19
I don't know how22 we will move forward, and I don't want to23 be in the midst of it.24 But what I would say is, my25 214 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 responsibility is to be prepared with the2 information we need should we be told that3 we need to close a health center, and I am4 pulling together that information.5 And we will need to have a lot6 of conversations with people, and we will7 need to do a lot of very hard work8 assuring that people have access to care.9
This question10 really goes to Plan B throughout the11 entire government.12
But is it14 $2.36 million in savings assuming a health15 center is closed for an entire year?16
Well, if you18 haven't sent layoff notices today to the19 staff of a health center, they won't be20 closed until -- people will be on your21 staff because of bumping and other things22 that are going to happen in Civil Service23 for six months from the date you send out24 the notices.25 215 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
So, I mean,3 in other words, if you don't have it4 identified now, you really aren't going to5 have $2.36 million in savings; isn't that6 correct?7
I think I12 understand what your point is. I hear13 you.14 (Laughter.)15
I don't hear16 you.17 (Indiscernible; parties talking18 over each other.)19
So how much23 would you actually save if the24 implementation comes in. Provide the25 216 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Chair with how much you'd actually save2 next year by closing a health center if3 implementation is beginning in August,4 after we find out what the State's going5 to do.6
Thank you.9 COUNCIL PRESIDENT VERNA:10 Councilman Green, are you sure you're11 finished?12 (Laughter.)13
Yes, ma'am.14 COUNCIL PRESIDENT VERNA:15 Doctor, I want you to know we really have16 the greatest respect and admiration for17 you.18
We20 think you're doing a magnificent job and21 it's not just in the Health Department.22
I24 don't know how you do all that you do.25 217 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
I have the world's5 best staff.6 COUNCIL PRESIDENT VERNA:7 Wonderful.8
And here you have9 the leadership of the Health Department10 and my other departments.11
So we12 applaud all of you. Thank you very much13 us.14 (Applause.)15
This17 committee will stand in recess for a half18 hour. It is now -- so we'll be back at19 2 o'clock.20 Thank you.21 (Lunch break taken.)22
The23 Committee of the Whole is now back in24 session.25 218 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Mr. McPherson, who's the next2 group to be called?3 MR. McPHERSON: Behavioral4 Health.5 (Witnesses come forward.)6
Hello.7 Good afternoon, Dr. Evans. Please8 identify yourself for the record and9 proceed with your testimony.10
Good afternoon. I'm11 Dr. Arthur C. 14 Good morning, President Verna15 and members of Council I am Dr. 8 In FY '10, the Department will9 continue its efforts to address behavioral10 health and mental retardation needs of the11 Philadelphia citizens. 12 The Department is committed to13 supporting the mission values and goals14 that have been articulated in the15 Philadelphia Plan. I want to give you a16 few examples of the efforts:17 School-based Behavioral Health18 Services. The Department has had a long19 history of partnering with the20 Philadelphia School District to meet the21 behavioral-health needs of students. 25 222 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 DHS/MRS also provides treatment2 services in schools to over 5,100 children3 who have high needs. 9 Homeless Services. Over the10 past two decades, the Department has11 played a critical role in the City's12 efforts to address homelessness. 4 The Early Intervention Program5 is for children, birth to three, who live6 in Philadelphia County and who have7 significant developmental delays. 12 In the current year, 4,57013 children were served in the program. 23 Criminal justice efforts. The24 Department has continued to support a25 224 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 variety of initiatives in partnership with2 the criminal justice system to support3 individuals requiring behavioral-health4 treatment. 11 In addition to the direct12 supports provided by the Department,13 DHS/MRS has undertaken a variety of14 efforts related to improving the quality15 and the accountability of services. 18 First is the Cognitive Therapy19 Partnership. This is an innovative20 collaboration to advance the quality of21 care provided to persons with22 behavioral-health conditions by placing23 evidence-based tools in the hands of the24 therapists who serve them. The program25 225 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 partners include world-renowned2 psychiatrist Dr. Aaron T. 14 The Network for the Improvement15 of Addiction Treatment is an example of16 the Department's focus on increasing17 efficiency in the behavioral health18 system. NIATx, as it is called, was19 developed by an organizational management20 group from the University of Wisconsin in21 conjunction with the Federal Center for22 Substance Abuse Treatment to promote the23 efficient use of treatment capacity and24 the development of strategies to improve25 226 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 access to care and client retention and2 programs. 4 NIATx is proving to make5 significant improvements in access to care6 and in keeping clients engaged in7 treatment. For example, providers8 participating in this initiative have been9 able to reduce wait times for needed10 services by up to 75 percent. 14 Enhancing minority15 participation. Most DHS/MRS contracts are16 with not-for-profit organizations and,17 therefore, are not officially classified18 by the Office of Economic Opportunity as19 to minority status. 23 Minority participation is a key component24 of our efforts to reduce known25 227 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 behavior-health disparities and to improve2 overall effectiveness of our treatment3 system. 5 When the determination and6 designation of minority status of7 nonprofits is made using minority board8 composition and/or executive leadership,9 the minority contracting percentage in the10 Department exceeds 35 percent. 22 An example of the Department's23 emphasis on accountability is the creation24 of provider profiles. In March 2009, the25 228 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Department introduced a new provider2 profile report. 7 Finally, the current economic8 situation has created challenges at the9 state, federal, and local level in10 supporting individuals who are uninsured11 or underinsured.
16 Since the bulk of the resources17 supporting the Department are State and18 federal dollars, we will continue to19 closely monitor the budget deliberations20 which are occurring in Washington and21 Harrisburg. 2
Thank3 you very much, Doctor.4 The Chair recognizes Councilman5 Greenlee.6
Thank you,7 Madam President.8 Good afternoon, Dr. Evans.9
On your --11 and this is a kind of a broad question,12 but on the issue of homeless services that13 you talk about --14
-- I know16 this may cross over into other departments17 or whatever, could you talk a little bit18 about the outreach that you do,19 particularly for homeless folks that20 either have various addiction problems or21 mental-health problems to get them aware22 of what they can do and maybe --23
-- "force"25 230 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 isn't the right word, but maybe try to get2 them into the program.3
We have a very close6 working relationship with the Office of7 Supportive Housing, and have for many8 years. And, in fact, before I came to9 Philadelphia, the City was really regarded10 well in terms of its partnership with11 behavioral health and the housing12 community in terms of outreach to the13 homeless community.14 Our department actually funds15 the outreach services within the City, and16 one of the reasons that we do that is17 that, as you know, a large proportion of18 the people who are homeless have19 behavioral-health problems. They either20 have serious mental illness or they have21 very serious addiction problems.22 And so, through those efforts23 and because those people are connected to24 our system, we're better able and more25 231 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 efficiently able to get those individuals2 into treatment.3 One of things that we've learned4 through the process is that it really5 takes time to engage people who are on the6 street. And one of the things that I7 think that our contractors do really well8 is to establish those relationships so9 that they can encourage people to get into10 treatment and get the care that they need.11
Okay. Has12 the budget issues entered into that at13 all? I mean, are the people that you've14 have working on this had to be cut back at15 all or --16
No. There's no cuts17 that we've had to make in these services.18
Okay. And19 would you say you see some kind of20 accomplishment in this?21
Well, I think the25 232 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Mayor, very early on into his2 administration, made a strong commitment3 and developed a plan for reducing the4 number of street homeless people in the5 City. And, again, we've been working very6 closely with the Office of Supportive7 Housing, and I think we've made some very8 significant gains.9 As I mentioned in my testimony,10 we have gotten housing for 145 single11 individuals, permanent housing.12
Most of those14 individuals -- well, actually, a hundred15 percent of those individuals were homeless16 at some point.17
We anticipate, by19 the end of the fiscal year, we will have20 gotten 200 people into permanent housing.21 That is a really significant number of22 people --23
-- that we've been25 233 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 able to really take off the street and put2 into a permanent housing situation.3
I know4 it's a -- it's not a easy situation, and I5 know you guys do a great job with it. So6 thank you.7
You're12 welcome.13 The Chair recognizes Councilman14 Goode.15
Thank you,16 Madam President.17 Good afternoon, Dr. Evans.18
In your21 testimony you say that DBH/MRS supports22 the City's efforts to manage the prison23 population through early parole and24 diversion of appropriate individuals into25 234 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 treatment. During Fiscal Year 10, you2 anticipate that over 3200 individuals will3 be supported by these efforts.4 In terms of those 325 individuals, how many do you believe6 actually can be diverted into treatment7 through early parole and some other means?8
That numbers9 includes people who are involved in a10 variety of things that the Department is11 involved in. So, for example, we support12 the Philadelphia treatment court, we13 support the community court. So there are14 a variety of people who are embedded15 within that number.16 In terms of the people who are17 in the Philadelphia Prison System who we18 divert or who come out by early parole, I19 don't recall what the exact number is, but20 every year, we are able to save the City21 literally thousands of bed days because we22 are able to get people, working with the23 courts, into treatment.24
Well, can you25 235 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 get us that projection for Fiscal Year '102 and also if you have those numbers for3 Fiscal Year '09 year-to-date.4
Sure.8 What I can tell you is that9 in -- at a point in time in January of10 this year, January 31st of this year, we11 had 724 people who were involved in the --12 for our program, but we can give you the13 total number that we serve in one year.14
Okay, great.15 Secondly, the issue of minority16 participation. I don't know if you are17 aware of the conversation that we had with18 Dr. Schwarz this morning.19
I just want21 to emphasize specifically we are very22 pleased with the information regarding23 minority providers, but that really is not24 necessarily the crux of what we're looking25 236 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 for.2 At the end of the day, even3 though we salute that level of4 participation in terms of providers, we5 want those providers to use taxpayer money6 and still practice the same business7 diversity that everyone else is required8 to.9 Do you know offhand how much10 your department spent last year in terms11 of Class 200 Funds?12
Um, total? I'll get13 that number for you.14 If you are asking in terms of15 minority participation or just in general?16
Okay. And20 how much of that went to disadvantaged21 businesses?22
How much of24 that went to disadvantaged businesses?25 237 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
It's hard to say,2 and I mentioned this in my testimony.3 Because nonprofits are not classified as4 minority business, what we've done -- and,5 in fact, we started this about three years6 ago -- is to look at --7
Dr. Evans,8 the question I'm asking you is if you fund9 minority providers, all of that money, I'm10 assuming, doesn't go strictly toward wages11 and benefits. That -- some of that money12 is then used to procure other goods and13 services.14
So the16 question is: Are they being held to the17 same standard? and do we know what their18 level of participating is in their19 procurement of goods and services?20
That's right. So21 no, we don't know and we don't collect22 that information.23 What we do know is that about 7524 percent of their costs are associated with25 238 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 staffing.2
And, therefore, the4 bulk that we're paying for is staff who5 live in -- primarily in the City of6 Philadelphia.7
Well, that's8 the majority of what have you're paying9 for, but still, you're also -- 75 percent10 of it may cover salaries and benefits, but11 beyond that, there are dollars associated12 with goods and services. And that's a13 number that we need.14
Specifically16 not only in terms of what the track record17 is, but Dr. Schwarz has committed to for18 Fiscal '10 and into the future actually19 setting goals for participation.20 And we don't need a21 reclassification of nonprofits as22 disadvantaged businesses; what we need is23 for their for-profit subcontract activity24 to be held to the same standard.25 239 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
You're6 welcome.7 Dr. Evans, can you tell us what8 percentage of the City's population9 receives assistance for problems to10 behavioral health or mental retardation?11
I can tell you the12 numbers within the public sector. There13 are a lot of people who receive care in14 the private sector, which we wouldn't know15 about. So we -- the City has about 1.416 million people --17
The City has about20 1.4 million people, and 400,000 of those21 individuals are people who are on medical22 assistance, and in any given year, about a23 100,000 of those individuals will access24 care. So about 25 percent of the 400,00025 240 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 that we have responsibility for will2 access care.3
Thank4 you.5 Doctor, I have heard of nothing6 but praise regarding your school-based7 programs. Can you tell us what amount and8 what percentage -- well, you did go into9 the school-aged children who do receive10 service, but do we know whether the School11 District also budgets funds for these12 services?13
They do. And one of14 the things that is going on right now is15 that there is a lot of talk and discussion16 with the School District. In fact, we17 have a meeting every Tuesday in which the18 School District attends, along with the19 Department of Human Services, because one20 of the things that we know is that various21 departments pay for a lot of different22 things. And one of the things that23 Dr. Schwarz has been trying to get a24 handle on is exactly what is being paid25 241 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 for by whom so that we can better2 coordinate that.3 So we know that there is some4 overlap. We are trying to minimize that5 and really better coordinate those6 services across the various child-serving7 agencies.8
That's9 interesting.10 Under the heading of Cognitive11 Therapy Partnership, you referred to a12 program for the implementation of13 evidence-based psychotherapy. Can you14 elaborate on that, please?15
Sure. One of the16 things that the field has -- and this is17 true in both general health care medicine18 and in behavioral health, is that there is19 about a 15- to 20-year gap between what we20 know from the scientific literature and21 what's widely practiced in the field.22 And so, over the last, I would23 say, seven to ten years, the field has, in24 health care in general and in behavioral25 242 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 health in particular, been much more2 intentional about trying to understand3 what's been demonstrated in the scientific4 literature and transport and make sure5 that that's practiced widely in the field.6 We have here in Philadelphia a7 tremendous opportunity, because one of the8 creators of probably the psychotherapy9 practice that has the most scientific10 evidence, which is cognitive therapy or11 cognitive behavioral therapy, the12 originator of that therapy lives here, in13 the City -- or lives in the area and is at14 the University of Pennsylvania.15 And about two years ago, he16 approached us and indicated that he'd like17 to work with us to have his practice more18 widely disseminated in the field, which19 was a tremendous opportunity. And so, for20 the last couple of years, we've been21 undergoing a training process to embed22 that practice more widely in our treatment23 system.24
Thank25 243 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 you.2 The Chair recognizes Councilman3 Jones.4
Thank you,5 Madam President.6 Thank you and good afternoon.7
On the lines9 of how the same client population hits our10 budget three separate times, and how do we11 begin to codify those services in a way12 that we kind of drive them more towards a13 holistic approach to cities?14 I mean, we see the same15 population in the homeless shelter that we16 see on the street.17
And, I guess,22 is there an analysis to look at how we can23 better kind of drive those services and24 keep them in a constant stream of25 244 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 treatment as opposed to a bifurcated way2 that we kind of apply those services?3
Sure. I think it's4 a great question because I think it's at5 the heart of what we're trying to do in6 the City and, again, under Dr. Schwarz's7 leadership to make sure that City agencies8 that are human-service and health-service9 agencies are working in a more coordinated10 fashion.11 If we use the homeless12 population, as I mentioned earlier, the13 individuals who are homeless are often, as14 you mentioned, in the criminal justice15 system, often have behavioral-health16 needs. And so, what we recognize is that17 we have to work in close coordination with18 our sister agencies, because in the19 absence of doing that, we're not going to20 be as effective in terms of working with21 the people.22
On that note,23 when it comes to community courts, being24 the one at Center City, that services25 245 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Center City --2
Well, you know, a6 lot of the people that end up in that7 corridor are doing misdemeanors, they're8 doing sort of public -- they have9 behaviors that are problematic publicly.10 And a lot of those people will have11 underlying behavioral-health problems,12 either an addiction or a mental-health13 problem.14 And rather than those people15 going into jail, which really serves no16 one, we've been working with the courts to17 get those people connected to treatment.18 And so, you know, that's sort of the kind19 of support that we provide to the court.20
Does that21 cost your budget any additional dollars,22 or are these staffers that are --23
I don't think so. I24 think -- and, again, it's a great question25 246 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 because, you know, on the one hand, you2 could say doing outreach and case finding3 increases your budget.4 The reality is that the sooner5 that we get people into treatment, and6 when we're able to intervene in some of7 these other systems, it actually -- if it8 doesn't save our department money, it9 actually saves other City departments10 money.11 And so we believe that it's a12 cost-effective strategy to get to people13 sooner, get to them earlier, and divert14 them out of systems that they really don't15 need to be in.16
I think -- I17 don't know if we have to do a cost-benefit18 analysis as to where the services are19 provided, under which juncture they are20 best deployed, but when we look at the21 example of Red Hook in Brooklyn, New York,22 they put the case managers in the23 courtroom; and, similar to what we do in24 Philadelphia, the clients tend to come to25 247 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 them.2
And so4 they're able to provide the service, don't5 have to look for them. They don't spend a6 lot of time looking for them because they7 are, in fact, coming there.8 And I'm trying to analyze -- and9 one of the things that I note the budget10 limitations force us to do is that there11 should not be a population of people in12 need of mental-health services in the same13 facility with people in need that are14 economic casualties to what's going on15 with the economy, along with people who16 have serious drug-rehabilitation problems.17 Mixing those three populations18 is almost counterproductive. And,19 similarly, in jail, in incarceration, the20 same thing happens.21 So if we could figure a way to22 apply a way to segregate those populations23 and give them the unique services each24 population needs, I think we could do it25 248 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 in a more effective manner for the client2 but also in a more cost-effective manner3 by deploying people where they can best4 help in the quickest, most efficient way.5
We don't disagree6 with that. And I think the work that7 we're doing with the courts is a good8 example of where we're trying to do9 exactly that.10 I think -- and I didn't really11 talk a lot about it in my testimony, but12 we have, I think, right now, probably the13 best, certainly in the years that I've14 been in Philadelphia, the best working15 relationship of people within the criminal16 justice system around the issue of17 separating out people who don't need to be18 in the criminal justice system versus19 people who really need to be there.20 We meet with -- through a21 variety of forums, with the Courts and22 with the Public Defender, with the23 Probation Department.24 And I think, again, for the25 249 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 first time, we have consensus that it2 doesn't make a lot of sense for a person3 who primarily has a mental illness to be4 in the criminal justice system, when they5 could be better treated in the treatment6 system.7
Has anybody8 from the Administration done a matrix that9 says, Here's what it costs me, this10 client, in a prison, here's what it costs11 to service this client per day in a12 shelter, and here's what it takes for us13 to go out into the street to find this14 client, and which one is the more15 cost-effective measure by which to service16 that population.17 Has anybody done that analysis?18 (Timer bell rings.)19
We look at the cost20 of the -- of what it costs to keep a21 person in prison versus the cost of --22
I think that's25 250 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 around a hundred dollars, 95 dollars,2 something like that.3
Okay. So when we5 can treat a person, the initial costs are6 going to be more than that potentially,7 particularly if a person needs acute care.8 But over time, it will go down9 precipitously as we are able to step10 people down to lower levels of care.11 So if you look at sort of the12 course of treatment, the cost, the average13 cost, is much lower than that of keeping a14 person in a prison bed.15
I will yield16 for the next round of questioning.17 Thank you, Madam President.18
Thank21 you, Madam President.22 Along the lines of Councilman23 Jones, of the clients that are served24 through Behavioral Health, how many are25 251 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 insured either through Medicaid, through2 private?3
Well, most of the4 people are insured because -- if I could5 just step back for a moment.6 The City of Philadelphia has the7 Health Choices contract for Behavioral8 Health. So for everyone in the City who9 has Medicaid, the City, our department, is10 responsible for providing their behavioral11 health. That's about 400,000 people. So12 a hundred percent of those people have13 some kind of entitlement.14 There's another group of people15 for whom we have responsibility, who are16 uninsured or who are underinsured. And17 that number is probably at around the 15-18 to 20,000-person range.19
And what20 does that cost us? Of that cost, how much21 of it is reimbursable and how much of it22 are we carrying as part of our General23 Fund cost?24
Well, practically25 252 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 none of it is General Fund because our2 budget is primarily state and federal3 dollars. So about percent of the4 $1.5 billion in the City General Fund,5 about $14 million. Most of those dollars6 then leverage other City dollars -- other7 State and federal dollars that we bring8 in.9 So the amount -- so the bulk of10 the cost of the services for the uninsured11 really comes through the State and federal12 grants that we get, that we bring into the13 City.14
So we get15 the State allocation whether those 400,00016 people access our system or not?17
Right. So we get a18 capitated payment, which means that for19 each person who's in the medical20 assistance program, we get what is called21 a per-member, per-month payment. And on22 average, it's about $140 per member, per23 month. That then becomes a revenue for24 the program for the year, and that's done25 253 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 on a monthly basis.2 If the City can manage within3 that, we are then allowed to take the4 savings and reinvest them back into our5 system. If we go above that, we then have6 to go into our contractually-mandated7 reserves to cover that.8 So we do get a set amount based9 on the number of people that we have in10 that program.11
We have two types of14 reserves that we have to carry. One is15 called an equity reserve; it's 5 percent16 of medical -- of revenue, I'm sorry, and17 that's about $35 million.18 And then we have to have a risk19 and contingency funds, which is 45 to 7520 days of paid claims. And right now, we're21 at about 58 days of paid claims.22
Okay. Of23 the children that you serve, are any of24 those uninsured that could be insured? Is25 254 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 there any eligible population there?2
For the most part,3 children are insured, and we don't have as4 big an issue for -- with uninsured5 children.6 The real difficulty is more of7 people who are adults, particularly8 substance-abusing male adults, who are9 coming out of the criminal justice system.10 And so, we tend to be able to serve11 children.12 Dr. Schwarz mentioned in his13 testimony the issue of immigrants, or14 undocumented individuals. And that is a15 concern for us.16
Earlier in the week,18 I met with a group of African and19 Caribbean individuals who are very20 concerned about people who can't get21 insurance and what that means for access22 to care. So that is an issue.23
What is24 your public outreach investment in trying25 255 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 to get people insured who may be in our2 system that are uninsured? And I was3 going to ask this of Dr. Schwarz; I didn't4 get back on time.5
Sure. Well, we're6 very aggressive at doing that because the7 way our funding works is that when people8 have medical assistance, that is an9 entitlement. So as the population grows,10 so does our revenue.11
The uninsured, on13 the other hand, is a capped allocation,14 and so we get a set amount.15
And, in fact, over17 the last several years, we've been -- that18 allocation has been cut. This year, we19 received -- the current fiscal year that20 we're in, we received a cut. We're21 projecting another cut next year.22
It's about 225 256 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 percent. It's about $2 million for both2 mental-health and substance-abuse3 services.4
Did they8 get a cut in the federal allocation?9 (Timer bell rings.)10
They got -- they11 received less revenue than they had12 projected. And so, they had to come back13 to us and say, based on their new revenue14 projections, we would have to sustain a15 cut.16
But how24 much does that represent in terms of25 257 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 money?2
Well, it was3 $2 million that we cut from a variety of4 places.5
Thank you,10 Madam President.11 Good afternoon, gentlemen.12
I just want15 to be clear that you understand the tenor16 of Councilman Goode's questions. We're17 all paying attention to the involvement of18 disadvantaged businesses. And the19 specific request is not only knowing who20 the subcontractors are, but also knowing21 who are prime and who are subs.22
Yes. We do -- our23 contractors are not allowed to sub out the24 work that we contract with them for. So25 258 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 they may have contracts, as Councilman2 Goode suggests, for I don't know, toilet3 paper or other kinds of goods and4 services, to run their facilities.5 But they are not allowed to then6 turn around and sub the work out to7 another provider.8
Okay. Just9 as a matter of record, one particular10 major provider has come to my attention11 over the last number of years, the Public12 Health Management Corporation.13 So I've introduced a resolution14 calling for hearings to see how they15 conduct their business in that area.16
This18 morning, a discussion also centered around19 the CHIP Program and doing all we can in20 the City to ensure that we capture every21 young person that qualifies.22 What in your system handles that23 type of process, young people or children24 who come through any of the Behavioral25 259 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Health doors? What is done internally to2 get them enrolled in the program so that3 they're benefiting from this service?4
If you're talking5 about CHIP, we don't have a particular6 mechanism to encourage that other than,7 you know, encouraging people to get their8 children insured.9 In terms of medical assistance,10 there are a lot of doors that families11 come through in which we can encourage12 them to get health insurance, whether13 that's a women and children's treatment14 program or through their schools or those15 kinds of things.16
So17 encouragement means what? Talking with18 them, providing the specifics, encouraging19 them, actually urging them to take20 advantage of this service so that their21 children are insured.22
Okay. Can24 you provide to the Chair a listing of all25 260 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 your drug- and alcohol-treatment2 providers?3
Okay. I5 have a case that's four years old. It6 came to me by way of a mother in despair7 over the last six months. And I've been8 working on another case that's now at9 least two years old.10 Both children have autism, and11 they have met with many impediments,12 hurdles, and hoops with the School13 District, of which I've also alerted the14 School District.15 My question is: In your16 testimony, you state that you have a long17 history of partnering with the18 Philadelphia School District to meet the19 behavioral needs of students. Discuss20 with me what happens when a child comes to21 your attention that has autism.22
Well, there's been23 some recent legislation that I think is24 going to make it much easier for children25 261 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 with autism to get services.2 Currently, we do provide, or pay3 for, services for children who have4 autism, who have medical assistance. So5 if you have a child who has autism and6 needs services, you can let me know, and7 we can intervene.8 What the legislation does,9 though, is that it requires people who10 have private health insurance to -- it11 requires those insurance plans to cover12 those children for the first, I believe,13 it's $30,000, and then they kick into14 medical assistance.15
Let me stop16 you right there. I want to make sure I17 understand that.18 So those dollars will follow19 that child even if the parent decides that20 there's no Philadelphia-based school to21 meet the child's needs; is that what that22 $30,000 pays for?23
I believe so. I24 think the private insurers are trying to25 262 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 figure out what their network of services2 are, so I can't speak to that.3 What I can speak to is that we4 do have autism providers within our5 network.6 (Timer bell rings.)7
And I think if you8 have a child who's having difficulty9 accessing services, you can certainly let10 us know and we can work with you and work11 with the family to try to identify12 appropriate services.13
I'll14 certainly have an offline discussion with15 your designee on those two cases.16
You're23 welcome.24 The Chair recognizes Councilman25 263 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Jones.2
Senator3 Hughes does a conference annually called4 "Breaking the Silence," and I had a5 opportunity to attend it. It deals with6 the reluctance people have to admit to7 mental illness or mental-health needs of8 themselves and family members.9 But as a part of the conference,10 one of the specialty groups that he drew11 attention to were senior citizens who, for12 abandonment, loneliness, or other issues13 suffer depression. And I wanted to know,14 of that group as well as the Asian15 population of immigrants that have come to16 this country that have language barriers,17 how are we approaching those two special18 populations?19
Sure. Let me start20 with the aging population. We have, over21 the last couple of years, had a Behavioral22 Health Alliance for Older Adults. One of23 the challenges we have is that, because we24 are the Medicaid provider and not the25 264 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Medicare provider, most of the care for2 older adults really rests with the3 Medicare HMOs. Nevertheless, we do have a4 number of people who are within our5 treatment system who are older and would6 we've worked with.7 The Behavioral Health Alliance8 for Older Adults is a partnership between9 our department, PCA, the Corporation for10 Aging, some of the HMOs who serve older11 adults, and the University of12 Pennsylvania. And the idea is to provide13 outreach and information to connect people14 to services that they need and to provide15 some assessment.16 As you know and as you17 mentioned, for older adults, one of the18 things that happens is that people become19 very isolated. And what this program20 does, or what this initiative does, is to21 evaluate people -- or to screen people, I22 should say, within certain settings that23 older adults find themselves and then24 connect people to services as they need25 265 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 'em.2 Last week, we submitted to the3 State Department of Public Welfare a4 proposal to expand that program or to5 continue that program to the next level.6 So while we don't have primary7 responsibility for the older-adult8 population, there are a lot of things that9 we're trying to do. I've personally done10 presentations to coalitions of individuals11 who are working with older adults, to both12 hear what some of the issues are and to13 also to look at possible ways that we can14 continue to strategize with them.15
And I16 appreciate those efforts above and beyond17 the insurance restrictions.18
But what do20 we do today when a senior calls in and21 says, "I'm lonely. My family has left me,22 my friends have passed on"? Is there a23 central point where we can contact and24 refer them to that is City-based or25 266 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 federal-based or state-based that we2 should refer them to?3
Sure. You could4 refer them to our 24-hour line at CBH, and5 I can get that number for you; I don't6 remember that number right off.7 And then we also have a variety8 of other resources. We have a suicide9 hotline which operates 24/7, 365 days a10 year.11
We also have a13 website for family members who are14 interested in finding out what service are15 available. It's called Networks of Care,16 and if you just Google "Networks of Care"17 and type in "Philadelphia," our website18 will come up.19 You can search on all of the20 resources in the City. You can put in21 your zip code, you can put in key words,22 and it will give you back all of the23 licensed options for those treatment24 programs.25 267 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
And as we get2 through these years of this3 administration, I'd like you to expand4 upon what the options are for seniors --5
--7 particularly in light of the challenges8 that you have toward Medicaid, Medicare.9 But we need to bridge those gaps, work10 with the federal government and the state11 government to find unified ways,12 cost-effective ways to address this13 population, because the demographics14 suggest that we are aging and graying.15 And so, these services are going to have a16 greater demand in the future as opposed to17 less.18 In your testimony, you talked19 about transformation of facility-based20 treatment.21 (Timer bell rings.)22
And I wanted23 you to elaborate on that and kind of give24 us --25 268 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
You talked3 about the transformation of facility-based4 treatments. And I'm assuming --5
Sure. So one of the6 things that we're doing that's happening7 in our field is a move away from simply8 what we would call managing symptoms, so9 sort of a -- and this is an overstatement,10 but a traditional way of sort of looking11 at treatment is the reduction of12 symptomatology.13 So if you are hearing voices,14 you know, the goal is to get you to stop15 hearing voices. And, obviously, that's16 very important.17 But there's a greater18 recognition that our role doesn't end19 there, that really what we need to do is20 to help people become better integrated21 and more independent within a social22 context.23 And the analogy that I would use24 is that if I were to break my leg, I25 269 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 wouldn't want just my leg to be healed; I2 would also want to walk and to run and to3 do all of the things I did before, that I4 would want to fully recover. And so, in a5 similar way, the behavioral health field6 is saying we need people to fully recover7 to be independent, high-functioning8 individuals.9 And, historically, we've had a10 system that is really focused on managing11 symptomology, keeping people sort of out12 of hospitals. And so a lot of services13 were facility-based. People came into14 those programs, they had their therapy,15 and then they went back home. And really,16 nothing changed a lot in their life.17 And so we've undertaken, I18 think, a really cutting-edge initiative to19 say we want our providers to change their20 roles from simply providing treatment to21 really being coaches and people who can22 help facilitate the recovery processes,23 which means they have to be in the24 community.25 270 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 And so, I'll give you a couple2 of quick examples. We have staff who --3 in our providers who take people out and4 help them learn how to use public5 transportation, help them learn how to use6 the library system, to learn how to get7 jobs, and those kinds of things.8 So it's really moving out of9 these facility-based programs into the10 community and helping people to be better11 integrated into the community.12
I've13 interrupted you from telling me how you're14 dealing with cultural and language15 barriers.16