Because one18 of the things we found out was the19 acceptable norms within certain20 communities are not the same as21 traditionally here in America. We have22 relationships between father-daughter,23 husband-wife.24
We are -- we have --4 we're making a -- we're putting a5 tremendous amount of effort into the issue6 of culture and how that impacts upon7 service delivery. And you had asked8 specifically about the Southeast Asian9 community.10 Three years ago -- well,11 actually, four years ago, we met the Asian12 community, and one of the things that we13 agreed to do with them is that they would14 create a task force specifically looking15 at issues for their community.16 They came back to us with a set17 of recommendations that we agreed to18 implement. And we've continued to do19 that.20 And so we have this, again, a21 very strong commitment to this issue, and22 we continue to do that work.23 I personally attend a lot of24 events in the Asian community so that we25 272 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 begin to develop those kinds of2 relationships.3 And you said something very4 important. You said that people see these5 issues very differently.6 So, in Cambodia, for example,7 and Khmer, they don't have a word for8 "mental illness." And so, when you're9 talking about working with different10 populations, you need to know that. If11 there's not a word for what we do and12 you're trying to work with those13 communities, you're just not going to be14 as effective.15 And so, we've worked very hard16 at making those connections, modifying how17 we deliver services, and really listening18 to people. I think that's very important.19 And so we spend a lot of time just20 listening to people, going to events, and21 making sure that they know what we're here22 to serve them.23
Thank you,24 Madam President.25 273 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
You're2 welcome.3 The Chair recognizes Councilman4 Green.5
Thank you,6 Madam Chair.7 You testified that your8 department supports the City's efforts in9 managing the prison population through10 early parole and the diversion of11 individuals into treatment, and we heard12 from the Prisons Commissioner earlier this13 week about the creation of a mental health14 court to provide intense supervision of15 mentally-ill offenders on probation and16 parole.17 What's your involvement in this18 project?19
We're very involved.20 I have several staff that are involved in21 that project. I'm personally involved in22 that project.23 I meet with various judges. The24 President Judge, for example, of Municipal25 274 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Court, is very involved in that. The2 Supervising Judge in Common Pleas Court,3 the Criminal Justice Supervising Judge.4 So we're very involved in that.5 And I think, as I mentioned when6 I was in my response to Councilman Jones,7 I think we have a level of cooperation8 that I've not seen before around this9 issue of how do we deal with people with10 mental-health problems who find themselves11 in the criminal justice system.12 Where we're at now is, we have13 developed a set of services that we can14 actually divert people into. We've been15 working with the Public Defender, the16 District Attorney, and the Courts in17 identifying people who are in the Prison18 System who could, and should be, and could19 be better served by getting them into a20 treatment setting.21 And so what we've done so far is22 sort of a precursor to the mental health23 court that ultimately the court wants to24 establish.25 275 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
What's the2 cost of putting somebody in that kind of3 treatment versus prison?4
We haven't done a5 per-person cost. I think it depends a lot6 on sort of the set of services that you7 put around the person. Certainly, we8 could, you know, calculate what an average9 cost is.10 But for individuals who have a11 solid home situation or are residents, the12 costs are going to look different than a13 person who might be homeless, and so, you14 kind of have to factor all of that in.15
Well, I'd16 like you to factor it all in, and please17 provide it to the Chair, because it seems18 like it has the potential to provide19 services that are needed in the community20 but also potential savings. Or even if21 it's not a savings, if it's a wash, it's22 something that should be promoted.23 And I just would like to know if24 you have enough resources to -- if you're25 276 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 satisfied with the resources you have2 available for this activity at the moment.3
I can tell that you4 we believe we need more resources. And,5 in fact, we have submitted a proposal to6 the State to expand residential options7 for individuals who might be eligible for8 this program. So --9
Well, that's10 an important point you're making. We pay11 for people in our prisons unless they're12 sent to State prison, right?13
And what15 you're saying is, there's potential State16 reimbursement for putting people in17 treatment rather than in our prisons.18
Right. Well,19 anything that we do at the Department20 practically will save the City General21 Fund, because 99 percent of the dollars in22 the Department are State and federal23 dollars. So to the degree that we are24 able to move people into treatment is a25 277 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 direct savings to the City General Fund.2
Well, so, how3 do we help you accelerate this program?4
And how much6 do you anticipate to save? This program's7 just coming up, but it will be in, you8 know, sort of more experienced full swing9 in 2010, how much do you -- how many10 people do you anticipate taking out of the11 system in 2010?12
Well, the team that15 we -- we've created something called a --16 a sort of Community Treatment Team, which17 is an evidence-based practice.18 (Timer bell rings.)19
And we can put 7520 people on each team. And so, our21 commitment to the court right now is that22 we will -- we have created that team, and23 our goal to take 75 people out over the24 next several months.25 278 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 I'm not sure that we can do that2 within this fiscal year, but I think3 fairly closely, within maybe the end of4 the summer, we should be able to do that.5
For this year. If8 we're talking about FY '10, you know, our9 hope is that we would double that and have10 another team of 75 that we could bring, so11 that we could bring another 75 people out.12
Okay. Thank17 you, Madam Chair.18 So with respect to the savings19 in the City side as a result of your20 activity in this area on an annual basis,21 if you could please provide that to the22 Chair.23
And, also, if25 279 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 the Administration could let us know if2 those savings are reflected in the FY 20103 Prisons Budget Appropriation request; and4 if so, point to exactly where.5 Thank you.6
Thank7 you.8 The Chair recognizes9 Councilwoman Sanchez.10
Can I do11 a point of information first?12 (Laughter.)13
'Cause14 there's something that Councilman Green15 said that I think it's important that gets16 clarified.17 We have a captive allocation for18 the people that are on Medicaid, so --19 'cause you talked about potential revenue20 resources. We already are capped at what21 we're going to get for these individuals,22 right?23
We're capped at the24 per-member, per-month amount. We're not25 280 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 capped at the number of people that will2 come in.3
And that's important5 because there are more and more people6 going onto the Medicaid rolls as the7 economy worsens. And so, our revenue is8 going to grow, but also the demand on9 service is going to grow.10
Right,11 right, right.12 So it's important to know,13 'cause one of the things that we're14 looking for, and maybe you can, if you15 don't have it with you, provide it to the16 Chair, where are the fees in your revenue17 generators as a result of those services?18 When we provide additional services, our19 reimbursement, are we hundred percent20 reimbursed, or are we subsidizing any of21 those services?22
What --25 281 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 through CBH?2
Okay. So5 that's an important notation because that6 means that --7
-- our9 goals should be to get more people10 serviced --11
--13 because then those folks become fully14 subsidized individuals being served.15
So in17 light of that, what are we investing to18 get there?19
In terms22 of our prevention services, what are we23 doing to do more intervention with people24 can and get 'em on those pipelines?25 282 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
What are3 we investing?4 'Cause that has a return. If we5 have folks that are kind of floundering in6 three different departments, we're not7 getting a full reimbursement versus if8 that person is attracted and allocated9 correctly.10
And so, just so I'm11 clear on what you're saying.12 So for individuals who, say, may13 be homeless or in the criminal justice14 system, how do we get them tracked so that15 they are sort of fully on the state and16 federal dollars as opposed to --17
Okay. And I think19 it goes back to what I said in terms of20 working with other City departments. So,21 for example, if you take children for22 example, we meet every Tuesday.23
Myself, Commissioner25 283 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 of DHS, often Dr. Schwarz, our staffs, and2 the School District, and we go over3 children who are cross-systems children,4 children who are in multiple systems --5
Let me6 ask you, is that done -- that's a question7 for Councilman Green. How are we8 cross-referencing those lists and9 protecting people's privacy to make sure10 that we're capturing everything?11 While I appreciate the12 high-level discussion, 'cause I think it's13 important in terms of how we -- what we14 set as policy and practice. How are we15 making sure that stuff isn't falling16 through the cracks in terms of using17 technology for that?18
I think there are19 two parts to that question.20 So part of the question is, in21 those -- even though we have high-level22 discussion in those, we also talk to23 specific children.24
Okay.25 284 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
And we talk about2 how we need to wrap services around those3 kids and what's the appropriate funding4 stream for each particular child.5 So it's not a high-level,6 theoretical discussion; it's a very7 practical discussion.8 And, frankly, the reason that I9 sit in the room and Dr. Schwarz and other10 folks is that a lot of times, it comes11 down to policy interpretation, policy and12 what is going to be paid out of -- you13 know, what service is going to paid out of14 what pot.15 And so, again, those forms are16 used to do that kind of discussion so that17 we are directing kids -- or, in this case,18 kids to the appropriate funding stream and19 making sure that we are maximizing any20 kind of federal and state dollars.21
Okay.22 'Cause one of the things you mentioned as23 it relates to adults was the expansion of24 residential options.25 285 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 In light of some of the siting2 situations that we've had, what is it3 that -- what policy changes are you making4 to ensure that as we place these5 facilities in neighborhoods and then the6 not-in-my-backyard situation comes up,7 what are we doing as we contract with8 these providers around that siting in9 terms of policy?10
Well, our policy and11 our expectation is that providers will12 work with the community that they are13 siting their programs in. Often, we don't14 know when a provider obtains a site. For15 example, for --16 (Timer bell rings.)17
I know,18 and I guess that's my question. What are19 we going to do different in terms of what20 you put in your contracts for the21 providers before we get to a situation22 where we have to do some regulatory stuff23 here in Council, which will impede your24 ability to do your job well.25 286 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 So my thing is, what is going to2 be put in our new contracts July 1st to3 ensure that that gets done better --4
As you10 know, I'm being pushed for regulation --11
Councilwoman, I15 completely understand. We've had a lot of16 these discussions.17 You know, our ability to site18 programs -- and we don't site programs; we19 fund providers who site programs -- is20 already impeded because of community21 opposition and people, frankly, just not22 wanting services in their community.23
And, frankly, I25 287 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 would love to see some kind of citywide2 policy on this issue because it is3 becoming increasingly difficult for us.4 And, you know, the question5 about expanding residential options, I6 would love to do that, but I also know7 that it's going to be very difficult even8 if we get the money from the State.9
I can tell you, our11 experience is going to be that it's going12 to be very difficult for us to site it,13 even if we have the resources.14 And so, I would love to see a15 citywide policy around how we site these16 programs, how we distribute them around17 the City. We try to do that in the18 most -- in the fairest way that we can.19 We now look at data, we look at20 sort of the distribution of programs, and21 we develop our RFPs based on where -- the22 parts of the City where we don't see those23 services.24 And in terms of what we ask of25 288 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 the providers, we put into our RFP that2 one of the things that you have to do as a3 provider is to meet with the community and4 get community support, and that's a5 position that we'll continue to maintain.6
I'd be7 interested in what policy8 recommendations -- what other cities are9 doing as it relates to that, because that10 language is not enough, and it's not --11 what's going to happen is, as a result of12 some of the issue we've had recently is,13 you're going to have more and more civic14 groups engaged in this process, and we're15 going to have more and more unproductive16 discussions.17 So really would like -- and I18 think it's important that the City at this19 time, in addition to your analysis of20 around where the programs are in the City,21 the distribution versus the need, because22 one of the -- you know, I acknowledge that23 I probably have a greater need, but that24 doesn't mean that I should have the number25 289 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 that I have.2
But in5 light of that, I think that we should try6 to look at other best practices in other7 cities and institute some policies around8 that, because without that, the language9 that you have in terms of meeting with the10 community is not enough right now.11
Well, we can do19 that, we can do that, but my point is that20 it would be helpful to have your21 perspective around that because you22 clearly have some ideas and views about23 it. And so, we can certainly come up with24 something, but --25 290 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
'Cause I2 think one of the things that -- and,3 again, this impacts the zoning and some of4 the other situations.5 One of the things that we have6 to be able to see is -- I mean, one of the7 things -- what are the loophole that8 people are going from rooming houses to9 halfway houses to treatment houses because10 they've figured out that's the easy way to11 site yourself in some of these12 neighborhoods.13 So, again, we -- I think there14 should be a special task force that's15 really put together on this so that we can16 more proactive because what's going to17 happen is -- you know, I'm on elected18 official, I got to get elected. I don't19 want to walk into meetings with a thousand20 people screaming at me because we haven't21 been proactive in saying, okay, what is22 the distribution that we're using in light23 of the fact that all the studies show that24 smaller residential situations are better25 291 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 for the people that we're trying to treat.2
We agree with that,3 but I have to tell you that even when4 there are two- to three-person facilities,5 we get community opposition. We get6 community opposition for services for deaf7 children, two- to three-family home for8 deaf children.9 So, again, I would love to10 get -- hear your views about that.11
The16 Chair recognizes Councilman Rizzo for a17 point of information.18
You just said19 something that got my attention.20 I don't think the community is21 necessarily opposed in all ways to the22 core of those facilities. I know that I23 lived in a community that was going to24 have a facility; I'll leave it unnamed.25 292 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 It wasn't the facility that was2 the problem; it was the people that were3 coming to the facility, that created the4 nuisance in the community. So I think we5 have to be fair about the community and6 their true concerns.7
I think that that's8 fair.9 And I think, to put this in10 perspective, we have literally hundreds of11 facilities -- not we --12
But we fund hundreds14 of providers who have facilities all over15 the City and, for the most part, you don't16 hear about them. They're in the17 community, they a part of the community.18 People aren't opposing them.19 And so, I absolutely agree with20 you, Councilman, that I don't want to21 paint too broad a brush.22
But it's becoming24 more challenging is the point that I'm25 293 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 trying to make.2
I hear you,3 but you also have to be in the shoes of4 the community when they accept a facility5 and then the part that they didn't know6 about was what was going to follow it.7
We agree. And when11 that happens, we are very active in trying12 to make sure that those issues get13 resolved.14
Thank you,19 Madam President.20 Let me underscore the21 suggestion, recommendation, perspective22 that's been offered by Councilwoman Maria23 Quiñones-Sanchez.24 I welcome that sitdown to talk25 294 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 about how we look at this from a citywide2 perspective, because everybody is saying3 "not in my backyard."4
And that's6 unacceptable.7 To Councilman Jones' point, when8 the Prison officials were here, if we are9 serious about intervention and doing some10 things differently, besides putting our11 residents in jail, then we also have to be12 serious about figuring out how we13 accommodate them in the communities where14 we live.15
So I17 welcome that discussion.18 And I'm hear to hear that the19 various departments that affect children20 are talking across systems. When I came21 here nine years ago, it was not happening.22
And so, I'm24 delighted to hear that.25 295 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 I want to revisit this question2 around children with autism, and I'm3 pleased with your willingness to deal with4 these two cases, but I need to know what5 the standard operating procedure is when a6 mother has hit some brick walls at the7 School District. Where in your system can8 she go to, and who then takes her hand and9 walks her through the system to avoid10 these impediments:11 An application process that is12 extremely lengthy, with timelines attached13 to it around medical evaluations;14 Finding an outcome that is15 tailored to the child's needs, even if it16 means sending that child out of the17 county.18 What these parents have19 experienced is some unwillingness or20 resistance by the School District to not21 want to send the child out of the county22 and/or where they are sent is a23 babysitting service.24 And that's a quote from two25 296 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 parents.2 And the entire process, from3 where I sit, seem extremely time-consuming4 even for those parents who are being5 agents for their children.6 So where in your system does the7 process start, and how is that parent8 shepherded through the process so that not9 four years later, they're still trying to10 get a placement for their autistic child?11
Right. So I --12 again, that process has changed a little13 bit with the recently-passed legislation.14 What I would say is this:15 Obviously, we don't have control over the16 School District.17
And if people are19 having those difficulties, there's not a20 lot that we can do about that other than21 to reach out to our colleagues who have22 been enormously responsive to us and try23 to work it through that way.24 What I would say is that if you25 297 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 have those situations, or if there's a2 person in the community, that the simplest3 way to deal with it is to call us. I will4 give you our CBH number: 888-545-2600.5
And they6 get a person on the other end of the line?7
They will get a8 person on the other end who can advise9 them as to the process, and we will take10 it from there.11
Okay. What12 department at the School District is at13 the table for young children who come to14 the attention of several different15 systems? What department?16
Well, we meet with17 several different people. Brenda Taylor18 is a --19
Yeah, as a primary22 person that we work with, but there are23 other people as well.24
Okay. On25 298 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 of your budget, there's a $695,0002 increase for Socio-Emotional Learning3 Family, Incorporated for Homeless4 Services. So that's a substantial5 increase. And I don't know if you have6 the --7
So how13 might they differ from the important work14 of OESS?15 (Timer bell rings.)16
Michael Cavone,17 Deputy with the Department.18 This organization is19 self-organization. That's what the20 acronym -- that's what the organization21 stands for.22 They actually developed this as23 part of the Mayor's Homeless Plan last24 spring, a safe-haven facility. Again, the25 299 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 intent Dr. Evans was talking about earlier2 is taking individuals directly from the3 street into housing through the engagement4 process.5
I didn't recognize11 the name either until I looked at all four12 letters.13
Alphabet14 soup. We know about that.15 Thank you, Madam Chair.16
You're17 welcome.18 The Chair recognizes Councilman19 Green.20
Thank you,21 Madam Chair.22 I have almost the same exact23 questions that I had on the mental health24 court on community drug-treatment placing.25 300 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 In other words, I think the Commissioner2 testified that drug- and alcohol-treatment3 evaluators have been moved into the prison4 complexes. Are you involved in that as5 well?6
We're -- we work7 with the Prison System to create really a8 continuum, so that the Prison has a9 program, Behind the Walls. They actually10 have couple of programs in Behind the11 Walls, in which there is intervention12 around people's drug and alcohol problems.13 And then we work to make sure14 that when those people come out, that they15 transition into services in the community.16
Is the17 program Behind the Walls reimbursed in the18 same way that a program outside the walls19 is?20
No, it can't be. So21 I'm not exactly sure how they fund that.22 I'm not sure if they use some grant23 dollars or the City General Fund.24
If the25 301 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Administration could get back to us about2 that.3
There is -- I should4 say the methadone Behind the Walls Program5 is something that we do fund.6
Oh, okay. Do11 you know how many inmates are currently12 awaiting placement in community drug-13 treatment centers?14
If the16 Administration could provide that.17 And then, also, I think I know18 the answer to your question, but whether19 or not there's sufficient community20 drug-treatment centers in the City.21
Well, I think -- I22 should sai that I think there is a lot of23 capacity in our system. I think the issue24 is that at the right capacity.25 302 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 So one of the things that we've2 done over the last couple of years is to3 take excess capacity in certain services4 and make it a much more specialized5 service.6 So, for example, in my7 testimony, I talked about chronic homeless8 programs. Those programs were existing9 programs that were underutilized. We10 asked the programs to change their design11 so they could target specifically the12 homeless individuals, and they've been13 enormously successful at addressing those14 needs.15
Okay. So if16 you could also just give us the cost17 differential between having an inmate in a18 community drug-treatment center versus19 prison.20
Same sort of22 question.23 Obviously, if we're looking at24 moving people who have mental-health25 303 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 problems that have put them into the2 prison system, we should be perhaps3 looking at, especially where we have4 non-violent offenders involved in the5 prison system, looking at moving people6 into treatment centers versus prison in7 terms of, you know, helping them.8 And I also, once again, believe9 we would see a return on investment for10 that decision.11
We do. And, for12 example, the Forensic Intensive Recovery13 Program, which has been in existence for a14 number of years, we see all kinds of15 returns for that program, which gets16 people out of the criminal justice system17 into treatment earlier.18 There's a decrease in recidivism19 for those individuals, it saves bed days,20 and reduces criminality.21
Okay. Well,22 that's great. But what we're looking at23 is, how can we expand these programs and24 save money in the General Fund and provide25 304 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 better service to our citizens with state2 and federal dollars.3
To7 specifically arrange those -- well, yeah.8 I mentioned that there are a couple of9 proposals that we have before the State10 now to expand our ability to serve those11 populations, so we're constantly looking12 at those options and putting proposals13 before the State.14
Okay. And if15 the Administration could provide us with16 data about the savings we would receive in17 the General Fund as a result of having a18 lower prison population or whatever as a19 result of the getting those State grants.20
And the22 likelihood, in your opinion, of getting23 those State grants.24
So the detail2 indicates that a federally-funded Cost3 Reimbursement Grant for DBH from the4 Philadelphia Health Management Corporation5 is being reduced by 50 percent. Why is6 this grant funding stopped?7
The Cost24 Reimbursement Grant from DBH to25 306 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Philadelphia Health Management Corporation2 is reduced. Why this grant fund dropping?3
Philadelphia Health10 Management Corporation received that I11 believe was running -- it was anticipated12 to run its course over a four- or13 five-year period.14
Okay. Are we15 leaving money on the table by not16 spending?17
No. It may be a24 problem in other departments; we don't25 307 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 have that problem.2
With respect3 to grant funding specifically, though, are4 you aware of any instances where we've not5 spent a grant and then ended up having it6 --7
No, we don't,8 because one of the things that we do --9 actually, our providers actually incur10 more costs to provide the services than11 we're able to reimburse them. So we don't12 run into a situation where we're actually13 leaving money on the table.14
Okay. And on15 of your testimony -- last year, you16 testified that the Department's target17 recidivism rate for FY '09 was 15.518 percent, the same as FY '08 and higher19 than the national Medicaid standards of20 10 percent.21 What's the final recidivism rate22 for FY '08, and are you on track to meet23 the FY '09 goal?24
The percentage --25 308 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 the recidivism rate is comparable to where2 it was last year. We're doing a number of3 things, some of which I mentioned in my4 testimony, to reduce that.5 When we're able to reduce wait6 times to get into outpatient care, that7 reduces the likelihood of recidivism.8 When we use evidence-based practices like9 cognitive therapy, we're better able to10 retain people in the treatment and have11 more effective treatment.12 So we're using multiple13 strategies to reduce our overall14 recidivism rate.15 The last thing I'll mention16 about this is that I mentioned that we're17 doing provider profiling because one of18 the things that we need to do is to not19 just look at one generic number but really20 look at how each provider does in that.21 And simply by looking at the22 individual recidivism rates, what we found23 is that there's some providers that are24 actually pretty good and well within our25 309 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 -- the target that we're trying to get.2 And there are other providers that are3 not.4 And so that gives us the ability5 now to go back and look at what are the6 practices for those providers who have7 lower rates versus the providers who have8 higher rates.9 So my point is that we're doing10 a number of things to try to reduce that,11 because, frankly, it costs us money when12 people recidivate back into those higher13 levels of care.14
It depends. If it's17 a Health Choices vendor, we pay them on a18 fee-for-service basis. If it's a grant19 provider, we pay them through a grant20 mechanism.21
And in terms22 of paperwork, what are they required to23 send you and how do they get paid?24
Through Health25 310 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 Choices, it's the typical billing2 paperwork. And most providers submit that3 information to us electronically. I would4 say 98 percent -- if you take out5 third-party liability claims, probably 986 to 99 percent of that is submitted to us7 electronically.8
Could you9 please provide data on that specifically?10 because what I understand from some11 providers is that there's a ton of12 paperwork to get paid, and it's a very13 inefficient process. That may be more DHS14 than you but --15
But what they17 have to do in terms of time, where people18 aren't -- administrative staff that's19 spent getting paid is significant, and20 they could -- would rather use those21 resources helping people.22
If I could just23 respond to that.24 I don't disagree with that. I25 311 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 think that we -- and there are two2 different issues. One is paying a claim3 versus what do we ask people to do4 administratively to participate in the5 program.6 And I think on that end, I think7 that there are things that we ask people8 to do that we can be much more efficient,9 and there are number of things that we've10 done.11 I mentioned the NIATx12 initiative. We are looking internally.13 Not only are we asking providers to look14 at their systems and be more efficient,15 but we're using those same process16 improvement techniques to look at our own17 process. We have an internal work group18 that's looking at how we reduce paperwork.19 We've already developed a more20 streamlined assessment form, and there's21 some other things that we're going to be22 doing.23 So we don't disagree with that,24 and we have some initiatives underway25 312 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 right now to do that.2
Is there any3 reasons those forms have to be on paper at4 all with your providers?5
Well, I think that's6 another great question.7 I would like to see us go8 entirely paperless. And, in fact, a9 couple of years ago, we gave providers10 many grants to convert their systems to11 make sure that they have the technology12 that they needed in order to be -- to13 completely to submit all of their14 information to us electronically.15 One of the things that we are16 doing is updating our website. It will go17 live in June of this year. And the18 infrastructure of the architecture of the19 website is such that we will be able to do20 e-business, because our goal is to, over21 time, over the next couple of years, move22 as much of our business processes to an23 electronic format that people can do24 across the Internet.25 313 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 COUNCIL PRESIDENT VERNA:2 Councilman, I'm sorry. Your time is up.3
Please4 provide the Chair with any cost-benefit5 analysis that's been done in your6 department in that regard.7 Thank you.8 COUNCIL PRESIDENT VERNA:9 Councilman Jones.10
Thank you,11 Madam Chair.12 Two real quick issues. One,13 what services do you provide for14 caregivers or the families of people that15 are housed with their -- people that are16 of need of service that are housed with17 families, what kind of support services do18 you give?19 And a kind of elaboration on20 Councilwoman Reynolds-Brown's point of21 children under 5 in public schools that22 find themselves in need of services, how23 do we support those two groups?24 The first one was caregivers.25 314 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1
Parents with6 dependent children that are in public7 schools.8
When you say9 "caregivers," are you talking about10 caregivers of adults or caregivers of11 children?12
Of both.15 Well, we have a respite program16 that was just funded this year to give17 respite to parents of the children who18 have serious emotional problems. And19 that's something that a lot of parents20 want and --21
That's, yeah, for24 people who have children who have25 315 4/22/09 - COMMITTEE OF THE WHOLE - FY '10 BUDGET1 seriously emotional problems.2
In terms of the5 caregiver or to the -- well, we haven't6 gotten to that point yet.7 I think the point of this8 program is that there are a number of9 families out there who have children who10 have very significant needs, and the11 parents need some respite, some ability to12 have some respite around that.13 And fortunately, through this14 grant, we're able to provide that.15