September 2003 NACBHDD Newsletter
The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors
In this Issue...
NACBHD Moves to the Next Level:
Organization Reviews Accomplishments and Prepares to Move Forward
NACBHD has made enormous strides over the past few years, despite the economic downturn, according to NACBHD’s immediate past President and current chair of the Infrastructure Committee, Jim Stewart. At a time when many organizations’ membership numbers and budgets have suffered, NACBHD has remained strong in both areas. (Membership is now 336.) Most significant, the organization has amassed a list of accomplishments that have allowed it to become highly visible in the national policy arena. Now, with a recently elected and diverse Board of Directors and a committee specifically appointed to address how best to redefine the organization’s infrastructure, NACBHD stands poised to further increase its visibility and influence at the national level.
Significant Achievements of a Maturing Organization
Stewart explains that NACBHD has taken great steps forward over the past few years, with many solid accomplishments that have made it a visible player at the national level, including:
The Infrastructure
Stewart explains that as a result of NACBHD’s maturation, the Board decided earlier this year to hire a full-time Executive Director. Tom Bryant has served as part-time Executive Director for the past eight years. Bryant is founder and chairman of Nonprofit Management, Inc. (NMI), of which NACBHD is a client.
In addition to the Board search for a full-time Executive Director, the Infrastructure Committee (composed of members of the previous Executive Committee) has been charged with reviewing what type of staff and logistical arrangements might be most beneficial to NACBHD. Options for staff and logistical support include staying with NMI, shifting to an arrangement NACo, or using another vendor.
A job description for the full-time Executive Director has been developed, with hopes of having an individual in the position by the end of the calendar year. Stewart notes, “With a full time Executive Director, we will be in a better position to continue the good work at the federal level by Bob Egnew over the past year and a half.”
Current Staff Arrangements
In the wake of Lauren Wolfe’s departure as NACBHD’s Deputy Executive Director, Tom Bryant and NMI have made Kemp Baker and Gwen Samelson available on
an interim, minimum cost basis as administrative staff for the organization, pending the identification and successful employment of a new full-time
Executive Director. Kemp has been with NMI for a year as the number two staff person with the Friends of the National Institute for Dental and
Craniofacial Research. Gwen just joined NMI part time to help with all client databases. Kemp came to us from the Carter Center, and Gwen from
the staff of Tipper Gore, so both have an interest in and knowledge of our substantive activities. They can be reached at (202) 234-7543, or
Kemp@nacbhd.org and Gwen@nacbhd.org.
New NACBHD Board Officers Hope to Build on Accomplishments, Widen Membership
The following members recently were elected to two year terms as officers on the NACBHD Board of Directors. Each discussed their professional experience and their activities with NACBHD, as well as their hopes for the organization over the next few years.
Deborah Donaldson, President
Donaldson oversees Sedgwick County, Kansas’ developmental disability organizations, the Department of Aging, the Department of Corrections, and COMCARE, the community mental health center, in her position as Director of Human Services for Sedgwick County. Donaldson recognizes that the structure and composition of human services departments, as well as the entities NACBHD members are involved in, can vary widely. (Her department also provides services for individuals with physical disabilities.)
Sedgwick County Services and Programs
As part of the senior staff in the county, Donaldson manages 800 employees and a $70 million budget. She believes her client base is in the thousands (Sedgwick County’s population is about 450,000) and she says, “We touch a lot of lives every year.” And she says, “I think we’ve been really fortunate to have a couple of large federal grants.” Donaldson has been involved in work with evidence based practices and Medicaid reform. In addition, her department has a $1 million fund focused on prevention, specifically on helping prevent youth from entering the criminal justice system.
Increasing and Widening Membership
Donaldson says that NACBHD has made “tremendous strides” as a viable entity at the federal level, and she wants to make sure that continues. Her hope and intent over the next few years is to develop and attract members in the area of developmental disabilities and substance abuse, and to increase visibility in both areas.
Enhancing the NACo Relationship
Donaldson is also very interested in continuing and enhancing the relationship with NACo. There are 22 states whose behavioral health services have a strong county connection; therefore, the relationship with NACo is an important one. In addition, NACBHD members may be involved in providing a variety of disability services, whether they are mental health, developmental disabilities, substance abuse, or some combination of those, such as Donaldson is involved in. She wants to present NACBHD as representing all entities.
The Importance of NACBHD Membership and Involvement
Donaldson notes that NACBHD membership is extremely important in terms of Medicaid funding and reform, and in terms of being “at the table” on federal issues. She encourages members to be involved in committees, as a means for valuable input and information sharing.
Donaldson previously chaired the Conference Program Committee, and has been a NACBHD member since 1995. She has been with the county for 29 years, and in her current position for five years. Prior to that, she was Director of COMCARE, and in this role, oversaw developmental disabilities services for the county. Donaldson is a licensed clinical therapist; and she has a Master’s in Psychology, as well as an M.B.A.
Margaret Hanna, President-Elect
Marge Hanna, Executive Director of the Bucks County, Pennsylvania, Drug & Alcohol Commission, also chairs the Legislative Committee as part of her duties as President-Elect. She will work with Bob Egnew, NACBHD’s policy consultant, on tracking legislation, and will chair Board meetings in Donaldson’s absence, as well as generally provide back-up for her.
Bucks County Drug & Alcohol Commission, Inc.
Pennsylvania is one of the 22 states with county based services. Bucks County, with a population of about 600,000, borders on Philadelphia and New Jersey. MH/MR is a separate department within Human Services. Although Hanna’s department is nonprofit (Pennsylvania allows for a private, not-for-profit option), it is the designated county authority for drug abuse treatment, and as such, receives and distributes all local, state, and federal funds designated for this purpose. Much of Hanna’s time is spent overseeing funds and bringing promising practices to the local level. She is also part of the county management team for Bucks County Behavioral Health Services, the entity that oversees public sector Medicaid for the county, a $27 million project. (Hers is one of a few counties who manage their own Medicaid funds.)
One of Hanna’s primary efforts and interests is working with the criminal justice system and with issues related to co-occurring disorders; and she will continue as a member of NACBHD’s Corrections and Substance Abuse Committees. The issues she faces in her county are similar to those faced in other counties -- individuals presenting as more seriously ill with co-occurring disorders, and with more serious medical problems, and jails continuing to have individuals with serious mental illness and co-occurring disorders who would be better placed in community settings.
Greater National Recognition and Wider Representation
Hanna hopes to work with other officers to “reenergize the organization,” and to follow-up on the strong foundation laid by Bob Egnew in making NACBHD “part of the Washington circle.” Her hope is to have greater county recognition at the national level, and to strengthen the relationship with NACo. She notes that hiring a full-time executive director is a first for NACBHD, and represents “the next stage of growth.” She would also like to see NACBHD grow in terms of its developmental disabilities and substance abuse representation.
In addition, Hanna says, “The biggest challenge is to get away from ‘silo thinking’ to how we can collectively address issues in a more collaborative and comprehensive way” -- to look for innovative ways for funding of integrated services and treatment and state of the art integrated programs.
Hanna is approaching her 30th year with the Drug & Alcohol Commission. Prior to her current position, she held other jobs within the commission; and she has her own business, Hanna Enterprises, through which she provides consulting and training at the national and state level in various areas, including strategic planning, prevention, best practices, leadership and management training, grant writing, and financial management of not-for-profits. She has an M.Ed. from Penn State.
Sherry Knapp, Secretary
Sherry Knapp, Chief Executive Officer, Hamilton County, Ohio, Alcohol and Drug Addiction Services (ADAS) Board, is the county government authority for alcohol and drug treatment and prevention services. Hamilton is the third largest urban county in Ohio, includes the city of Cincinnati, and has a population of about 900,00. In Ohio, separate county authorities manage MR/DD, mental health, and substance abuse, although the smaller counties merge mental health and substance abuse in one authority.
ADAS Board
Knapp’s department has responsibility for needs assessment, planning, development, funding, and monitoring of publicly funded alcohol and drug prevention and treatment services including Medicaid. In Ohio, state law forbids counties from providing services, so that a primary focus is how services are managed and directed through nonprofits, with services subcontracted through 20 different organizations.
One of Knapp’s major initiatives is performance based contracting – to prove that there is a benefit to the services funded – with certain elements, such as employment, stable housing, non-involvement with the legal system, and abstinence, as outcomes which are currently being measured and analyzed. Data will be used to help make adjustments in clinical work, in planning, contracting, and for strengthening the system. As Knapp says, “Are taxpayers getting value out of the money they are putting into the system?” She feels we need to do a better job of showing the value of services to policy makers and community members.
A Model Program
Knapp has already received positive feedback on a publicly-funded, countywide access system called the Recovery Health Access Center (RHAC), which offers a 24-hour phone number for access to the drug and alcohol service system. RHAC also provides clinical assessments and transitional support for persons awaiting admission to treatment. This is new for Ohio; not many counties are doing this. This more consumer-friendly and efficient program may be an example of a program that meets the goals of the President’s Commission on Mental Health. (See following article.)
Increasing Influence and Strengthening Alliances
As the Board looks forward, Knapp says, “I see NACBHD increasing its influence in the behavioral health field on a national level, forging a stronger alliance with state health directors, and improving the quality and lives of the people we serve.” She previously served as Chair of the Substance Abuse Committee and will continue as a member this year. She is committed to assuring that the goals and needs of the alcohol and drug service systems are adequately addressed by NACBHD and that county authorities facilitate successful development of effective services for co-occurring disorders.
Knapp has been CEO of ADAS for four and a half years. Prior to that she held managerial positions in other states -- as director of the state division of substance abuse for Rhode Island, and previously, as the clinical director of a community behavioral health center in Pennsylvania. She holds a Ph.D. in Psychology.
Chuck Benjamin, Treasurer
Chuck Benjamin, is Executive Director of the North Sound Regional Support Network in Mount Vernon, Washington. He was unavailable for comment at the time of publication.
Final Report of the President’s Commission on Mental Health: What Happens Next?
The final report of the President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America (www.mentalhealth.gov), was recently released. What happens next in terms of implementing the six “intertwined” goals set forth in the final report?
Work is underway in two key areas. After the Commission presented the final report to the White House and HHS Secretary Tommy Thompson, the secretary charged SAMHSA, under the direction of administrator Charles Curie, with conducting “a thorough review and assessment of the report with the goal of implementing appropriate steps to strengthen our mental health system.” (See July 22 press release at www.hhs.gov/news.) In addition, the Campaign for Mental Health Reform, a group of mental health advocacy organizations, is partnering to take advantage of an opportunity Campaign coordinator Bill Emmet characterizes as “once in a generation.”
NACBHD spoke with the Chair of the President’s Commission, Mike Hogan, Charles Curie, and Bill Emmet of the National Association of State Mental Health Program Directors (NASMHPD), about plans for implementation of the report.
Commission Chair Urges Local Authorities to View Report as “A Menu of Opportunities” Mike Hogan, Chair of the President’s Commission on Mental Health, emphasizes that for many reasons, implementation should start immediately at all levels – that it is a state and local responsibility, even though federal funding streams are involved. Transformation is the key rather than reform. He suggests “looking at the report as a menu of opportunities,” rather than waiting for something to be done at the federal level. With a system that is even more complex than it was at the time of the Carter Commission report nearly 30 years ago and with mental health care a decentralized responsibility and money in large federal programs like Medicaid and Medicare, implementation “from the top” is not the best way to think about the process, says Hogan.
“Everybody in a position of leadership ought to be looking at this as an opportunity.” Hogan believes county directors, depending on what’s on their plates, should look at the report in a “strategic and opportunistic sense.” For example, Hogan himself is looking for examples of what works in Ohio. He has found that in looking for more consolidated individual treatment plans, while no one agency may be able to affect this, the issue has started to be addressed powerfully in Ohio.
Recovery and Resiliency
The Executive Summary is a “crisp” document, but Hogan urges reading the entire final report for thorough information. There are many recommendations in the text, some of which Hogan characterizes as “powerful but ephemeral,” such as how to promote recovery as a shared value. Hogan says that the “headline” for the commission is the understanding that recovery and resiliency are possible, and that for many reasons, the service delivery system has not allowed for resilience and recovery. Hogan reports that this concept was really “driven home to the Commission” when Rosalynn Carter spoke with the Commission about the experience of the Carter Commission, and explained that what is substantially different from the Carter Commission years is the potential for individuals to recover from mental illness -- “a profound statement that we really reacted to.” In addition, the consumer voice was very strong in the fundamental notion that recovery is real.
Look for Future Commission Publications
Several future commission publications will be of interest to the field:
While Hogan has many related speaking engagements over the next six months, his role with the Commission has officially ended, and he emphasizes, “The leadership in the field has got to grab the ball now.” “The report is a treatment plan for a sick system, and recovery doesn’t happen when the treatment plan gets written.” He was gratified by the initial coverage of the final report and says that in terms of information dissemination about the report, “There can’t be enough.”
SAMHSA’s Role: SAMHSA and an Action Plan for Transformation
Hogan and the commissioners are “gratified by” Secretary Thompson’s designation of SAMHSA and administrator Curie in the implementation process,
noting that this signifies a strong, coherent response to the report.
Curie says he hopes to have the framework for an action plan for implementation outlined in the next two to three months, with Kathryn Power, who has extensive experience managing public mental health systems, as SAMHSA’s internal lead in facilitating the action plan. (Power is the new Director of the Center for Mental Health Services.) They will look at all that is currently occurring in the mental health system, together with the report recommendations, to assess the transformation goals. The action plan will be a document that is periodically updated, an evolving tool tied to the development process and federal budget. Key federal agencies that helped with the report will help with the transformation.
The action plan will dynamically address the concept of transformation – to move the system to be truly consumer and family driven, or as Curie characterizes it, “assuring that the system reaches a level of transparency,” instead of being viewed as “a mystery,” as became clear from the Commission’s report. Four characteristics of a transformed system would be:
He hopes that the action plan will begin strengthening existing partnerships and help build new partnerships, e.g. between evidence-based practices and academia.
What Can Counties Do Now?
Curie believes county directors should be thinking about how to strengthen linkages, e.g., depression presenting in primary care settings and appropriate linkages to mental health. In addition, there are models of mental health services in schools that work; Curie says these could be replicated.
Curie says, “Now the hard work is ahead of us -- to make sure we have an action plan that has legs and has an impact that concretely moves the field forward through realizing those goals.”
The Campaign for Mental Health Reform
Bill Emmet, project director, NASMHPD, will coordinate the Campaign for Mental Health Reform’s efforts related to implementing the goals of the final report. The Campaign, with a steering committee composed of the Bazelon Center for Mental Health Law, the National Alliance for the Mentally Ill, NASMHPD, and the National Mental Health Association, is a product of leaders of mental health organizations coming together to take advantage of the opportunity presented by the release of the Commission’s report and build on it. “Part of this [evolves] from recognizing the mental health community has not always worked together in the past, but when they have they can achieve significant things, like parity,” says Emmet. “We do see this as a great opportunity. We want to make sure the mental health field takes advantage of this.” Additional organizations are partnering with the Campaign, including NACBHD.
Working with, Supporting SAMHSA
Emmet says the Campaign is “eager to see SAMHSA become as much as a centralized leader in mental health policy as possible.” He furthers explains that, “If mental health is to be the national priority that the report says it is to be, there has to be a strong lead agency and we are prepared to help it become a strong lead agency.” Regarding funding issues in the SAMHSA reauthorization, Emmet notes the central emphasis is SAMHSA’s ability to control various funding streams more effectively to help the mentally ill around issues such as housing and employment.
The Campaign wants to work hand in hand with SAMHSA to help move the goals forward, and they are respectful of the time it will take to formulate the SAMHSA action plan. They want to help “push SAMHSA into the lead.”
Legislative Opportunities, SAMHSA Reauthorization
As advocates, the Campaign is still studying whether there may be opportunities to develop new legislation. However, Emmet also notes that it is important to look at opportunities on the Hill and what can be done legislatively – opportunities that may not appear to be overt goals of the report, but ultimately support the work of the commission, such as SAMHSA reauthorization, reauthorization of the Vocational Rehabilitation Act (which Mike Hogan cites as incorporating positive evidence-based practices) and the Criminal Justice and Mentally Ill Offender Treatment Act.
What Can Local Authorities Do?
For local authorities, Emmet says one of the central issues is the development of comprehensive state mental health plans. “If I were in a county, I would ask state folks what that process is going to be,” and be part of “stepping up to the plate to help with the development of comprehensive state plans.”
Future Campaign Plans
The Campaign is currently analyzing potential administrative and legislative actions; and they want to bring out a document to reflect the best thinking on those issues, projected for sometime in the fall.
In addition, the Campaign is looking for opportunities to do public opinion research (of the broad voting public) to help frame the argument for policymakers. The implications of the report go well beyond the mental health field, and the Campaign is hoping to capture the concept that mental health is basic to overall health in the public opinion research, as well as the more “ephemeral” concepts of stigma and recovery. While the average person on the street likely may not be aware that recovery from mental illness is possible, “we need to make policymakers aware that it is,” says Emmet. On a final note, Emmet says it is especially important for county authorities to convey to all the people they work with, from law enforcement to local business people, the message that recovery is possible.
Look for more information at www.mhreform.org in the coming months.
NACBHD’s Role
Tom Bryant, NACBHD’s Executive Director, and co-chair, with former First Lady Rosalynn Carter of the Carter Commission, notes NACBHD, as a partner in the Campaign for Mental Health Reform, is involved in the implementation in two fundamental ways: in building momentum for support of SAMHSA and administrator Curie and in “taking the Commission recommendations local.” Specifically,
Bryant says this involves:
Bryant hopes that the an outline of the SAMHSA action plan will be available by the time of the Rosalynn Carter Symposium on Mental Health Policy in early November. Ten to twelve NACBHD representatives will be attending the symposium for the first time.
From the Hill: Report from NACBHD’s Director of Public Policy, Robert Egnew
Dual Eligibility and DSH Provisions of Medicare Prescription Drug Bill Under Consideration
The 108th Congress goes into its final month of the first session beginning September 2nd, and the major issue they are facing is trying to pass
the Medicare Prescription Drug bill, which is in conference committee. Both versions of the bills are voluminous, and some of the provisions
are difficult to understand, or to interpret what their impact may be.
There are two portions of the Medicare Prescription Drug bill that is of particular concern to NACBHD members.
Premiums, Co-pays, and Gaps in Coverage
Both the Senate and the House bill require monthly premiums of approximately $35 and annual deductibles (S-$275; H-$250). Both bills have co-pays, with the Senate having a 50% co-pay, up to $4,500, and the House having a 20% co-pay, up to $2,000. Both bills also have some provision to provide low-income subsides for premiums and co-pays, if an individual is under the 135% of poverty line.
Both the House and Senate version also have gaps in coverage known as the “donut hole.” In the House version, coverage is up to $2,000 annual expenditure, and “catastrophic coverage” does not kick into until there has been an annual expense of $3,500. Therefore, $2,000 to $3,500 would be out of pocket expenses. The Senate’s version of stop-loss begins at $3,700.
Dual Eligibles
The House version of the bill also covers “dual eligibles,” while the Senate version excludes coverage for dual eligibles and continues having their
pharmacy costs reimbursed by Medicaid. This is a very significant difference between the House and the Senate bills. The National Association of
Governors (NGA) came out earlier this month strongly favoring the House version of the bill for this very reason. While this benefit would be phased
in over 14 years, it would ultimately provide an estimated $7 billion of fiscal relieve to states.
Impact Unclear
It is unclear how deductibles or co-payments would be dealt with for individuals with SSI, and if states or counties would have to provide funds to cover these costs for clients. It is also unclear how much of a benefit this would be for individuals who use primary psychiatric medications. Would the annual cost of the drugs exceed the initial threshold and fall into the “donut hole” coverage or not? Clearly a provision which includes dual eligibles is highly desirable, but how exactly it will impact state and local costs may have to be determined at some point in the future.
DSH
Both the Senate and the House version of the bill contain DSH amendments.
Since many states have billed portions of state hospital costs to DSH, this could be an important issue in any given state. The DSH provision would also provide some relief to large urban counties who operate acute hospitals.
It is unclear what compromises maybe made in the conference committee. Some people feel that the DSH amendments maybe deleted in order to reduce the cost of the total package. There is some concern in certain sectors that a compromise will not be reached and that the issue may die when the session runs out in October. Given that the Senate must pass all the appropriation bills, with the exception of Homeland Security, and that conference committees must reach agreement on each of the appropriations bill, it is unlikely any other major piece of legislation will pass during this session.
Developmental Disabilities: Recent News
From Mike Chambers, former chair of NACBHD’s Developmental Disabilities Committee, and Executive Director of the MH/MR Program Administration Association of Pennsylvania:
The National Council on Disability recently (September 9) launched its report “Foreign Policy and Disability: Legislative Strategies and Civil Rights Protections To Ensure Inclusion of People with Disabilities,” followed by a press conference and a panel discussion of the report. Speakers included Senator Tom Harkin, Congressman James Langevin, Co-chair of the Bipartisan Disabilities Caucus, and NCD Council Member Kathleen Martinez.
Lex Frieden, Chair of the NCD, stated in his invitation to colleagues: “In its report, NCD concludes that inclusion of people with disabilities in US foreign policy will be achieved only when specific legislation is enacted for that purpose. The principles of non-discrimination, access, and inclusion of people with disabilities have been established as civil rights under American law. NCD calls for Congressional action to ensure that these protections are applied to all US government activities abroad. The reforms proposed in the report are needed to ensure that people with disabilities are given the opportunity to fully contribute to US foreign policies and programs abroad. NCD recommends that Congress adopt legislation to ensure inclusion of people with disabilities in all US programs abroad. Such legislation would require that any program funded by US money operate in a manner that is accessible and inclusive of people with disabilities. NCD also recommends that the Foreign Assistance Act be amended to create an office on Disability and Development at USAID, similar to the office on Women in Development.
This report is a pivotal event for the disability rights community, and NCD’s recommendations have major implications for the future of US foreign assistance efforts. While we work towards civil rights and community integration in the United States, we must also recognize that the discrimination and abuse of people with disabilities is a worldwide problem. The launch of this report brings together a broad coalition of people concerned with disability rights, foreign policy, and international development to examine how we can develop a foreign policy that is supportive of the human rights and economic empowerment of people with disabilities.”
The following information is also provided by Mike Chambers, through Beltway Briefs, a weekly series which covers administrative activity, litigation, legislative activity, media issues, research initiatives, and national advocacy of interest to member state agencies. For information on Beltway Briefs, contact Dan Berland at dberland@nasddds.org or call (703) 683-4202.
Settlement Agreement Reached in Maine Waiting List Lawsuit
The State of Maine has entered into a settlement agreement with the plaintiffs in a two-year old waiting list lawsuit. The agreement includes specific timeframes for initiating community services for adults with developmental disabilities. Filed in August 2001, the petitioners in Rancourt, et al. v. Concannon, et al. accused the state of failing to furnish "with reasonable promptness" home and community-based services to persons with mental retardation and other developmental disabilities, as required under federal Medicaid law. In November 2001, the U.S. district court serving Maine denied a motion by the state defendants to dismiss the suit based on the state's sovereign immunity protections under the 11th Amendment to the U.S. Constitution, noting that the 1st U.S. Circuit Court of Appeals has rejected similar claims in many other, similar lawsuits.
In May 2002, the district court certified the case as a class action complaint, accepting the plaintiff’s contention that the class should include "all developmentally disabled individuals who:In July 2002, the 1st Circuit denied the state's petition to review the district court's class certification action. The settlement agreement covers: (a) services furnished as part of the state's HCBS waiver program for persons with mental retardation (MR waiver program); (b) day habilitation services for adults with mental retardation, a covered service under Maine's Medicaid state plan; and (c) case management services for adults with mental retardation, another service coverage under Maine’s Medicaid state plan. By no later than January 1, 2004, the effective date of the agreement, the state Department of Behavioral and Developmental Services (BDS), the agency responsible for administering the MR waiver program and overseeing the delivery of other Medicaid-funded specialized services to persons with mental retardation and other developmental disabilities, is responsible for developing and implementing an electronic information system to track the delivery of the above-listed Medicaid-funded services to members of the class. BDS is responsible for sharing with the plaintiffs’ counsel quarterly reports that track class members from the date of service application, through eligibility determination, to service initiation for a period of six quarters, beginning July 1, 2004.
- are current or future recipients of Medicaid in the State of Maine;
- are no longer entitled to receive benefits through the Maine public school system;
- are eligible to receive intermediate care facilities and other services for the mentally retarded or care under the HCB waiver program; and• are not receiving services to which they are entitled to in a "reasonably prompt manner."
Under the terms of the settlement agreement, BDS is obligated to furnish day habilitation and case management services under the state plan as well as non-residential services provided under the state's MR waiver program to members of the class within 90 days of the execution of an individual service agreement. In the case residential training services under the state's MR waiver program, however, the agreement allows the department up to 18 months from the date the service agreement is executed to initiate services to a class member. The 18-month time frame, BDS officials explained, was arrived at after reviewing the department's experience in developing and locating the licensed homes for adults with mental retardation and related conditions. Typically, the complete process takes less than 18 months, but BDS officials wanted to be sure they ended up with a timeframe the state would be able to meet in the vast majority of cases.
In the case of HCBS waiver services, the state's obligations under the settlement agreement are limited to the utilization and spending caps specified in the state's CMS-approved MR waiver program. In addition, the agreement specifies that the state will be considered to be in compliance with the terms of the agreement as long as the agreed upon timeframes are adhered to in the case of 90 percent or more of the class members applying for services during any given fiscal year. The agreement will terminate as of December 31, 2006 unless the court finds that the state has failed to comply with the terms of the agreement.
An electronic version of the settlement agreement in Rancourt, et al. v. Concannon, et al. may be obtained by e-mailing lsarigol@nasddds.org. For additional information regarding the terms of the agreement as well as the state's implementation plans, contact Jane Gallivan with the Maine Department of Behavioral and Developmental Services at 207-287-4212 or via e-mail at jane.gallivan@state.me.us.
More information on Rancourt can be obtained from www.hsri.org/docs/litigation072803.DOC, item #10. This information is produced by Gary Smith of the Human Services Research Institute.
Also from Mike Chambers and Justice for All – a service of the American Association of People with Disabilities (www.aapd-dc.org)
Tired of empty promises from Washington, 200 disabled activists will literally "march on Congress," challenging lawmakers to act on legislation that will allow all Americans to receive long term care services in their own homes, instead of being forced into nursing homes as they are under current Medicaid policy. Beginning with a September 4th press conference at the Liberty Bell in Philadelphia, marchers will travel 144 miles through Delaware and Maryland, ending their trek September 17 at a rally on Capitol Hill in Washington, D.C. where they will be greeted and joined by an expected 20,000 supporters. The goal of the rally and march is to promote passage of MiCASSA and Money Following the Person legislation, a call for real Medicaid reform instead of block grants, and full implementation of the Supreme Court's Olmstead decision.
"We've been working for over ten years to get this legislation passed," said Eric von Schmetterling of Philadelphia ADAPT, "and Congress keeps refusing to act, despite the fact that there are 600 organizational supporters, and despite the fact that every additional day they keep their heads in the sand, they are wasting the lives of older and disabled Americans who remain warehoused in this nation's nursing homes and institutions."
The legislation in question, S971 and H.R. 2032, is commonly known as MiCASSA, the Medicaid Community-based Attendant Services and Supports Act. MiCASSA provides that people with disabilities, young and old, can choose to receive the services they need in their own homes in the community rather than being forced into nursing homes and other institutional settings by the current "institutional bias" in Medicaid law. Senate Sponsors of S971 are Sen. Tom Harkin (D-IA) and Sen. Arlen Specter (R-PA), and 11 co-sponsors: Sen. Edward Kennedy (D-MA), Sen. Hilary Clinton (D-NY), Sen. Joe Biden (D-DE), Sen. Thad Cochran (R-MS), Sen. John Corzine (D-NJ), Sen. Mark Dayton (D-MN), Sen. Frank Lautenberg (D-NJ), Sen. John Kerry (D-MA), Sen. Mark Landrieu (D-LA), Sen. Charles Schumer (D-NY), and Sen. Christopher Dodd (D-CT). In the House, Sponsors, Rep. Danny Davis (D-IL) and Rep. John Shimkus (R-IL), have been joined by 72 of their colleagues as co-sponsors of H.R. 2032.
First introduced in 1997 by then Speaker of the House, Rep. Newt Gingrich (R-GA), MiCASSA set the stage for the 2001 "New Freedom Initiative," the first major thrust of newly elected President George W. Bush. The New Freedom Initiative, which mandates removal of barriers to community participation for people with disabilities, also followed a 1999 decision by the U.S. Supreme Court in Olmstead vs. L.C. and E.W that said keeping people in institutional settings when they could be served in the community constituted discrimination, and was therefore illegal.
"We may have the Olmstead decision and the Money Following the Person on paper," said Crosby King, Maryland ADAPT organizer, "but right now those are only moral victories. We are increasingly frustrated at the lack of strong enforcement of Olmstead, and the lack of real legislative action on the Money Following Person. We're marching over 140 miles in two weeks to draw attention to Congress' inaction, and to demonstrate what we're willing to endure while Congress sits in plush, air conditioned comfort, ignoring the over 2 million Americans hidden behind institutional walls."
Recent CMS Appointments
The Centers for Medicare & Medicaid Services (CMS) recently announced the appointment of Glenn Stanton as acting director of the Disabled and Elderly Health Programs Group. (See August 13 press release at www.cms.hhs.gov/media/press/release.) The Disabled and Elderly Health Programs Group has jurisdiction over Medicaid services for the populations of nursing homes, certain clinical laboratories, and other health care facilities. Stanton was previously deputy director of the program.
Stanton has 20 years of service within the public health system at the federal, state, and county levels, and has played a central part in HHS’s Independence Plus Initiative to facilitate self-directed health care, as well as serving on the President’s New Freedom Commission on Mental Health. Prior to CMS, he worked as state director of Developmental Disabilities Services and as executive director of a three-county community mental health program in Michigan.
David Wiebe, Chair of NACBHD’s Medicaid Committee, who, along with other NACBHD representatives, recently met with Stanton to discuss county government’s large stake in Medicaid, particularly in regard to the disabled population, characterizes Stanton as very in tune with county and consumer issues. “Glenn was very receptive to an open dialogue with county government programs and to discussing important issues around Medicaid reform.”
NACBHD Events and Announcements
February Legislative Conference
The NACBHD Legislative Conference is scheduled for the last week in February 2004, at the Juries Hotel in Washington, DC. We are pleased to announce that we will be welcoming SAMHSA administrator Charles Curie as a speaker at the conference. While specific dates and other final details will be confirmed soon, Conference Program Chair George Braunstein says “We’re going to continue in a tradition of giving people useful information so that they can advocate for what they want and need.” In addition, it is hoped this year that members will enjoy a greater opportunity for dialogue with speakers and sharing of ideas – what Braunstein characterizes as a “more interactive format.” And, there will also be an opportunity to interface with NACo on important issues. Plans include, according to Braunstein, “something to make sure that key issues of importance to NACBHD are integrated into the NACo conference (scheduled in the same time frame.) Check the website and your mail for information about this important event.
Board Retreat Set for October
The NACBHD Board will meet in Savannah, Georgia, October 24 and 25 to discuss committee reports, the Executive Director search, infrastructure issues, and the relationship with NACo.
Look for Membership Campaign Information in October
NACBHD now has 336 members and hopes to have more! Many thanks and much credit goes to those who stepped up in the past year to make sure that NACBHD’s voice is heard throughout the public behavioral health policy community. Don’t forget to renew your membership, or join NACBHD for the first time, and become part of efforts to increase our visibility in the national arena. Membership information will be sent out in October. You may renew online at www.nacbhd.org. Or contact the national office by phone at (202) 234-7543, or by email at gwen@nacbhd.org.
National Survey on Drug Use and Health Findings Now Available from SAMHSA
The new, improved, 2002 Household Survey has been renamed the National Survey on Drug Use and Health and its findings are now available as part of SAMHSA’s 14th annual National Drug and Alcohol Addiction Recovery Month (Recovery Month) observance, which emphasizes that alcohol and drug addiction is a chronic, treatable problem affecting the entire community, and emphasizes strides in treatment. This year’s Recovery Month theme is “Join the Voices for Recovery: Celebrating Health.”
The survey is based on interviews with 68,126 individuals in their homes, including those residing in dormitories or homeless shelters. Individuals in the active military, prisons, or other institutionalized populations, or those who are homeless, were not included in the survey. Among the surveys findings: In 2002, 7.7 million people ages 12 and older, needed treatment for a diagnosable drug problem, and 18.6 million needed treatment for a serious alcohol problem. However, only 1.4 million received specialized substance abuse treatment and only 1.5 million received treatment for alcohol problems. Other issues the survey addresses include: the numbers of people who did not believe they needed treatment (“the denial gap”), those who tried but were unable to obtain treatment, illicit drug use by youth, and non-medical use of prescription drugs.
The findings from the National Survey on Drug Use and Health are available at www.DrugAbuseStatistics.samhsa.gov.
October Mental Illness Awareness Week Will Emphasize Recommendations of President’s Commission on Mental Health
Mental Illness Awareness Week (MIAW), part of NAMI’s Campaign for the Mind of America, is scheduled for October 5-11 this year. The Campaign for the Mind of America, is a multi-year focus on several fronts (education, advocacy, science and research, support, and active funds) and “highlights the need to build a comprehensive, efficient, system to screen, evaluate, diagnose, and treat mental illness at every stage of life” (www.nami.org).
In a concerted effort to support the President’s New Freedom Commission’s goals and recommendations, NAMI is offering a toolkit in support of MIAW. Some components of the toolkit include:
Bipolar Awareness Day (the first ever) and National Depression Screening Day are October 9.
For more information on Mental Illness Awareness Week, see www.nami.org. Information about National Depression Screening Day can be accessed at www.mentalhealthscreening.org/depression.htm.
2003 National Training Conference on Homelessness for People with Mental Illnesses and/or Substance Use Disorders
The Homeless Programs Branch of the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA) invites you to attend a national training conference on homelessness, mental illness, and substance use. The conference, HOPE: The Key to Ending Homelessness for People with Mental Illnesses and/or Substance Use Disorders is being co-sponsored by CMHS and SAMHSA’s two other centers, the Center for Substance Abuse Treatment (CSAT) and the Center for Substance Abuse Prevention (CSAP), and is a follow-up to the December 2001 conference, We Can Do This! Ending Homelessness for People with Mental Illnesses and/or Substance Use Disorders.
The event will take place December 3-6, 2003 at the Pointe South Mountain Resort in Phoenix, AZ and will feature full-day, half-day and one and a half hour training sessions focused on the housing, treatment and support needs of people with mental illnesses and/or substance use disorders who are homeless. Training sessions will feature evidence-based and promising practices in service delivery and housing, as well as cross-cutting principles for promoting collaboration, systems change and recovery. Providers, consumers, policymakers, and advocates from all disciplines are encouraged to attend, with 600 attendees anticipated.
In addition to attending individual training sessions on a variety of topics, conference participants will also have the opportunity to hear representatives from national homeless advocacy groups and local service programs discuss the latest policy developments affecting housing and services for people who are homeless, as well as strategies for developing collaborative partnerships and integrated systems of care to end homelessness among individuals with mental illnesses and/or and substance use disorders.
Among the many additional features of the conference will be a pre-conference institutes on addressing chronic homelessness, a pre-conference train-the-trainer session on supportive housing, and full-day training sessions on outreach and engagement, cultural competence, expediting SSI/SSDI claims and creating permanent supportive housing. Participants will also have the opportunity to visit local homeless services programs and a resource room with free information and resources. A limited number of scholarships are also available for homeless or formerly homeless consumers of mental health and/or substance abuse services to attend the conference.
For further information on the conference agenda and registration, please contact the National Resource Center on Homelessness and Mental Illness at (800) 444-7415 or www.nrchmi.samhsa.gov.
Job Announcement
Behavioral Health Director
(Deputy Agency Director for Behavioral Health Services)
Orange County Health Care Agency
Salary: Negotiable Based Upon Qualifications and Experience
The Orange County Health Care Agency, located in a region known for its outstanding quality of life, is seeking a Behavioral Health Director (Deputy Agency Director for Behavioral Health Services). Reporting to the Health Care Agency Director, this challenging position leads all Behavioral Health services, including adult mental health, children and youth mental health, and alcohol and drug abuse services, which last year served 64,000 individuals in a County population of 2.9 million. Ranking 5th largest in the nation, Behavioral Health operates with a $200 million annual budget, 850 employees and many contract providers.
The new Director will join the organization at a time of exciting change. Two major initiatives already underway include implementation of a major Behavioral Health reorganization plan that improves oversight of its multidisciplinary service delivery system; as well as implementation of a new, comprehensive Agency information system. The Behavioral Health Director is also a vital member of the Agency’s executive team.
The ideal candidate will be an experienced, high-level, mental health executive with a strong knowledge of California behavioral health services. This includes an extensive background in program management, compliance, budget, and alcohol & drug abuse services. This proven leader will have a successful track record of managing organizational change and a broad vision for the future of Orange County’s behavioral health services. In addition, this ideal candidate will be an innovator and change agent with outstanding collaborative, interpersonal, and communication skills. California licensure as a mental health professional (Licensed Clinical Psychologist, Clinical Social Worker, Marriage and Family Therapist, or Psychiatric Nurse) and/or a Master’s degree in Business or Public Administration, Mental Health or Public Health, or related field is highly desired (additional qualifying experience may be substituted for the required education on a year-for-year basis). A detailed brochure is available.
To be considered for this exceptional career opportunity, submit resume, three work-related references and current salary by Friday, October 3, 2003 to:
CSAC Human Resources Advisory Services
Attn: Kris Kristensen
241 Lathrop Way
Sacramento, CA 95815
Tel: (916) 263-1610 or (916) 263-1401
Fax: (916) 561-7205
Email: resumes@cps.ca.gov
www.cps.ca.gov/shannon
The NACBHD Bulletin is published electronically six times a year by the National Association of County Behavioral Health Directors, 1555 Connecticut Avenue, NW, Suite 200, Washington, DC 20036. NACBHD is an affiliate of the National Association of Counties.
Articles of interest to county/local behavioral health professionals are welcome by the 15th of the month prior to publication. Please submit copy to Nancy Sydnor-Greenberg at nesydnor@erols.com or to Editor-in-Chief, Dr. Sandra Naylor Goodwin, sgoodwin@cimh.org.
