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Performance of the Department of Mental Health

Wednesday, June 21, 2006

Performance of the Department of Mental Health

Stephen T. Baron

Good afternoon, Chairperson Catania, members of the Committee on Health and staff. I am Stephen T. Baron, Acting Director of the Department of Mental Health. I appreciate your taking such swift and positive action on my confirmation and the support for my leadership your action indicates. In particular, I want to thank Chairperson Catania for the time and energy he has given to addressing the work of the Department of Mental Health particularly his assistance in ensuring that the residential services contracts were placed on the Council agenda yesterday. Your assistance helped resolve an unfortunate situation for the department and providers. Thankfully, due to the commitment of the providers I am not aware of any consumer losing their housing due to the payment issue.

Since my April 10 start date, the most immediate and complex issue I’ve faced is the system we use to pay our mental health service providers. Significantly, the mission and purpose of DMH is to provide services to consumers. Payments to providers who serve these consumers are an essential part of stable system. Payments to providers are not an end to themselves, however, and unfortunately too much energy has been consumed as we struggle with a complex system that may not be in the best interests of our consumers.

My highest priority since assuming this position has been to make timely, accurate payments to the providers. We are not there yet. There are three current categories of issues: residential services contracts, the MHRS system and unfinished ’05 payments.

The residential services contracts were resolved yesterday.

In the short run, we are giving problem-solving on MHRS payment issues our constant attention. I have instituted a three times a week meeting to track provider payments. Through this meeting and other analysis, we have developed a remediation plan and have worked closely with the providers on its design.

This plan, which we currently project will be rolled out by July 10, is designed to fix a problem that has not allowed providers to submit claims that can be reviewed and adjudicated. This is all being doing within the constructs of our budget allocation. We believe that this plan should address proper provider payment issues for FY06. The lessons learned from this exercise will influence our planning for longer-term solutions.

As I become more familiar with the provider payment issues, it is increasingly clear that in addition to performance issues, there also is a structural or design issue that we must confront. A number of these issues have been identified by DMH staff and are addressed in the KPMG report, which will be reviewed with you and others.

We need to create an operating infrastructure that permits DMH and its providers to be focused on consumers, their treatment, and the outcomes of that treatment. I believe a major component of this is the creation of a robust claims payment system that incorporates clinical outcomes.

Our goal is to create a more efficient claims payment system that gives consumers better services and ensures that the District receives the maximum benefit for the dollars given to DMH for services.

Before we can move forward, we must address our past obligations, however. Despite the support of this Committee and the hard and diligent work of DMH staff, there remains approximately $1 million of legitimate FY’05 MHRS claims owed to seventeen providers. I will follow up with you regarding our plan for addressing these payments.

Thank you and I look forward to our discussion.

Payment of providers is a priority of DMH staff. In the short term I am happy to report through the hard work of DMH staff and active support from the Office of the Chief Finance Officer we are warranting and paying claims weekly.

As Councilmembers, you know well from the communications you have received providers that the problem is not solved. We are committed to working with all providers to resolve their difficulties. Today, we began meeting with each of them to identify their specific problems. But we realize that this is a short-term strategy.

The long-term solution will be based on determining whether DMH has the ability to adequately perform all the tasks to ensure that a claim is appropriately authorized, adjudicated and paid in a timely and consistent manner.

Over the next several months we will examine other options to internal claims processing including, but not limited to, having the Medical Assistance Administration assume claims payment responsibilities, contracting out the administrative services functions or a combination of these strategies.

As noted above, there is need for a collaborative planning process. This process will focus on the service system and should address:

  • Finalizing the priority populations to be served, which is at the heart of determining our core businesses, upcoming budgets and the range of services needed.
  • Determining the potential service demand (for both Medicaid and non-Medicaid individuals), the structure within which that demand will be met, and the types of providers and the services needed.
  • Clarifying the role of the DC Community Services Agency. The DCCSA serves the largest number of consumers in the public mental health system and the largest number of non-Medicaid individuals.

St. Elizabeths Hospital is another area that needs to be addressed. St. Elizabeths, like many state psychiatric hospitals, faces a number of challenges that we are addressing.

Last week, the Civil Rights Division of the US Department of Justice issued a report alleging a number of physical infrastructure, staffing and clinical care issues based upon a site visit in 2005 and a records review. We are reviewing that report very carefully. It should be noted that since the DOJ site visit last June, we believe, St. Elizabeths has made important progress in certain areas identified in the DOJ report.

I look forward to DMH providing a better physical space for patients and staff to carry out the important mission of providing quality patient care as we are progressing towards construction of a new 292-bed hospital. Hopefully, in three years, from the beginning of construction, we will have a new hospital, to house our improving clinical services.

I accepted Mayor Williams’ offer to lead the Department of Mental Health because I believe in my ability to translate the Department’s potential for state-of-the-art service delivery into reality. There is tremendous potential here. We are fortunate to have a skilled workforce, a committed advocacy community, and an experienced provider base to build upon.

The District of Columbia’s public mental health system should be and can be a national leader and be the jurisdiction that personifies easy access to care, a robust range of services, strong interagency collaborations and partnerships, consumer centered and a coherent financing system that supports comprehensive individualized care for District residents.

Mr. Catania, thank you very much for this opportunity to share my views of the Department of Mental Health and its future. I welcome your questions.