The rites of spring brings the RI budget process – Richard Asinof

by Richard Asinof, ConvergenceRI, contributing writer

Photo: In a 2020 photo, Karen Rathbun, vice president of administrative services at Community Care Alliance in Woonsocket, points to a hole in the wall with insulation pouring out, caused by water damage from a leak in the roof at the state-owned building, which was identified in 2017

This weekend marked the beginning of spring, and with it, the Rhode Island General Assembly has plunged deep into its aspirational phase in hearing testimony for proposed legislation to influence the FY 2023 spending plan, holding budget hearings on a number of bills. Many will no doubt be held for further study.

Last week, there were housing bills and payday lending bills; next week, there are hearings on recreational marijuana and pharmacy benefit managers, oh my, with plenty of verbal skirmishes.

The problem, of course, is that the testimony delivered is often far, far removed from the actual spending plans endorsed by the House Finance Committee in its final budget proposal.

Still, given the level of ongoing crisis in mental health and behavioral health care in Rhode Island, it seems somewhat prudent to pay attention to the legislative solutions being proposed by community-based providers.

One of the more outspoken advocates for community-based behavioral health investments has been Benedict Lessing, Jr. long-time president and CEO of Community Care Alliance.

On Wednesday, March 16, Lessing presented testimony in favor two bills: H 7857, which would establish Certified Community Behavioral Health Clinics [CCBHC]; and H 7627, which would establish a revolving fund to support the capital needs of community organizations providing community-based mental health services in Rhode Island.

Here are some excerpts from Lessing’s written testimony. In support of H 7858, Lessing wrote: “This important legislation will significantly improve Rhode Island’s Behavioral Health System through the provision of a comprehensive array of services within community settings. Over several years adults, children and families struggling with behavioral health concerns, [including] depression, anxiety, suicidal ideation, addiction and more serious disorders, have lacked access to the vital community-based mental health services required to manage crises and facilitate recovery.”

Lessing continued: “This crisis has manifested in daily and weekly overdoses, children struggling to remain in school settings and adults having difficulty functioning. COVID exposed this crisis that has been evolving for years but has also made it worse.”

The CCBHC model, Lessing explained, “is important in that it employs evidence-based and [evidence-] informed practices that are effective in working with adults, children and youth with addiction and serious mental health concerns. It is also critical for Rhode Island to adopt the federal Certified Community Behavioral Health Clinic model for a number of practical reasons:

• The federal model provides incentives for enhanced Medicaid funding that will significantly support the model.

• Budgeting for services to be delivered will be based on actual expenses. This is particularly important given the depletion in the behavioral health workforce. It is also a critical recognition that a robust community-based system of services actually saves the state money by decreasing the utilization of more expensive hospital and institutional services.

This also reinforces the importance of rate reform that reviews and adjusts rates regularly based on actuarial and market data. Rates for behavioral health services overall have not been enhanced to meet current realities in [more than] 10 years.

• The federal model is predicated on a prospective payment approach which assures community-based providers of ongoing cash flow to support services, as opposed to the traditional and less effective fee for service methodology that has created opportunities with managed care to delay, deny and ration services.”

In conclusion, Lessing wrote: “H 7858 provides Rhode Island a unique opportunity to enhance and improve community-based mental health services in a manner that has not occurred in decades. CCBHC is a lifesaving and sustaining behavioral health model. It has been clear that successive administrations have lacked the vision, empathy for people that experience mental health and addiction challenges as well as the competence to address evolving, complex behavioral health concerns.”

A revolving fund
Beyond changing the model for delivery for community-based behavioral health services, Lessing also offered written testimony in support of H 7627 to establish a revolving fund to support the capital needs of organizations providing community based mental health services in Rhode Island.

As Lessing testified: “This funding is particularly important to support and sustain the physical infrastructure including such basic items as roof replacements, HVAC systems, repair, renovation and the acquisition of facilities that provide community-based mental health services. Whereas staffing and programs are critical to the implementation of a community mental health system, its physical infrastructure is also important to accessibility of services in local communities.”

As Lessing explained it to R.I. Finance Committee members, once upon a time, historically, “The state of Rhode Island had vision; its community mental health infrastructure was financed by state and federal funds. The physical manifestation included accessible outpatient facilities and residential treatment programs; many [of the facilities were] owned by the state and leased back to non-profit organizations. This infrastructure supported people with acute, serious and severe psychiatric concerns.”

The outcome, Lessing continued in his testimony, populations served in local communities avoided expensive and less effective institutional care. But not anymore, according to Lessing.

“In the last 20 years, Rhode Island abandoned its vision of a comprehensive behavioral health system, including the support of physical infrastructure. What occurred has been the deterioration of outpatient and residential facilities,” Lessing said.

“A number of outpatient sites were abandoned due to disrepair and safety concerns which were the responsibility of BHDDH and later DOA/DCAMM [the Division of Capital Asset Management]. Maintenance and repair of residential treatment sites is a continuing problem which many providers frustratingly advocate to DCAMM to address. Delays in maintenance, for months and years creates further damage, additional expense and safety concerns.”

According to Lessing, “This situation has necessitated community-based organizations abandoning sites due to safety, discontinuing programming and seeking other facility resources at greater expense. Due to poor service delivery rates not been adjusted in years, organizations have little in the way of positive financial margins to take on this additional expense.”

Lessing then shared the story of Community Care Alliance’s own experiences with state neglect of such buildings and its failure to make timely repairs. “CCA has had multiple difficult experiences with poor maintenance for state-owned properties. The most significant has been the necessity to abandon a property designed and built for the Community Mental Health Center with federally appropriated and state bonds. For 40 years, this site was a beacon to Woonsocket and Northern Rhode Island residents seeking mental health services. After several years of a lack of repairing the roof with water running into the walls creating mold and safety issues, we relocated 50 staff to alternative quarters at CCA’s unplanned expense. This caused the agency to lose 200+ clients, staff morale plummeted, and the move created confusion in the community as to where to receive services. “

Lessing continued: “This situation has been well documented by Convergence RI; I will make copies of the article available to the committee as well as additional photographs. We have also experienced similar circumstances with the deferred maintenance of residential treatment programs that have at times have become unsafe. This situation is unconscionable relative to the dignity and well-being of people residing in these facilities with severe and persistent mental illness.” [See link below to ConvergenceRI story, “Is the state guilty of neglect with its community assets in Woonsocket?”]

In conclusion, Lessing said: “It is also problematic as these are critical resources that could be used to reduce the census of Eleanor Slater Hospital. H 7627 is a step in the right direction to restore the State’s physical behavioral health infrastructure. Similar to infrastructure support received by community health centers by the federal government, community mental health organizations need similar assistance. Nonprofits such as Community Care Alliance save the state of Rhode Island millions of dollars in avoidance of hospital level care and other institutional services.”

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To read more articles by Asinof, go to: https://rinewstoday.com/richard-asinof/

Richard Asinof is the founder and editor of ConvergenceRI, an online subscription newsletter offering news and analysis at the convergence of health, science, technology and innovation in Rhode Island.

To read more stories by Richard Asinof: https://rinewstoday.com/richard-asinof/