Treatment providers worry rapid intervention bill will flood their programs

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Treatment providers worry rapid intervention bill will flood their programs

Tue, 04/15/2014 - 11:45am -- tim

by Laura Krantz vtdigger.org Mental health and substance abuse services providers worry a bill intended to funnel people away from the corrections system and into treatment could flood their programs with new clients without additional funding.

Julie Tessler, the director of the designated agency network of nonprofit service providers, is worried about the financial impact of S.295, a sweeping criminal justice bill that passed the Senate and is now being vetted by several House committees.

State addiction providers are also concerned about the financial affects of S.295, but they are taking more of a “wait-and-see” approach.

The bill’s chief proponent, former state’s attorney Bobby Sand, says the program will have a limited scope and will merely accelerate placement for Vermonters who need treatment.

The purpose of S.295 is to create a statewide system of pretrial screening, assessment, treatment and supervision of people who have been arrested.

Some people who are screened will be referred for a clinical assessment with mental health and substance abuse experts and receive treatment, though not necessarily in place of a criminal charge.

“We definitely will be sending people into the system of care that we haven’t seen before, necessarily, and they’re going to need supports,” said Julie Tessler, executive director of the Vermont Council of Developmental and Mental Health Services.

The council represents a network of 16 private, nonprofit providers, including Rutland Mental Health Services, the Clara Martin Center and United Counseling Service.

The bill could exacerbate three challenges the designated agencies face, Tessler said.

First, the fee-for-service system of payment the agencies use with insurance companies is particularly ill-equipped for substance abuse clients, Tessler said.

Substance abuse patients often do not show up for scheduled appointments but the agency must still pay the clinician to be there, she said.

Second, insurance reimbursement rates are low for substance abuse services, Tessler said, so most agencies lose money providing those services.

Last, the amount of services an agency can provide is capped by the amount of money allocated to that agency from the state. Some spend that amount before the end of the year, Tessler said.

Andy Pallito, commissioner of the Department of Corrections, left, and Bobby Sand, senior policy adviser for the Department of Public Safety, talk with lawmakers on Jan. 9, 2014. Photo by Anne Galloway

“To start with not making an allocation for preferred providers to do our share of the work doesn’t make a lot of sense,” Tessler said.

There was talk of the Department of Health hiring a person to perform clinical assessments, she said, but that is uncertain.

In addition, it is difficult to hire and retain qualified addiction and mental health professionals, Tessler said, because the rate of pay is lower than in private settings.

Part of the reason the designated agencies cannot pay higher salaries, Tessler said, is because of the low insurance reimbursement rates.

HowardCenter in Chittenden County advertises more than 100 job openings on its website.

A version of next year’s state budget passed by the House calls for a study of better payment models for substance abuse and mental health services.

Tessler voiced her concerns Friday before the House Human Services Committee. The committee also heard from the Alcohol and Drug Abuse Programs division (ADAP) of the state Health Department.

ADAP treatment chief Jackie Corbally said ADAP is also trying to determine the impact S.295 could have on its programs, which include designated agencies as well as methadone treatment clinics and inpatient facilities such as Maple Leaf Farm.

There is no way to know until the program actually rolls out, Corbally said.

“Our providers are concerned about what is the impact of this legislation,” she told legislators Friday.

Budgets aside, the hope is that people will be more likely to show up for treatment services if they are propelled by a court order and a reminder from a compliance monitor, a new position S.295 creates, she said.

Next year’s Department of Corrections budget sets aside $760,000 to hire approximately 10 compliance monitors for the state.

People referred to treatment through the court intervention program are likely to have ended up in treatment sooner or later, according to Sand, who is now a senior policy and legal adviser for the Department of Public Safety and is shepherding the bill through the Legislature.

“These are folks who largely are going to end up in the community system anyway,” Sand said. Getting them there sooner is a good thing, he said.

Sand said he hopes the House will amend the bill to narrow the types of offenses for which people are eligible for a needs screening.

“I think it’s important that the initial universe of people who we offer screenings to and the initial universe of people who get referred for supervision by the compliance monitor be fairly small, so that we figure out what our capacity is,” he said.