Healthy FamiliesThriving Communities Collaborative Council 1112 11th Street NW, Suite B Washington, DC 20001 Phone: (202) 299-0900 ____________________________________________________ Testimony of Richard Flintrop Representing the Healthy Families/Thriving Communities Collaborative Council before the Committee on Health Regarding Performance of the Department of Health Care Financing March 6, 2014 Good morning Chairperson Alexander and members of the Committee on Health. I am Richard Flintrop, Director of Policy and Planning for the Healthy Families/Thriving Communities Collaborative Council. I am pleased to have this opportunity to testify on the performance of the Department of Health Care Finance. I do so as a member of the Behavior Health Association and the Medical Care Advisory Committee. I would like to focus my comments today on issues relating to children’s mental health. While as we discussed yesterday, DBH has made major improvements to services for children diagnosed with serious mental illness especially by working with the CSAs to establish a broad menu of evidence based family centered interventions. However, appropriate services to children with mental health challenges who do not meet that threshold are woefully inadequate. From the Collaboratives’ perspective, this gap makes it far more difficult for us to successfully engage and assist our most vulnerable youth. Unresolved mental health issues contribute to truancy and school failure, homelessness, chronic unemployment, youth violence, teen pregnancy and other negative outcomes. It is supposed to be the Managed Care Organizations’ responsibility to identify and respond to the needs of children with mental health illness early enough that they do not have to penetrate deeper into the systems and require more intensive interventions. For years, many of us have been pleading for the data that would document this void and give us the information needed to collectively work to address them. I am pleased that DHCF, under the leadership of Director Turnage, has taken steps to begin to do so. I want to acknowledge the involvement of DBH staff in the development of the RFP seeking new MCOs last year. There is no question that the new contracts now raise the expectations around mental health services to children and offer opportunities to hold the MCOs responsible for doing so. We are pleased that last month DHCF released the first District of Columbia’s Managed Care Quarterly Performance Report. This report provides the department, stakeholders and the community with valuable information with which to quantifiably measure the successes and shortcomings of the MCO network. When Director Turnage presented this report to the MCAC recently, it was clear that the agency is taking this data seriously, and will move to make modifications in their monitoring, develop corrective action plans and amend contracts in order to achieve improved outcomes. As has been pointed out in previous testimony, for the first time we have solid expenditure data relating to children’s mental health, and that data paints a dismal picture; the average expenditure per child per month for mental health services is only $6.25, with one provider spending only 59 cents per child. But there is much more we need to know beyond the dollars spent. The effort of the DC Collaborative for Mental Health in Pediatric Primary Care to integrate children’s health is very positive. Development of uniform mental health screening assessments and training pediatricians to use them should begin to open the door for earlier access to services. But once it is determined that a child has a mental health need, then what? Is there an appropriate service to meet the child’s particular need, can those services be accessed in a timely fashion and in a setting that engages both the child and their families? Do children remain involved with services long enough to achieve successful outcomes? As DHCF works to improve the utility of the Quarterly Reports, we hope that they will aggressively expand their data collection and analysis to capture measures of utilization and performance in these areas. At this point, it appears that the MCOs are not yet taking the issue of children’s mental health seriously. If you look at the websites for the MCOs, there is scant information about mental health services overall, for example, the Trusted Health Plan consumer manual simply states, “Mental health care is for both adults and children. This can help when you feel depressed or anxious.” Then, it states that if you need help you should call either the Beacon crisis hotline or the DMH (sic) Hotline. A skeptic may think that they are consciously minimizing the importance of mental health, and are far too eager to move clients into the DBH system. I would also suggest that immediate attention needs to be paid to the requirements for adequacy of the provider network as it relates to mental health. How many providers have been successfully paneled by MCOs and do those providers have the capacity to meet the needs of children referred to them? Most important, the MCOs should establish uniform reimbursement rates so that it is attractive for providers to join their networks rather than face a financial loss for doing so. Overall, we see DHCF moving in a positive direction, especially when faced with the challenges of implementation of the Affordable Care Act and the new MCO contracts. Director Turnage has built a competent and dedicated team to assure the best health outcomes for the 220,000 Medicaid beneficiaries and these efforts deserve our full support going forward. Thank you for this opportunity to testify.