AFA Update, Wednesday, January 21, 2015- Education, Higher eds, Health and Human Services and Riverview

AFA had a full day of briefings today from the Department of Education, the higher education institutions, The Department of Health and Human Services and Court Master Daniel Wathen to discuss the Consent Decree governing the operation of Riverview Psychiatric Center. The Education committee joined the morning briefings, Health and Human Services the afternoon.

Audio of today’s hearing is here.

Department of Education (DOE)

Acting Commissioner Tom Desjardins was joined by several staff from the department, including new hire former State Senator Deb Plowman who will serve as the department’s lobbyist.

Desjardins spoke to initiatives contained in the budget:

  • $9M General Purpose Aid to Education (GPA) subsidy increase of 1%- includes $6M to change funding for Public Charter Schools. Removes burden of local costs from school districts, the state will pay both the state and local share.
  • $11.7M GPA Miscellaneous- targeted/direct costs
  • $10M Fund for the Efficient Delivery of Services- intended to incent cooperation and consolidation among districts by providing funds for the upfront costs

Sen. Valentino questioned the loss of $4M of casino money for Pre-K. Desjardins noted that the Department has replaced this funding with a federal grant of a comparable amount for four years. Questions remain about the wisdom of supplanting those funds.

Rep. Martin questioned the Governor’s stated intention to reduce the number of school superintendents, a proposal he noted he supported a quarter of a century ago. Desjardins said that the intention does not find expression in legislation.

Suzan Beaudoin presented an overview of the state’s formula for providing state support for local education costs. Her presentation is part of the materials linked below. The formula is referred to Essential Programs and Services (EPS).

A table of the additional funding for GPA is here

A presentation on EPS is here

A short explanation of EPS is here

An example of the subsidy document received by your school districts is here

 

Higher Education

 

University of Maine System (UMS)

Chancellor James Page of UMS gave an overview of the funding initiatives proposed to support the university system.

 

  • Education & Operations Additional $3M in FY16 and $6M in FY17, the appropriations would be nearly at 2008 levels of funding
  • Debt service $2M in each year to help address a $400M+ deferred maintenance backlog
  • Maine Economic Improvement Fund (MEIF) $5.3M- for research and economic development

 

In response to a question from Rep. Jorgensen, Chancellor Page noted that UMS continues to freeze tuition.

 

Chancellor Page’s testimony is found here.

 

Maine Community College System (MCCS)

President John Fitzsimmons opened by speaking directly to the end of his 25 years as head of MCCS. He then discussed the history of the system beginning under Governor Hildreth in 1946.

 

The Governor has not offered any additional support for the MCCS in his budget.

 

The system is ready to begin full credit transfer between it and UMS.

 

Asked about student price sensitivity, President Fitzsimmons shared research the system has done that shows a $5/credit hour increase ($150/year) reduces enrollment by $20%.

 

Maine Maritime Academy (MMA)

President Bill Brennan discussed the Governor’s proposal to address maintenance needs at MMA. $807,000 is proposed for a series of projects. Rep. Jorgensen asked if MMA is also not increasing tuition. President Brennan indicated that they are increasing tuition.

 

The written comments of President Brennan are available.

 

Department of Health and Human Services (DHHS)

Commissioner Mary Mayhew and other staff from DHHS addressed the AFA and HHS committees with an overview of the DHHS portions of the Governor’s proposed budget and a brief orientation to the department.

 

Materials from the Department are available here.

 

The Commissioner walked the committee through information on existing waitlists for services and the cost to address those lists. Overall for 3,000 individuals the department estimates a need for $54M annually.

 

Turning to Medicaid Managed Care the Commissioner and Stephanie Nadeau, MaineCare director described a shift from a traditional approach to “Value Based Purchasing” (VBP).

 

  • 20% of MaineCare members incur 87% of costs
  • This 20% often have multiple long term or chronic conditions

 

VPB purports to treat physical and mental health in a combined fashion. Providers are accountable for the outcomes of the services they provide.

 

Part of this effort is the Emergency Department Collaborative aimed at reducing avoidable or inappropriate use of Emergency Room services. The Commissioner touted:

  • $9.9M in savings ($3.7M in state funds)
  • A reduction of average ED visits by more than half

 

Nadeau discussed the Health Homes initiative targeted at individuals with multiple chronic conditions in Part A and those serious and persistent mental illness (SPMI) and children with serious emotional disturbances (SED) in Part B.

 

Part A:

  • 170 primary care practices
  • 10 community care teams
  • 50,000+ enrolled MaineCare members

 

Part B:

  • 25 organizations
  • 70 locations
  • 2,000 MaineCare members

 

People experiencing SMPI have difficulty managing their own care and staying healthy.

 

Accountable Care Communities- This effort uses a shared savings model to incentive providers to better manage the provision of care.

 

Other initiatives include pharmacy management, radiology management and pain management.

 

The Commissioner gave an abbreviated introduction to the $33M 3-year State Innovation Model Grant (SIM).

 

The materials linked above also contain another way of presenting the major DHHS initiatives proposed by the Governor. Quickly summarized:

 

Initiatives FY2016 FY2017
Structural Gap & Consent Decree 14,832,871 13,349,616
Primary Care and Preventative Services 13,092,664 15,249,952
Nursing facilities 9,737,005 14,481,642
Waitlists 20,141,215 26,324,846
Medicaid payment reductions and service eliminations (41,725,090) (46,724,560)
Fund for a Healthy Maine (10,044,145) (10,052,567)
General Assistance & Legal non-citizens (7,189,485) (7,777,326)
Riverview & Dorothea Dix 3,578,773 3,363,221
FMAP Adjustment (16,493,132) (21,456,186)
Personal services funding adjustments 4,339,475 4,362,604
All other initiatives 12,650,863 12,556,858
Total 2,921,014 3,678,100

 

 

Highlights of the Commissioner’s presentation:

 

  • 57% of municipalities will see an increase in state General Assistance reimbursement
  • The waitlists data provided in the previous presentation does not agree with this presentation. The Commissioner will follow up
  • The federal government’s share of costs (FMAP) in the MaineCare program is slated to increase
  • The budget assumes the continued drawdown of Disproportionate Share Hospital (DSH) [1] federal funds, up to $20M annually,  to support the decertified Riverview Psychiatric Center (RPC)

 

Court Master Dan Wathen- Riverview Consent Decree

 

Former Chief Justice Daniel Wathen, who serves as the Court Master for the Consent Decree covering Riverview.

 

The Consent Decree requires the State of Maine to establish and maintain a comprehensive community mental health system.

 

540 people are on the waitlists for Community Integration services, for an average wait of 40 days but some individuals are on the list for up to a year.

In Wathen’s opinion the budget proposal takes big steps towards addressing the community aspects of the services called for by the Consent Decree.

 

On the RPC side Wathen is encouraged by focus on additional permanent staffing for RPC. He also anticipates an additional FY15 budget request for meeting the Consent Decree.

 

Funding for adequate training is still lacking in the budget in Wathen’s opinion.

 

Regarding the use of law enforcement to intervene in RPC the Court Master noted that officers are no longer stationed on the units, they are called far less frequently and when they are called the incidents are reported and can be investigated. However, Centers for Medicaid and Medicare Services (CMS) prohibits the use of officers with weapons to subdue a patient. Officers may only be used if it is expected that criminal charges will result from the use of officers. Wathen may decide that the Consent Decree has a different view than CMS.

 

He also called for the department to submit legislation allowing the use of involuntary medication with forensic patients as is the case with civil patients. The civil process does require due process and a court order.

 

Sen Valentino asked what would be necessary to end this 25 year commitment and court supervision.  Wathen clarified that the funding in this budget, on an ongoing and consistent basis, plus execution is what he believes is necessary. “If they can’t do it with this, thy can’t do it.”

 

Schedule

 

Thursday AFA is joined at 1:00 pm by the Judiciary committee to hear from the Judicial branch and the Commission on Indigent Legal Services (MECILS). At 4:00 pm Commissioner Anne Head of the Department of Professional and Financial Regulation (PFR) joins the committee.

 

You may listen live through the Legislature’s website or join us in Room 228.

 

 

[1] The United States government provides funding to hospitals that treat indigent patients through the Disproportionate Share Hospital (DSH) programs, under which facilities are able to receive at least partial compensation.

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