The House Democrats today released their proposal for the 2016 supplemental budget. For hospitals and health systems, the most significant part of the budget is more than $45 million investments in mental health to combat the state’s mental health crisis. Mental health is WSHA’s top budget priority.
In a news conference, House Appropriations Chair Hans Dunshee described mental illness as something that touches us all, as people in communities all across the state struggle with mental health issues. The budget funds significant community mental health resources and provides substantial funding to Western State Hospital to make it a more desirable place to practice, as many qualified providers are choosing to work in the private sector instead.
Rep. Dunshee uses money from the budget stabilization account to fund forest fire costs, K-12 levy assistance, and homeless services and programs. The budget also includes some additional revenues from closing tax loopholes, and the budget writers said this money would be targeted to teacher salary increases.
Regarding mental health, the budget calls for:
- Short-term treatment in the community: Funds four new 16-bed crisis triage facilities for assessment, diagnosis and treatment for those suffering from acute mental health crises ($2.6 million), and three new mobile crisis teams ($2.8 million); and four new housing and recovery services teams to support individuals transitioning out of an inpatient setting and into the community ($2.0 million).
- Loan repayment for mental health professionals: Allocates $1 million in loan repayment for mental health providers. While we support this increased funding, WSHA was seeking a $3 million appropriation.
- Appropriate rate setting at new hospital psychiatric units: After significant urging by WSHA, the budget directs the state Health Care Authority to set psychiatric rates for new facilities in a similar way to existing facilities, ending a long-time practice that paid new facilities significantly lower rates – a disincentive to opening new units.
- Long-term treatment at state psychiatric hospitals: Funds salary raises to recruit and retain psychiatrists and other psychiatric hospital staff ($9.5 million), 25 additional nurses for Western State Hospital ($3.6 million), and a one-time appropriation to address overspending and new expenditures to meet the Centers for Medicare & Medicaid requirements ($11 million).
- New Behavioral Health Innovation Fund: Creates a new innovation fund to implement a variety of strategies to improve long-term care for mental health patients. The Department of Social and Health Services must apply for the use of these funds ($13.7 million).
- Youth depression screening: Provides $1.9 million for annual screening for depression for children ages 11 to 21.
- Western State patient discharge: Directs Western State to discharge 30 patients with long-term care needs. We have concerns about whether there are appropriate community placements for these patients.
- Long-term placements in the community: Authorizes placement of up to 30 patients on 90-day commitments in community hospitals. A number of WSHA member hospitals are interested in providing this service.
Regarding other health care issues, the budget:
- Reduces spending by $4.2 million state and $8.5 million total (state and federal) in “cost avoidance” as a result of avoiding admissions and enabling earlier discharges by increasing access to skilled home RNs and LPNs working with children who need medically intensive care. These savings from managed care plans and the fee-for-service program would come from adding $3.1 million state and $6.3 million federal to increase the pay rate for home health nurses.
- Funds rulemaking to expand the prescription monitoring program by allowing hospitals to register their staffs as a group (related to HB 2730, which WSHA strongly supports).
- Funds additional staff (.5 FTE) to ensure hospitals are following the state’s charity care laws and rules.
- Funds a work group through the Office of the Insurance Commissioner to study ways to eliminate balanced billing for health services.
The proposal also had a public hearing in the House Appropriations Committee today at 3:30pm, and it is scheduled for executive session on Thursday, February 25. WSHA is strongly supportive of the investments in mental health.
The Senate will release its budget soon. There are likely to be significant differences between the House and Senate approach to the supplemental budget. With all three budget proposals (Governor, House and Senate) on the table, negotiations will begin in earnest.