Budget & Decision Package Proposals
2005-2007

Division of Alcohol and Substance Abuse
September 8, 2004

1. Residential Rate Study

Description: The purpose of this decision package is to adjust residential rates for chemical dependency treatment of adults and adolescents. This proposal will seek to adjust residential rates for the adult intensive inpatient, recovery house, and youth residential treatment Level II Secure modality. The groundwork for the upward adjustment of rates is based on an August 2004 Residential Rate Study that suggests current reimbursement rates are grossly inadequate to cover the cost of providing services to this sector. A rate adjustment will ensure that the Department of Social and Health Services (DSHS) can continue to attract and retain qualified providers for these services and avoid potential closure of residential programs.

Requested Funding: $3,422,072 (all General Fund-State) SFY 2006; $4,096,446 ($3,927.852 General Fund-State, $168,594 federal Medicaid) in SFY 2007. TOTAL: $7,518,518

2. Expanding Preventative Medical Services

Description: The purpose of this decision package is to provide chemical dependency treatment to: 1) all Adult Medicaid-eligible clients who seek treatment and 2) all youth ages 12-17 in need of treatment who are under 200% of the Federal Poverty Level (FPL), regardless of whether they are Medicaid-eligible or not. Due to budgetary constraints , DASA is only able to serve 31.3% of adults receiving Medicaid who are in need of treatment and 23.5% of youth ages 12-17 in need. Some 68.7% of Adult Medicaid eligible clients do not receive treatment, and 76.5% of youth in need and under 200% FPL do not receive it. Research indicates that providing treatment is a preventive medical service and results in significant Medicaid savings. Treatment reduces medical and psychiatric costs by over $252 per month per client for every person receiving treatment, emergency room visits are reduced by up to 48% for persons completing alcohol/drug treatment. Furthermore, chemical dependency treatment reduces dependency on public assistance, results in increased employment, reduces Child Protective Service referrals and child welfare system costs, lowers crime and criminal justice costs for both youth and adults due to large reductions in arrests. In addition, providing treatment for youth reduces school dropout and delinquency, and improves academic performance among middle and high school students. A recent study of Washington State middle schools indicated that on average, students whose peers avoided substance use had reading achievement test scores that were 18 points higher and math achievement test scores of 44 points higher than students with low levels of drinking or drug use.

Requested Funding: $26,984,047 ($18,735,944 General Fund-State, $8,248,098 federal Medicaid) in SFY 2006; $57,427,231 ($39,776,785 General Fund-State, $17,650,446 federal Medicaid) in SFY 2007. TOTAL: $84,411,278

3. Youth Level III Facility

Description: Funding is requested to provide services to high-risk, severely disturbed, chronic runaway youth with co-occurring chemical dependency and mental health problems whose out-of-control behaviors pose a risk of harm to themselves, other patients, and/or treatment staff. These youth are in need of a short-term, intensive, secure, multi-disciplinary evaluation and treatment stay to increase their ability to be treated in less intensive, longer-term chemical dependency treatment services. Funding is requested for a 16-bed facility.

Requested Funding: $1,656,000 ($1,455,250 General Fund-State, $200,750 federal Medicaid) in SFY 2006; $1,666,000 ($1,435,250 General Fund-State, $230,750 federal Medicaid) in SFY 2007. TOTAL: $3,322,000

4. Capital Facilities Acquisition

Description: Funding is requested whereby protocols would be established for ownership of chemical dependency treatment facilities by the state, with program operations contracted out to a third party. Options would include: 1) Purchasing facilities; 2) Re-using existing state-owned facilities; and 3). Building new facilities on state-owned land. Such ownership would help stabilize basic facility costs; ensure facilities with appropriate zoning are available in the future; attract contractors more easily; and provide stability to the treatment system.

Requested funding: $3,000,000 for the 2005-2007 Biennium. TOTAL: $3,000,000

5. Mentoring Programs, with the Economic Services Administration

Description: The purpose of the decision package is to implement a mentoring project in two local WorkFirst service areas to demonstrate the impacts of: A) providing positive, supportive mentor relationships with an adult for children in poverty and B) effective communication between agencies specifically directed toward meeting the mentoring needs of mutual clients. The focus population for this initiative will be children in grades 4-8 whose families receive WorkFirst support, particularly those who have at least one family member who is receiving or has received substance abuse treatment services through local DASA contractors. Children participating in this program will experience: increased school academic performance, increased school attendance, decreased violent or aggressive behavior, increased coping and stress management skills, and increased ability to function better within their family or their out-of-home placement situations.

Requested Funding: $172,500 in SFY 2006; $322,500 in SFY 2007. TOTAL: $495,000

6. Mentoring Program (DSHS proposal)

Description: This decision package is designed to implement a statewide mentoring program and increase the number of quality mentors in Washington. The package supports the work of the Washington State Mentoring Partnership (WSMP), an organization dedicated to strengthening and expanding youth mentoring in the state. WSMP is a public-private partnership supported by the Department of Social and Health Services (DSHS) and a variety of private-sector leaders, including Costco Wholesale. Funding is requested for one FTE to oversee the DSHS mentoring program and to provide continued funding for WSMP.

Requested Funding: $353,000 ($293,000 General Fund-State, $60,000 federal Medicaid) in SFY 2006; $347,000 ($288,000 General Fund-State, $59,000 federal Medicaid) in SFY 2007. TOTAL: $700,000

Description: The purpose of this decision package is to reimburse Indian Health Service facilities that provide chemical dependency treatment services to non-native Medicaid-eligible clients by providing a state match to federal dollars received from the federal Centers for Medicare and Medicaid Service (CMS).

Requested Funding: $1,946,000 in SFY 2006; $1,946,000 in SFY 2007. TOTAL: $3,892,000

Overview: Cross System Crisis Initiative

The purpose of the following three decision packages is to create an integrated and seamless 24-hour/7-day-per-week statewide initial crisis response and detention system for mentally ill, chemically dependent, and co-occurring disordered individuals. These packages are one part of a larger proposal to create significant changes in the way the state and local communities respond to the needs of individuals in crisis. The number of County Designated Mental Health Professional (CDMHPs) who are cross-trained to provide brief risk assessments for individuals in crisis, whether mentally ill or chemically affected, will be increased by 30. As part of the larger proposal, changes will be made to RCW 71.05 and RCW 70.96A and new legislation proposed to create a single system for initial crisis response and detention. One of the outgrowths of this package will be the need for new and enhanced resources for appropriate referrals for individuals who come through the crisis response system.

Description: This decision package is part of the Cross System Crisis Initiative. Some chemically dependent individuals utilize tens to hundreds of thousands of dollars worth of crisis services each year. Because they are not effectively treated and/or managed, they end up in a revolving door of emergency room visits, hospitalization, jail, detoxification, and emergency services. Chemical dependency case managers (CDCM) could help these individuals achieve and maintain stability by advocating for their needs and navigating access to community resources. DASA proposes to pilot CDCM in four sites, two suburban and two urban. A study would be conducted to determine the impact on service utilization.

Requested Funding: $366,000 in SFY 2006; $426,000 in SFY 2007. TOTAL: $792,000

Description: This decision package requests funding to support five new FTEs for chemical dependency professionals (CDPs) at both Eastern State (ESH) and Western State Hospitals (WSH). CDPs would coordinate placement of clients needing CD treatment into community resources upon discharge. In addition, they would provide consultation and training to hospital staff and could provide other CD services as needed including assessments to determine the level of CD diagnosis and treatment required. This decision package is part of the Cross System Crisis Initiative (CSCI).

Requested Funding: $275,000 in SFY 2006; $275,000 in SFY 2007. TOTAL: $550,000

Description: This decision package is part of the Cross System Crisis Initiative and it proposes to pilot two secure detoxification facilities--one in an urban area and one in a suburban area. Current acute and sub acute detoxification centers do not have the capacity to assess, evaluate, or detain individuals affected by alcohol and or other drugs. These facilities will provide immediate placement for persons detained under RCW 70.96A involuntary treatment laws. They would be unique from existing chemical dependency detoxification centers because they would commit persons for up to 14 days for better evaluation, assessment, and treatment. Current detoxification facilities cannot perform this function. This decision package is associated with the Cross System Crisis Initiative as the secured detoxification facilities located east and west of the state that CDMHPs and CDCDS’ would use when placing an individual in crisis in 72-hour detention or 14-day commitments.

Requested Funding: $1,457,000 in SFY 2006; $3,576,000 in SFY 2007. TOTAL: $5,033,000

 

Technical Adjustment

11. Drug Offense Sentencing Reform - Administering the Criminal Justice Treatment Account (CJTA)

Description: This decision package requests a technical correction to the Budget for meeting the SFY 2006 and SFY 2007 statutory provisions dictating the use of judicially supervised substance abuse treatment in lieu of incarceration, for offenders filed upon by local prosecutors. Funds are to be transferred from the Criminal Justice Treatment Account to DASA as mandated under RCW 70.96A.350.

Requested Funding: $8,250,000 (transfer from CJTA) in SFY 2006; $8,250,000 plus an increase based on the Implicit Price Deflator (IPD) (transfer from CJTA) in SFY 2007. TOTAL: $16,500,000 plus increase based on IPD