Lawmakers Look To Revamp Mental-Health Services

Apr 1, 2015

Legislation aimed at revamping Florida's system of delivering mental-health services is moving in the House and Senate and is gaining momentum.

The House version (HB 7119), which would hold providers to a new set of performance measures and open the bidding on state contracts to for-profit firms, was unanimously approved Tuesday by the House Health Care Appropriations Subcommittee.

In the Senate, a comparable measure (SB 7068) will get its second hearing Thursday in the Children, Families and Elder Affairs Committee.

The similar proposals are among a number aimed at fixing the state's mental-health care system this year. Rep. Gayle Harrell, chairwoman of the House Children, Families and Seniors Subcommittee, said Florida's system is too "fragmented" to meet the state's needs --- a criticism echoed by Senate Health and Human Services Appropriations Chairman Rene Garcia, sponsor of the Senate bill.

Harrell called the proposal a natural outgrowth of a major child-welfare overhaul that lawmakers passed last year.

"While we were doing that research last year, we recognized that the prime drivers of child abuse and child neglect were really rooted in substance abuse, mental health and domestic violence," Harrell said. "And indeed, domestic violence is very frequently the result of substance abuse and mental-health issues."

Studies also show that people with mental illness have much higher rates of unemployment, homelessness and incarceration.

But while most speakers at Tuesday's subcommittee meeting praised Harrell's bill, some also warned against provisions that would change the bidding process for state contracts.

"There are many good elements in this bill, but it also sets off alarm bells for significant unintended consequences, primarily opening the door for for-profit corporations to run an under-funded community-based system," Ann Berner, chief executive officer of the Southeast Florida Behavioral Health Network, told lawmakers.

Currently, what are known as "managing entities" administer substance-abuse and mental-health treatment at the regional level, bidding on contracts with the Department of Children and Families. There are seven managing entities statewide, and the House bill would require that at least two of them bid on each contract. Otherwise, the process could be re-opened to for-profit companies and Medicaid managed-care organizations.

Both chambers would require the managing entities' contracts to be data-driven and performance-based, including consequences for failing to comply.

Craig Latimer, Hillsborough County's supervisor of elections, advised the committee to pursue another of the bill's provisions --- a two-part study of the system --- before altering the bidding process.

"Do the study before any sweeping changes are made," he said.

Laureen Pagel, chief executive officer of Starting Point Behavioral Health Care, said her agency was the only provider of mental-health services in Nassau County --- and that she can't keep staff because the salaries are so low.

"My colleagues are closing their doors around the state," Pagel said. "It is a very fragile system right now, and frankly, I'm scared to death."

Currently, the managing entities estimate they're providing roughly $101 million a year in uncompensated care.

Pagel said key employees had left for higher-paying jobs and that she'd been looking for a staff psychiatrist since November. She described patients crying in her office over the loss.

"It's the patients who are suffering," she said.

John Bryant, assistant secretary for substance abuse and mental health at the Department of Children and Families, said the scenario Pagel described was "not uncommon."

"The competition for health-care professionals is immense," he said. "We have a very hard time recruiting and retaining psychiatric services and psychiatrists and physicians. … We've got to pay competitive salaries. We need, in a sense, a manpower initiative for behavioral health. Hopefully, that's something we can get addressed in this study."

Bryant, whose agency supports the bill, said the managing entities would likely be able to stay competitive even if the bidding process changes.

"One of the nice things about the (managing entities) is they have some flexibility within their budgets, and some of them are adjusting rates," he said.

Bryant estimated the annual cost of the state system for behavioral health care at $750 million, counting hospitals and community-based services.