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On June 14, 2010, Health & Medicine Policy Research group (HMPRG) hosted a forum, “The State’s Fiscal Crisis: Changing Our Collective Response.” With over 70 attendees, the forum explored the impact of the State’s budget and recent cuts on health and human services in Illinois. Participants heard from panel speakers about how we might collectively respond to the crisis and ensure responsible and adequate funding for education, health, and human services in Illinois. Materials from the forum can be found on the HMPRG website (www.hmprg.org)
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THE STATETHE STATETHE STATETHE STATE’’’’S FISCAL CRISIS: S FISCAL CRISIS: S FISCAL CRISIS: S FISCAL CRISIS:
CHANGING OUR COLLECTIVE CHANGING OUR COLLECTIVE CHANGING OUR COLLECTIVE CHANGING OUR COLLECTIVE
RESPONSERESPONSERESPONSERESPONSE
Kathye Gorosh, MBAKathye Gorosh, MBAKathye Gorosh, MBAKathye Gorosh, MBA
CEOCEOCEOCEO
New Age ServicesNew Age ServicesNew Age ServicesNew Age Services
[email protected]@[email protected]@newageservices.org
Human Services Impact: Substance AbuseHuman Services Impact: Substance AbuseHuman Services Impact: Substance AbuseHuman Services Impact: Substance Abuse
June 14, 2010June 14, 2010June 14, 2010June 14, 2010
WHATWHATWHATWHAT’’’’S IN A NAME??S IN A NAME??S IN A NAME??S IN A NAME??
SUBSTANCE ABUSE
SUBSTANCE USE
DISORDERS
RECOVERY
BEHAVIORAL HEALTH
ADDICTION
DRUG
TREATMENT
SUBSTANCE USE
OPIOIDS:OPIOIDS:OPIOIDS:OPIOIDS:
OMT
MAT
MMT
OTP
ATOD
DASA: SERVICES PROVIDEDDASA: SERVICES PROVIDEDDASA: SERVICES PROVIDEDDASA: SERVICES PROVIDEDDASA: SERVICES PROVIDEDDASA: SERVICES PROVIDEDDASA: SERVICES PROVIDEDDASA: SERVICES PROVIDED
� Case ManagementCase ManagementCase ManagementCase Management
� Child Care ResidentialChild Care ResidentialChild Care ResidentialChild Care Residential
� Community InterventionCommunity InterventionCommunity InterventionCommunity Intervention
� DetoxificationDetoxificationDetoxificationDetoxification
� HIV Testing and CounselingHIV Testing and CounselingHIV Testing and CounselingHIV Testing and Counseling
� Intensive Outpatient ServicesIntensive Outpatient ServicesIntensive Outpatient ServicesIntensive Outpatient Services
� DASA Early InterventionDASA Early InterventionDASA Early InterventionDASA Early Intervention
� Outpatient ServicesOutpatient ServicesOutpatient ServicesOutpatient Services
� Residential RehabilitationResidential RehabilitationResidential RehabilitationResidential Rehabilitation
� Residential RehabilitationResidential RehabilitationResidential RehabilitationResidential Rehabilitation--------ExtendedExtendedExtendedExtended
� ToxicologyToxicologyToxicologyToxicology
TREATMENT TREATMENT TREATMENT TREATMENT TREATMENT TREATMENT TREATMENT TREATMENT
NETWORKNETWORKNETWORKNETWORKNETWORKNETWORKNETWORKNETWORK
DASA administers a network of community-
based alcohol and other drug treatment
programs.
All treatment programs must be licensed by
DASA
�893 Licenses for Treatment and DUI.
� 494 Licenses held by 147 funded corporations.
� 399 licenses held by 283 unfunded
corporations.
LEVELS OF CARELEVELS OF CARELEVELS OF CARELEVELS OF CARELEVELS OF CARELEVELS OF CARELEVELS OF CARELEVELS OF CAREIllinois Substance Use Treatment Levels of Care
LEVEL DESCRIPTION
Level I (Outpatient) Outpatient treatment, individual and/or
group services, frequency determined by
assessment. Services average less than 9
hours/week.
Opioid Maintenance Therapy Outpatient treatment; methadone
maintenance; individual and/or group
services.
Level II (Intensive Outpatient) Outpatient treatment, individual and/or
group services, frequency determined by
assessment. Services average 9 hours/week
at a minimum.
Level III.2 (Detoxification) Monitored process of withdrawal from a
specific psychoactive substance.
Level III.3 (Residential Extended
Care)
Residential extended aftercare (recovery
homes), most often used as a step down
from residential treatment.
Minimum Unit of S e r v i c e S e r v i c e Code Rate
Admission and Discharge Assessment
Quarter Hour AAS $63.36 - per hour
$15.84 - per quarter hour
Level I (Individual) Quarter Hour OP $60.32 - per hour
$15.08 - per quarter hour Level I (Group)
Level II(Individual)
Quarter Hour
Quarter Hour
OP
OR
$22.80 - per hour
$5.70 - per quarter hour
$60.32 - per hour $15.08 - per quarter hour
Level II (Group)
Quarter Hour
OR
$22.80 - per hour
$5.70 - per quarter hour
Level III.1 Daily HH $64.86
Level III (Detoxification) Daily DX Provider Specific
Level III.5 Daily RR Provider Specific
Recovery Home - Adult Daily RH $46.65
Recovery Home - Adolescent Daily RH $118.45 Case Management Quarter Hour CM $46.68 - per hour
$11.67 - per quarter hour
Psychiatric/Diagnostic Per Encounter/Per Day
- $78.94
Opioid Maintenance Therapy (less than 105 patients)
Weekly OP $85.35
Opioid Maintenance Therapy (more than 104 patients)
Weekly OP $68.28
Early Intervention (Individual) Quarter Hour EI $60.32 - per hour
$15.08 - per quarter hour Early Intervention (Group) Quarter Hour EI $22.80 - per hour
$5.70 - per quarter hour
Community Intervention Quarter Hour CIH $45.56 - per staff hour
$11.39 - per quarter staff hour Child Domiciliary support Daily CRD $48.71
Toxicology Per Test TOX As specified in exhibit
HIV Counseling and Testing Quarter Hour HIV $56.24 - per hour $14.06 - per quarter hour
Reimbursement Rates FY 2010
SUPPORTED TREATMENT SUPPORTED TREATMENT SUPPORTED TREATMENT SUPPORTED TREATMENT SUPPORTED TREATMENT SUPPORTED TREATMENT SUPPORTED TREATMENT SUPPORTED TREATMENT
SERVICES SFY 2009SERVICES SFY 2009SERVICES SFY 2009SERVICES SFY 2009SERVICES SFY 2009SERVICES SFY 2009SERVICES SFY 2009SERVICES SFY 2009
�90,373 Individuals
� 60,267 Male
� 30,106 Female � 1,403 Pregnant
� 13% Youth
� 86% Adults
� 1% Seniors
Includes All DASA
funded services
S T I G M A
ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE
ABUSEABUSEABUSEABUSE� General Revenue Funds (Dollars in millions)
FY08 Appropriation Request = $164.5M
� FY09 Appropriation Request = $109.5M
� FY10 Appropriation Request = $109.3M
� FY11 Appropriation Request = $140.3M
ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE
ABUSEABUSEABUSEABUSEABUSEABUSEABUSEABUSE
DASA: All funds SFY 2008 to SFY2010
ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE ALCOHOLISM AND SUBSTANCE
ABUSEABUSEABUSEABUSEABUSEABUSEABUSEABUSE
DASA Medicaid SFY 2008 to SFY2010
TBD
New Age Services: New Age Services: New Age Services: New Age Services: New Age Services: New Age Services: New Age Services: New Age Services:
OMT Clients funded/YearOMT Clients funded/YearOMT Clients funded/YearOMT Clients funded/YearOMT Clients funded/YearOMT Clients funded/YearOMT Clients funded/YearOMT Clients funded/Year
Original
“budget relief”
Actual: 3/09
Revised –
retro to 7/1
THE GREAT SILO THE GREAT SILO THE GREAT SILO THE GREAT SILO THE GREAT SILO THE GREAT SILO THE GREAT SILO THE GREAT SILO
EFFECTEFFECTEFFECTEFFECTEFFECTEFFECTEFFECTEFFECT
HEALTH HUMAN
SERVICES
OTHER OTHER OTHER OTHER
SUPPORT SUPPORT SUPPORT SUPPORT
SERVICESSERVICESSERVICESSERVICES
STATUS: DHS/DASA FUNDING TO STATUS: DHS/DASA FUNDING TO STATUS: DHS/DASA FUNDING TO STATUS: DHS/DASA FUNDING TO STATUS: DHS/DASA FUNDING TO STATUS: DHS/DASA FUNDING TO STATUS: DHS/DASA FUNDING TO STATUS: DHS/DASA FUNDING TO
DATEDATEDATEDATEDATEDATEDATEDATE
� Contracts: Decreasing – since SFY 2008
� Payment: Time from Billing to Payment� SLOW SLOW SLOW
� 3 months to 6 months and even 10/09 [IL Partners]
� FFS Rates: unchanged since SFY 2002 (3% COLA in SFY 2006)� This amounts to a “cut” due to increased costs
� Consequences of untreated Substance use/abuseConsequences of untreated Substance use/abuseConsequences of untreated Substance use/abuseConsequences of untreated Substance use/abuse� Clients/Patients admin detox
� Programs Close; Intake Doors Slam Shut
� Increased Waiting Lists
� Decrease Access to Many Services
Addiction Healthcare Cuts
Yield Increased Costs:Additional Cuts in FY 11 to Addiction Prevention and
Treatment Services Result in $280 million in Related Costs
Failure by the State to adequately fund alcohol and drug prevention, treatment
and recovery services results in the State paying out billions in costs associated
with untreated addiction. Annually, the State of Illinois spends only $1 on
addiction healthcare services for every $33 that is allocated to pay for the
consequences of substance use disorders and addiction.
Of the estimated $4.85 billion spent annually in Illinois on issues related
to substance use and addiction, only $147 million is actually spent
on the prevention and treatment of alcohol and drug use and addiction.By cutting Addiction Prevention and Treatment state funding by 8% in
FY11, on top of cuts already imposed in FY10, the State will need to add an
additional $280 million to cover the expenses that will be incurred in
Criminal Justice, Education, Healthcare, Child Welfare, and Public Safety as
a result of untreated addictions.
Illinois Alcoholism and Drug Dependence Association
www.iadda.org
WHATWHATWHATWHATWHATWHATWHATWHAT’’’’’’’’S NEXT???S NEXT???S NEXT???S NEXT???S NEXT???S NEXT???S NEXT???S NEXT???� Reality at the agency level:
� Inability for Board to pass FY 2011 Budget
(varies based on %age of State Dollars that comprise the
agency’s budget)
� Given the “state of the state” – prepare staff and
clients/patients for layoffs and admin detox
� Look for additional places to cut expenses – not likely
since that has been ongoing since FY 2009
� Verify Line of Credit still available [NOTE: may be
harder this year w/ the State as the source of the
Account Receivable balance]
� Finding the best way to have a voice for our needs
