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
7. Native American Encounter Rate
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.
8. Chemical Dependency Case Management
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
9. Chemical Dependency Professionals at State Hospitals
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
10. Secure Detoxification Facilities
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
TOTAL POLICY ADDS FOR 2005-2007 BIENNIUM - $123,704,000 ($96,658,000
General Fund-State)
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
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