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STATE’
 THE STATE’S FISCAL CRISIS:
CHANGING OUR COLLECTIVE
        RESPONSE
   Human Services Impact: Substance Abuse

               June 14, 2010

            Kathye Gorosh, MBA
                    CEO
              New Age Services
         kgorosh@newageservices.org
WHAT’
WHAT’S IN A NAME??
 SUBSTANCE USE                     AB US E
                              CE
                      BS   TAN
                    SU               TION
 SUB
     STA                       ADDIC
DISO     NCE
    RDE      USE   BEHAVIO            OPIOIDS:
         RS                RAL
                   HEALTH             OMT
                                      MAT
                                      MMT

     COV ERY       DRUG
                                      OTP
RE                                    ATOD
                   TREATMENT
DASA: SERVICES PROVIDED
Case Management

Child Care Residential

Community Intervention

Detoxification

HIV Testing and Counseling

Intensive Outpatient Services

DASA Early Intervention

Outpatient Services

Residential Rehabilitation

            Rehabilitation--
                          --Extended
Residential Rehabilitation--Extended

Toxicology
TREATMENT
             NETWORK
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 CARE
         Illinois 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 Residential extended aftercare (recovery
Care)                             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                     Quarter Hour        AAS $63.36 - per hour
                              Discharge Assessment                                      $15.84 - per quarter hour
Reimbursement Rates FY 2010
                              Level I (Individual)              Quarter Hour        OP     $60.32 - per hour
                                                                                           $15.08 - per quarter hour
                              Level I (Group)                      Quarter Hour     OP     $22.80 - per hour
                                                                                           $5.70 - per quarter hour
                              Level II(Individual)                 Quarter Hour     OR     $60.32 - per hour
                                                                                           $15.08 - per quarter hour
                                                                                           $22.80 - per hour
                              Level II (Group)                  Quarter Hour        OR     $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    -     $78.94
                              Opioid Maintenance Therapy        Day
                                                                Weekly              OP     $85.35
                               (less than 105 patients)
                              Opioid Maintenance Therapy        Weekly              OP     $68.28
                               (more than 104 patients)
                              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
                                                                                        $56.24 - per hour
                              HIV Counseling and Testing        Quarter Hour        HIV $14.06 - per quarter hour
SUPPORTED TREATMENT
        SERVICES     SFY 2009
90,373           Includes All DASA
                 funded services
Individuals

              60,267 Male
              30,106 Female                1,403
                                           Pregnant

                                     13%
                                     Youth
                                     86%
                                     Adults
                                     1%
                                     Seniors
S T I G M A
ALCOHOLISM AND SUBSTANCE
         ABUSE
    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
         ABUSE
 DASA: All funds SFY 2008 to SFY2010
ALCOHOLISM AND SUBSTANCE
         ABUSE
 DASA Medicaid SFY 2008 to SFY2010
New Age Services:
OMT Clients funded/Year
                                “budget relief”
                                 Actual: 3/09

                        Revised –
                        retro to 7/1




                    l
                                                  TBD
                  na
               gi
             ri
            O
THE GREAT SILO
      EFFECT
HEALTH              HUMAN
                    SERVICES
         OTHER
         SUPPORT
         SERVICES
STATUS: DHS/DASA FUNDING TO
DATE
 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/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
WHAT’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

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Impact of Illinois state cuts - substance abuse

  • 1. STATE’ THE STATE’S FISCAL CRISIS: CHANGING OUR COLLECTIVE RESPONSE Human Services Impact: Substance Abuse June 14, 2010 Kathye Gorosh, MBA CEO New Age Services kgorosh@newageservices.org
  • 2. WHAT’ WHAT’S IN A NAME?? SUBSTANCE USE AB US E CE BS TAN SU TION SUB STA ADDIC DISO NCE RDE USE BEHAVIO OPIOIDS: RS RAL HEALTH OMT MAT MMT COV ERY DRUG OTP RE ATOD TREATMENT
  • 3. DASA: SERVICES PROVIDED Case Management Child Care Residential Community Intervention Detoxification HIV Testing and Counseling Intensive Outpatient Services DASA Early Intervention Outpatient Services Residential Rehabilitation Rehabilitation-- --Extended Residential Rehabilitation--Extended Toxicology
  • 4. TREATMENT NETWORK 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.
  • 5. LEVELS OF CARE Illinois 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 Residential extended aftercare (recovery Care) homes), most often used as a step down from residential treatment.
  • 6. Minimum Unit of S e r v i c e S e r v i c e Code Rate Admission and Quarter Hour AAS $63.36 - per hour Discharge Assessment $15.84 - per quarter hour Reimbursement Rates FY 2010 Level I (Individual) Quarter Hour OP $60.32 - per hour $15.08 - per quarter hour Level I (Group) Quarter Hour OP $22.80 - per hour $5.70 - per quarter hour Level II(Individual) Quarter Hour OR $60.32 - per hour $15.08 - per quarter hour $22.80 - per hour Level II (Group) Quarter Hour OR $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 - $78.94 Opioid Maintenance Therapy Day Weekly OP $85.35 (less than 105 patients) Opioid Maintenance Therapy Weekly OP $68.28 (more than 104 patients) 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 $56.24 - per hour HIV Counseling and Testing Quarter Hour HIV $14.06 - per quarter hour
  • 7. SUPPORTED TREATMENT SERVICES SFY 2009 90,373 Includes All DASA funded services Individuals 60,267 Male 30,106 Female 1,403 Pregnant 13% Youth 86% Adults 1% Seniors
  • 8. S T I G M A
  • 9. ALCOHOLISM AND SUBSTANCE ABUSE 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
  • 10. ALCOHOLISM AND SUBSTANCE ABUSE DASA: All funds SFY 2008 to SFY2010
  • 11. ALCOHOLISM AND SUBSTANCE ABUSE DASA Medicaid SFY 2008 to SFY2010
  • 12. New Age Services: OMT Clients funded/Year “budget relief” Actual: 3/09 Revised – retro to 7/1 l TBD na gi ri O
  • 13. THE GREAT SILO EFFECT HEALTH HUMAN SERVICES OTHER SUPPORT SERVICES
  • 14. STATUS: DHS/DASA FUNDING TO DATE 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/abuse Clients/Patients admin detox Programs Close; Intake Doors Slam Shut Increased Waiting Lists Decrease Access to Many Services
  • 15. 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
  • 16. WHAT’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