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Legislators’ Proposed Amendments to the Introduced State Budget

Written by Bruce Cruser

Bruce Cruser has been Executive Director of Mental Health Virginia since 2016, bringing a background in social work and community corrections, and many years of leadership experience in local and state government.

February 2, 2022

The 2022 session of the Virginia General Assembly began with an introduced 2-year state budget that includes a significant down payment to address the crisis in Virginia’s mental health system. Underfunded for decades before the pandemic, the system is unable to provide access to the unprecedented numbers of adults and children who are experiencing mental health problems.

Proposed amendments to the introduced budget would add even more funding to help address the complex challenges of a system with too few community treatment options, dwindling numbers of professional staff, and a record number of individuals in need.

Budget amendments provide a window into the relative priorities of legislators. Many amendments are brought to them by constituents, providers, organizations or advocates. Others reflect a legislator’s committee work or personal advocacy. Amendments that are similar may be combined in the compromises of the appropriations and finance committees. Those introduced in both the House and the Senate may have a better chance of final approval.

Below is a quick look at most of the proposed budget amendments related to mental health. Senator amendments have item numbers with an “s” at the end; Delegate amendments end with an “h.” You can see the actual amendments by going to the state budget website https://budget.lis.virginia.gov/amendments/2022/1/

Schools – Most proposals in this area support the goal of providing services to children and youth where they spend most of their time – in school.  

Study of school-based mental health services (McClellan 33#2s /Brewer 33#1s) create a task force of the Behavioral Health Commission to conduct a study of how to maximize school-based mental health services.

School-Based Mental Health Integration Pilot McClellan (311 #5s) and Price (311 #3h) go big with $10 million each year for the state to provide grants to school divisions to contract for community –based mental health services for students, from either public or private community-based providers. This gives flexibility for schools to meet student needs that are beyond the scope of school personnel. The pilot program would report back with their results.

School-Based Health Center Joint Task Force – Bennett-Parker (128 #1h) starts small with $50k for a task force to assess current services and recommend best practice, trauma-informed, school-based health centers as a vehicle for providing both medical and behavioral health services in school settings.

Post-COVID K-12 Mental Health Support Training Pilot Program – Reid’s $50k approach is direct service – a pilot in two school districts to teach school personnel, parents, and students about the signs and symptoms of mental health issues and how to intervene.

ARPA – Mental Health Screenings – Dunnavant (486 #17s) goes really big for one year by using $75 million in federal Recovery Act funds to implement universal screening and treatment of children in schools. The screenings would identify children with mental illness, substance use disorder, PTSD, social isolation, and learning disabilities to provide intensive counseling and supports.

Creating Treatment Capacity in Hospitals and the Community – The capacity problem is severe and these amendments cover much of the continuum of care, from direct funding to specific hospitals to add beds, to public/private partnerships, to filling the gaps in community care that divert individuals from needing a hospital.

Plan for Reducing State Hospital Admissions and Creating Capacity – Hanger (311 #1s) and Sickles (311 #1h) use $250,000 for a consultant to develop a series of policy and program recommendations, and an implementation plan for reducing state hospital admissions, length of stay and readmission rates.

Community-Based Behavioral Health Service Gap Innovation Grant Fund – Willett (312 #12h), Sickles (312 #11h), and Kiggans (312 #12s) put $50 million per year into a broad array of grants to provide behavioral health supports for children and adults that would not otherwise be available through the current system. Any public and/or private sector provider would be eligible for grant funding.

Public/Private Partnership for a Behavioral Health Facility – Pillion (312 #4s) and Kilgore (312 #10h, 312 #5h) use $23 million in state funds and a match in federal ARPA funds to help Ballad Health add 72 beds in southwest Virginia. Those served must include high acuity short term children, adolescent, adult and geriatric patients and help relieve pressure on state hospitals.

Behavioral Health Beds at Chesapeake Regional Medical Center – Spruill (312 #2s) and Leftwich (312 #8h) take a similar but smaller approach in the eastern part of the state, devoting $6.2 million to Chesapeake Regional Medical Center to support a 20 bed inpatient behavioral health unit diversion from state mental hospitals.

Behavioral Health Urgent Care Center – Vogel (312 3s) uses $5 million each year for Valley Health in Winchester to establish a Behavioral Health Urgent Care Center, to allow immediate access to psychiatric care.  

Virginia Beach Psychiatric Center Pilot – Kiggans (312 #11s) directs $165,000 for a mental health Intensive Outpatient Program (IOP) in Virginia Beach to support up to 300 individuals annually.

Crisis Intervention Centers – Ebbin (486 #23s and 313 #7s) takes $11 million one year from federal ARPA funds and $11 million the next year from state funds to help localities expand Crisis Intervention Team Assessment Centers (CITACs), Crisis Stabilization Units, and 23-hour Crisis Receiving Centers to provide crisis services locally and decrease the need for hospitalization.

Regional Crisis Receiving Center Pilot Program – Newman (313 #6s) puts $2.6 million each year in to a Community Services Board pilot in the Lynchburg region for a 12 bed crisis stabilization and detox center.

Expand Northwestern CITAC/ Establish a Behavioral Health Urgent Care Center – Gooditis (312 #2h) and Wiley (312 #7h) direct $7.5 million and $5 million respectfully to expand the CITAC at Winchester Medical Center to include adolescents and operate 24/7. Gooditis adds funds for Valley Health to operate a Behavioral Health Urgent Care Center.

MARCUS Alert Implementation – Favola (313 #5s) provides $9.3 million to CSBs in Region 2 (Northern VA) to pay additional costs of implementing the MARCUS Alert crisis response system.

Restructure Commonwealth Center for Children and Adolescents (language only) – Dunnavant (317 #1s) takes a total restructuring approach by closing the state’s 48 bed CCCA in Staunton. Instead, the state would build out community based services for children, and use the Children’s Hospital for the Kings Daughters in Norfolk and the Virginia Treatment Center for Children in Richmond.

Medicaid Insurance Rates for Behavioral Health Services – Based on the premise that what gets funded gets done, rate adjustments are intertwined with growing a sufficient behavioral health workforce.As we have seen with Medicaid expansion, whether or not someone can access needed services depends on a service being available and sufficiently funded. If the insurance rates for providers are too low, they won’t provide the service.

Behavioral Health Rate Study – Mason (304 #43s)includes $150,000 to study the Medicaid behavioral health rates.

Increase Rates for Psychiatric Residential Treatment Facilities – Deeds (304 #57s), Ruff (304 #11s and 304 #28s) and Barker (304 #22s) all devote over $4 million each year in state funds, and roughly the same amount in federal funds, to set a new minimum and maximum per day payment rate for psychiatric residential treatment facilities. Davis (304 #51h) and Fariss (304 #60h) would double that amount each year. The goal is to avoid hospitalization for children, and allow the vast majority of Virginia children to be placed with in-state providers, instead of being sent out of state due to cost limitations.

Continuation of 12.5 % Medicaid Rate Increase for Most Home and Community Based Services – Hanger (304 #47s) adds funding and language to continue the temporary 12.5% increase made in 2021 for most Medicaid home and community based providers – over $119 million from state and federal sources over two years. Willet (304 #26h) and Adams (304 #27h) do the same but with a total of $219 million over two years.

Medicaid Peer and Family Support Rate Increase – Deeds (304 #2s) and Hodges (304 #38h) increaseto  the Medicaid rates for certified peer recovery and family support services. Current rates are so low that few, if any, community services boards can afford to bill for reimbursement for these services.

Reimbursement Plan for Nursing Homes with Behavioral Health Needs – Dunnavant (304 #3s) and Adams (304 #54h) propose that the state develop a plan to increase reimbursement to nursing homes serving members with significant behavioral health needs. Nursing homes are having to increase services for this population. (Recommendation from the Joint Commission on Health Care).

Increase Assisted Living Auxiliary Grant Rate – Reid (344 #1h) devotes $38 million each year to increase the rate for these facilities and Dunnavant (344 #1s) wants to use $5 million the second year. Many of these facilities are home to adults with disabilities, including serious mental illness, and the current rate doesn’t cover the cost of care.  

Behavioral Health Workforce – Even before the pandemic, Virginia ranked 41st in the country in access to a trained behavioral health workforce.Hospital treatment beds and community treatment options, no matter how plentiful, are inaccessible if there is no one to staff them.

HB  624 Workgroup on BH Workforce Shortage – Roem (311 #6h) includes $50,000 to support House Bill 624, which establishes a workgroup to develop strategies to address the behavioral health safety net workforce shortage.

Community Services Boards Recruitment and Retention – Deeds (313 #4s), Hanger (313 #1s), and Sickles (313 #1h) all would add $167.5 million each year in state funds for critical workforce development initiatives of the local community services boards. This includes recruitment and retention bonuses, clinical supervision hours, loan repayment and scholarships.

SCHIEV – TAG Award Health Professions – Morefield (142 #4h) increases the tuition assistance grants for graduate students in health professions. $3.4 million the first year and $7.3 million the second year.

Psychiatric Nurse Practitioner Scholarship – Dunnavant (142 #5s) adds $10 million each year to fund a scholarship program for psychiatric nurse practitioners.

Increase the Mental Health Workforce Pipeline – Barker (144 #4s) – and a similar amendment from Sickles (144 #7h) – put in $1 million each year for a mental health workforce pilot at colleges in Virginia to fund costs of clinical supervision for masters level students in social work and counseling to get licensed. It would also expand mental health services to students on campus. The Virginia Health Care Foundation would consult with the State Council on Higher Education to implement the pilot.

Add 10 Psychiatric Residency Slots – Deeds (304 #53s) and Davis (304 #39h) add a total of $1.2 million each year to fund new psychiatric residency slots using Medicaid supplemental payments.

Behavioral Health Loan Repayment Program (language only) – Hanger (287 #1s) and Hope (287 #1h) would expand eligibility for the loan forgiveness program sites to include stand alone inpatient psychiatric facilities that serve uninsured or underserved communities.

Other Amendments

Suicide Prevention Campaign – Price (311 #8h) uses $125,000 in federal ARPA funds each year to launch a robust social media campaign for suicide prevention.  

Suicide Prevention/Mental Health Coordinator – Willett (470 #2h) funds about $325,000 over two years for the Dept. of Veterans and Defense Affairs to hire a mental health/suicide prevention coordinator for veteran services. Tata (470 #1h) takes a similar approach, for $240k over two years, focused on hiring a mental health coordinator consistent with a House bill, but the bill did not report from committee.

Forensic Discharge Planning (language only) – Deeds’ amendment (313 #3s) would allow more jails and community services boards to provide discharge planning for individuals with a serious mental illness prior to release from jail. Currently $3.7 million in funding is limited to only designated jails. Coyner’s amendment (313 #3h) would do the same but also broaden the language to include funding “may also be used for emergency client assistance resources.”

Private Provider Contracting (language only) – Dunnavant (311 #16s) would make a major change by allowing private providers to contract with the state to provide services currently limited to local public community services boards.

State Behavioral Health Authority (language only) – Dunnavant (318 #2s) totally changes Virginia’s system by creating a new State Behavioral Health Hospital Authority, and having the Department of Behavioral Health and Developmental Services transfer its authority for providing behavioral health services to the Department of Medical Assistance Services (DMAS).

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