VOCAL’s 2020 Legislative Priorities
Resolve Regulatory Obstacles for Behavioral Health Professionals.
Virginia’s behavioral health professionals, and the organizations which employ them, are experiencing significant capacity challenges. While innovative efforts are being pursued on the policy level, increased attention and funding is needed at the implementation stage for sustainable improvements across the behavioral health system. These obstacles are understood by subject experts, stakeholders, and service providers as mainly due to cumbersome and inconsistent regulations.
Between July 2017 and December 2019, fewer than five Virginian organizations have billed Medicaid for peer recovery support services. Explanations gathered from stakeholders regarding this underutilization, include: the administrative costs outweighing the potential gains from reimbursement rates ($26.00/hour), incompatible regulations with service needs (i.e. requirements of face-to-face contacts, limitations on the referral process, restrictions of supervisory qualifications), and the complexity of authorization documentation between different Managed Care Organizations. These unaddressed issues have resulted in the state appropriated Medicaid funds being left stagnant and inaccessible within the system, rather than in the hands of healthcare providers.
We strongly encourage members of the 2020 General Assembly to prioritize the resolution of the above mentioned challenges to ensure that service regulations are congruent with service provisions. Specific actions steps that our subject experts recommend are, a) eliminate barriers of reimbursement based on the form of service contact, and b) develop a standardized service authorization form to be used by each Managed Care Organization and provider. As these additions are emergency provisions concerning current services, we recommend their inclusion in the 2018 biennium “caboose” budget.
Reduce Workforce Capacity Barriers for Behavioral Health Professionals.
Virginia’s behavioral health workforce, which includes state employees, peer recovery specialists, administrative staff, clinicians, and physicians, is operating with limited human capital due to the extensive list of barrier crimes and the limited availability of clinical screeners. Many of our Community Services Boards have unfilled peer recovery specialist positions and managerial staff have noted that they have been restricted from hiring qualified candidates because of misdemeanor charges from five or more years prior.
Currently the three largest institutions providing psychiatric care to Americans living with mental health and/or substance use disorders are jail facilities. In Virginia, the number of incarcerated individuals in Department of Corrections facilities with mental health disorders has grown from 6,499 in 2009 to 8,398 in 20173. It should be no surprise that Virginian peers with mental health and/or substance use challenges have frequently had firsthand experiences with the criminal justice system.
To clarify, we do not endorse the elimination of the barrier crimes screening process in its entirety. We recognize and support the preventative measures the screening process provides for state-employed workers’ future clients. We do however ask that our elected representatives similarly recognize that past experiences with the criminal justice system can be key aspects of a peer recovery specialist’ qualifications.
We strongly encourage members of the 2020 General Assembly to include legislation that would expand the availability of approved clinical screeners and the overall number of screenable barrier crimes. While this situation is not necessarily one of our making, we have the opportunity to remedy a key aspect of the system through minimizing the barriers for rehabilitated individuals in obtaining gainful employment.
Increase Access to Peer Respite Services.
A peer respite is a voluntary, short-term, overnight program that provides non-clinical, community-based services to individuals experiencing extreme distress due to mental health and/or substance use challenges. Peer respites are staffed by certified peer recovery specialists; individuals with lived experiences of similar challenges. Peer respites, of which there are 14 nationally, operate 24 hours per day in a homelike environment. Individuals are welcome to stay at the respite center for, generally, one week while they work to return to a stable frame of mind and body. These programs aim to function as diversion from inpatient hospitalizations and operate in complement with other recovery services, as directed by the individual.
Leadership at Afiya, a peer respite center within the Western Massachusetts Recovery Learning Community which opened its doors in 2012, explain that respite centers allow for experiences of crisis to be reframed as opportunities to learn, heal, and grow. Afiya guests also shared that an inpatient hospitalization is an independent traumatic experience and having access to a respite center reduced the lasting effects of the situation.
Peer respites are an effective and available resource, currently untapped by Virginian policy leaders. We encourage members of the 2020 General Assembly session to commission an impact statement for the implementation of peer respite centers in Virginia.
VOCAL’s 2020 Legislative Priorities PDF.
Learn How a Bill Becomes a Law
VOCAL Bill Tracking Charts:
Advocacy Committee Call Schedule:
- January 17, 2020: Call minutes linked here
- January 24, 2020: Call minutes linked here
- January 31, 2020: Call minutes linked here
- February 7, 2020: Call minutes linked here
- February 14, 2020: Call minutes linked here
- February 21, 2020: Call minutes linked here
- February 28, 2020: Call minutes linked here
- March 6, 2020: Call minutes linked here
Thank you to everyone for your participation in the 2020 Legislative Session Advocacy Committee calls!