All right, good morning.

I'm at large council member Christina Henderson, chair of the committee on health.

Today is Friday, April 24th, 2026.

The time is 9 02 AM.

We are in room uh one twenty of the John A.

Wilson building.

This hearing is also being broadcast live on the Zoom Internet platform on Cable Channel 13, as well as my YouTube page at CMC Henderson.

I'm reconvening this meeting of the Committee on Health for uh part two of our hearings for the FY27 proposed budget for the Department of Insurance Securities and Banking, as well as the Department of Behavioral Health.

On Monday, we held a public uh hearing for public witnesses, and today we'll hear from uh Karima Woods, who's the commissioner of Disby, as well as Dr.

Barbara Bazeron, who's the director of the Department of Behavioral Health, as well as their teams.

Um I will just provide a little context for each of the agencies um and then we'll get into it.

The Department of Insurance and Securities and Banking works to protect district consumers from unhair unfair abusive practices while fostering an equitable business environment for regulated entities operating in the district.

First, to cultivate a regulatory environment that protects consumers, attracts and retains financial service firms to the district.

Um and we'll hear some follow-up questions about some of the things they raised, as well as um the documents that were provided to us on it in terms of the budget.

For those who are looking for some of these documents, you can actually visit the Chief Financial Officer's website, CFO.dc.gov, and on the main page, you'll find the documents for the proposed fiscal year 27 budget, not just for these two agencies, but for the entire government.

All right.

There's some other hearings that are going on, so they'll be around and we'll certainly turn to them when we get there.

Um we're going to start with Disby today, and then we'll follow up with uh Department of Behavioral Health.

So I'll call up Commissioner Woods as well as any of her folks that she wants to bring with her to the table.

Okay, Commissioner, um, I need to swear you in, um, but it's easier to do this if I swear in you or anyone else who might speak today.

Um if everyone can raise their right hands who might be joining you in this endeavor.

Lovely.

Um, do you swear to affirm under penalty of law that you um the testimony you're about to provide to the council of the district of Columbia and this committee is the truth, the whole truth, and nothing but the truth.

Great.

When are you ready, Commissioner?

Good morning, Chairperson Henderson, Committee on Health Members and Staff.

I am Karima Woods, Commissioner of the Department of Insurance, Securities, and Banking, also known as Disby.

I'm pleased to appear before the committee today to provide testimony on Disby's FY27 budget, which builds upon the successes achieved by the agency in FY25 and FY26 to date.

Mayor Bowser recently presented her fiscal year 2027 budget, GROW DC.

This budget sets DC up for growth by investing in education, public safety, health, and infrastructure, while making it easier and less expensive to do business in the district.

Grow DC builds on the mayor's budget from last year as the district supports the critical needs of our residents amidst a shifting economy across the region and nationwide.

This budget also shows the mayor's unwavering commitment to building a safer, stronger, healthier, and more equitable DC.

Disby regulates insurance, securities, banking, and other financial services in the District of Columbia.

Our mission is threefold to cultivate a regulatory environment that protects consumers and attracts and retains financial services firms to the district, to empower and educate residents on financial matters, and to provide financing to district small businesses.

Every day we translate this mission into action, ensuring residents have access to fair, transparent financial services, and strengthening the competitive landscape that makes the district a premier financial hub.

The mayor's FY27 budget provides Disby with the necessary resources to fulfill our mission.

The proposed FY27 budget for Disby is 35.2 million dollars, a 0.03% decrease from the approved FY26 budget.

The proposed budget is funded by 127,000 of local funds and 35.1 million dollars of special purpose revenue O type funds.

The FY27 budget supports 157 full-time positions, an increase of three revenue generating positions from our FY26 budget.

The FY27 proposed budget reflects a commitment from the mayor to continue Disby's vital regulatory and financial empowerment role, which positively affects the financial well-being of district residents and small business owners.

Now I will provide a brief overview of how Disby fulfills its mission with the few recent successes and plans as we move further into the fiscal year and prepare for the next one.

During the first six months of the fiscal year, the office provided financial education to more than 800 current borrowers and prospective college students through 20 outreach events.

Looking ahead, the office is expanding its regulatory capacity to identify servicing errors and strengthen consumer protections through formal examination authority, ensuring systemic problems are addressed and not just individual cases.

Another way that Disby fulfills its mission is by helping homeowners keep their homes and actively look to looking to prevent foreclosures.

The foreclosure prevention program has prevented 45 foreclosures.

These efforts resulted in preserving more than 27.4 million dollars in property value in the first two quarters of FY26.

Through the department's District of Columbia Business Capital Access Program, also known as DC BizCap, Disby continues to provide essential capital to district small business owners and entrepreneurs.

More than 80 percent of all businesses funded through BISCAP are minority and or women-owned, and the program also supports certified business enterprises.

In FY25 and 26 to date, DC BizCap has provided over 9.4 million dollars in funding to district small businesses through the state small business credit initiatives program.

The capital provided through DC BizCap was leveraged to access an additional 10.2 million dollars in private loan funding.

As a result of the support provided to those organizations, more than 514 district-based jobs were created or retained.

Disby's Office of Financial Empowerment and Education, also known as OFE, was established in FY20 to provide district residents with new tools and programs to empower them in their financial journeys.

OFE's programs provide critical pathways for district residents to improve their financial well-being across all eight wards.

Our programs, especially Bank on DC, Financially Fit DC, and Opportunity Accounts continue to offer life-changing opportunities to budget, save, and build wealth.

Some of OFEE's programs were expanded with federal ARPA dollars in previous years that are no longer available.

Disby has carefully reviewed how this and future budgets can still provide equitable and robust tools, resources, and outreach to district residents.

We are confident the mayor's FY27 budget will allow us to continue our slate of high impact programming, and we look forward to continuing to forge a path to financial education and empowerment across the district in years to come.

The district continues to be a national leader in captive insurance company licensing and FY26 to date.

The Risk Finance Bureau has licensed 21 captive insurance companies.

These include captives across diverse sectors, from consumer and financial technology and health care to instruction construction, transportation, and renewable energy.

Disby licenses over 230 captive insurers, reinforcing the district's reputation as a premier destination for businesses seeking efficient and innovative risk management solutions.

Captive insurers continue to contribute more than $4 million annually to the general fund and generate additional economic benefits through jobs as well as meetings and conferences they hold in DC.

FY26 to date, the compliance and analysis division, also known as CAD, closed approximately 487 consumer complaints and recovered approximately 280,000 for district residents.

Additionally, CAD provided 17 community engagement events to connect residents to mental health resources, teach fraud awareness, and provide wealth preservation strategies through estate planning workshops and legal clinics.

In closing, the resources allocated to DISBE will play a critical role in supporting the mayor's pledge to run through the tape for residents and small businesses in the district.

We remain committed to collaborating with you and the entire council on the department's vital mission to protect consumers, empower residents and their financial journeys, and invest in district small businesses.

I am optimistic about the continued progress and positive impact that Disby will have on district residents and small businesses and FY27.

Thank you for the opportunity to testify today, and I am happy to answer your questions.

And thank you to you and your team for helping in the prehearing conversations, not only with program staff, but also with your AFO to sort of better understand.

Sometimes the budget books are well, sometimes they're wrong, sometimes they're incomplete, and and they certainly don't always provide the context.

So I have some follow-up questions based on some of those and some of the information that we gathered.

All right.

So that was uh proposed decrease by $316,000.

Um so it's down to $5.59 million.

Now I know that doesn't seem like a lot of money, but I'm just curious uh is there a particular contract that we're no longer doing in IT, or is there a new type of relationship that we have with Octo or some other entity that's leading to that particular decrease?

From my understanding, the decrease you're referencing is mainly in the purchasing of equipment.

So there is a negative $319,000 change over from the previous budget.

So the budget for this sheet for FY27 would decrease by $319,000, and that's primarily attributed to the purchasing of equipment.

So that's what laptops, computers, that's my understanding.

Printers, et cetera.

Yes.

Sorry, this thing is often in the wrong space.

Okay.

Uh in public affairs, there's a 190,000 decrease.

What's that?

That's mine that's mainly attributed to um marketing for campaigns and also uh advertising.

Okay.

I will say it it sounds like significant decrease, but we still have enough in our budget to continue to do the necessary marketing that we need.

Okay, and this is for the various programs slash products that you guys offer.

Yes.

Okay.

All right.

Um now, those were some of the decreases.

Um, however, across the board, I think we're bringing on three additional FTEs.

Um weren't specific on which agent or which parts of the agency those folks are going to.

Do you have any clarity there?

Yes.

Um, one of the FTEs is for our securities uh license, our securities bureau, it's a securities licensing specialist.

Okay.

It's one of those positions that was cut previously, and so we're pleased to see that it is um that is back in the budget for FY27.

Um, another uh employee is for risk finance bureau, um, particularly for uh financial examiner.

Um, and then the the last one is for our CAD unit compliance and analysis division division for your senior safe compliance specialist.

Okay.

And these are all um important revenue generating positions for the agency.

Everybody likes to add that revenue generating, so we can't cut and take.

No.

Um for those particular divisions.

So let's start with securities licensing.

Were there already vacancies in that area?

There wasn't a vacancy.

This was a position, if I'm not mistaken, um, that was cut previously in previous fiscal years, and so we've been able to add it back in um to the licensing division of the securities bureau.

Okay.

Are there any current vacancies in the what is the compliance?

I think you call it CAB.

I try not to use all these acronyms, but compliant acts compliance analysis division.

Yes.

Um yes, um, but some of the vacancies are in the process of being filled, and so I know that um we have an outreach and engagement uh coordinator.

There was an offer extended to a candidate for that position.

Okay.

Um, in addition, we have the compliance um analysis analyst for the healthy DC.

Um that position we're we're we're it's pending selection, so it has been posted.

We have conducted interviews and we're um in the process of selecting a candidate.

All of those positions are in the CAD unit.

And the last position would be the consumer services and manager, and that position has been posted.

Okay.

And if I'm wrong, um Catrice Purdy, our chief of policy and administration will correct me.

Okay.

All right.

So prior to my tenure as having you under my committee, there was a uh a sweep that happens from one of your particular funds, it's 12.6 million.

Um I can't say I can give it back to you.

But what I'm asking is if you could talk a little bit about what if any impacts this has had to operations and what future challenges you might have if we don't address this particular ongoing sweep to the general fund.

Yes, there's been an ongoing um sweep from our budget, particularly our uh securities and banking regulatory trust fund since 2019.

Um and this the sweep has impacted um some of our regulatory functions.

We have been able to work through it, um, but it it would be beneficial if if you're not able to restore all of it, a portion of it, so that we can ensure that we remain on the forefront of regulation here in the District of Columbia.

Um it is important that we have the necessary positions, particularly as it relates to licensing and examinations so that we can protect consumers and that we can also ensure that we're fulfilling our full regulatory duties.

And so the fund itself where the sweep comes from is funded through industry fees and assessments.

And so the trust fund is used to support the department's overall operations.

So any ongoing sweeps have impacted our um licensing processing capacity, um, particularly in our banking bureau.

Um the the funds that are swept from the the fund as well also support all of the functions of the banking bureau, including our student loan office, including our BISCAP program, um, including our foreclosure and mediation work as well.

And so it is important that um at some point we we would like to see um that fund reduced in terms of the sweeps from the council uh for that particular fund.

Okay.

You said it started in 2019 or 2020.

2019.

2019.

This is the fun part of your budget is that it's all special purpose revenue.

So we're do our best.

Um the Office of Financial Empowerment and Education, as you mentioned in your testimony, oversees several initiatives to educate district residents on personal and business finances.

The proposed FY27 budget for financial empowerment has a $712,000 decrease.

Um is this mainly for the financial empowerment center going away or ceasing to exist?

The $717,000 or $712,000 reduction is primarily attributed to the financial empowerment center.

Okay.

Um so it's my understanding that those funds are being redirected to other parts of the agency.

Are we closing the center?

The center, yes, is closed.

Okay.

Was it due to lack of engagement or I guess you all saw a need for setting this up?

So how will its functions be absorbed into other parts of the agency's work?

So the the funding primarily for the financial empowerment center came from ARPA dollars.

Okay.

And so those dollars were primarily allocated towards the financial empowerment center.

We provided one-on-one financial coaching uh to district residents over a period of time.

Um I think the the main challenge has been that staffing has decreased.

We went from five counselors at the center to two counselors, um, and the overall um budget constraints did limit the capacity over the course of the the last year or so.

So we did have to really consider how can we still provide the necessary financial education and empowerment to residents in knowing that we would need to close this program.

So we have recalibrated some of our programs, particularly with our financially fit initiative, uh our bank on DC initiative to be able to still support residents.

I will say, just for your what the committee's awareness that there are other financial empowerment centers in the District of Columbia that are administered through the Urban League and the Urban Institute.

So although this particular one is closing, there are other centers that exist.

Okay.

It's ARPR dollars.

So I have to assume that the staff, even if there were only two counselors were aware that their positions were tied to federal funding that had a date certain in.

Yes.

I don't know for certain if they were aware where the dollars were coming from, but that's how we were funding it internally.

I guess I'm just trying to get at I don't like for people to find out that they're losing their jobs via budget hearing.

So have you guys had that conversation around the plans of the Financial Empowerment Center is going to be closing?

That conversation has been underway with the vendor.

I know that they were aware that funding would be coming to an end for the program.

Okay.

All right.

Um so there is a RFP or request for proposal for a new vendor to manage the opportunity accounts.

Um the FY27 proposed budget is for 845,000, which is a 295,000 increase for the program.

Uh why is the increase needed and how will it be used?

The increase will be used to provide additional match savings dollars to participants for the opportunity accounts program.

Okay.

845,000 is not the height of when of how much this program has had in the past, correct?

Correct.

Okay.

Um now we talked about this a little bit yesterday.

Uh not yesterday, even last time I saw you, Wednesday, on Wednesday.

Um about the FY26 supplemental, because this is an opportunity for us to talk about that as well, which had a proposed increase for opportunity accounts for FY26.

Why is that needed?

I believe it's a hundred and twenty-free.

So you have the FY26 supplemental.

There's a proposed increase for opportunity accounts.

Okay.

Okay.

How do we um the match dollars for opportunity accounts?

Is that considered local or is that from SPR as well?

That's SPR.

Okay.

Which one?

Which so for various SPR special purpose funds, there are some that come from particulars, or this is to be used for X purpose.

For from the securities and banking regulatory justice.

Oh, so this all comes from securities and banking.

Okay.

All right.

Um so in 2026, I guess which would be now, excuse me, the Office of the Inspector General did a risk assessment report on all the special purpose revenue funds across the government.

And they found actually the securities and banking trust fund to be at moderate risk level due to infrequent policy reviews, limited risk evaluations, and um they believe resulting in some inconsistent oversight.

Have are you aware of the OIG's uh recommendations as it pertains to this particular account?

I have recently become aware of it.

It's my understanding that the assessment was published earlier this month, and so my team and I have reviewed the recommendations coming out of it.

Um we have been working towards addressing some of the the policy gaps that are referenced, particularly through finalizing uh standard operating procedures for our securities bureau and our banking bureau.

Um, and so we have drafted those and I know they're currently under legal review.

Okay.

Um so I in terms of sometimes of how I know I OIG reports work, do you does this be submit a formal response?

Or I guess it's a little bit different because it's all of the agencies as opposed to just one particular program issue.

I guess I'm just trying to get at how what changes are you all planning to make in the upcoming year or upcoming few months rather around de-risking future maintenance gaps as it pertains to this fund.

So you're reviewing now.

I guess when should we check in in terms of next steps?

So in terms of next steps, our plan is to address the the policy gaps by the end of this fiscal year.

I will say this risk assessment is fairly new for us.

Um and so some of it we're still trying to fully understand as to what what it is that they need from us in addition to the standard operating procedures that we're putting in place.

Okay.

Um really quickly on I think councilmember Parker would want me to ask this.

Um as you know the council approved the PrEP DC Amendment Act of 2026 in March.

Um this uh provides new insurance requirements for coverage for cost sharing with regard to uh PrEP, PEP, and other HIV prevention services starting in 2027.

Um do you have an update on how you all are working to ensure that one insurance companies are aware of this new mandate as they prepare to submit rates for plan year 2027?

So I'm gonna ask if Phil Barlow, our associate commissioner for insurance can provide an update on that.

Great, thank you.

So uh we have communicated, you know, this.

I mean, the the industry generally keeps up with legislation and the requirements, but we have communicated uh the requirements to them uh through our insurance advisory committee and other places so they they are aware that it's happening.

We uh we will we also you know review the policy forms that uh that would indicate information like that, and so we we would incorporate that into our reviews of the uh the policy forms.

Okay, great.

So there shouldn't be any um issues in terms of implementation going forward, I guess in terms of folks submitting the required uh documentation for rate review.

So no, there shouldn't really be any any issues with that.

I mean, we have heard some we have gotten some complaints about some of these kind of things where the uh when we've looked at them, I think the main reason for this is uh is they were the way they were coded when they were submitted by the provider to the insurance company.

So we are looking to see what we can do to uh to you know address that as well so that minimizes the uh the friction because you know again when those things happen, you know, we get complaints and we can quickly address those, but we'd rather they not happen in the first place.

Okay.

Um pass that along to Councilmember Parker.

We uh we worked really quickly to try to meet the deadlines that you guys outlay in terms of what we got to get in before folks submit um rates for 27.

So hopefully we can um get that over the finish line.

Um Commissioner, while you're here, um we've had some questions from some advocates around uh oversight with regard to insurance carriers meeting their medical loss ratio requirements.

So for the public, MLR medical loss ratio is a requirement that insurers spend uh minimum percentage of their premiums on clinical services and quality improvements.

And if a carrier doesn't meet this, then they have to pay rebare rebates to consumers.

Um and unfortunately, we have had in the past some insurance companies who have not met their targets who have been supposed to be um making some rebates, and um Disby would be the agency that is providing oversight over whether or not they're following through insurance carriers are are you are you asking whether they are actually paying the rebates that they're supposed to pay?

Yeah, the answer is yes.

I mean they are they are playing paying the rebates that they are required to pay in terms of in terms of the issue about uh you know our preference is that the rates be set at levels where there are not rebates.

Yeah.

Um but uh unfortunately uh and and we've pretty much achieved that in the individual and small group.

Early on, we would see some rebates in the individual small group, and we addressed that with the carriers uh to to prevent that from happening.

But the problem is in the large group that includes the federal employees health benefit program and other programs that we don't have oversight over.

So there's not a whole lot we can do to uh on the large group side to uh to prevent um there from being uh rebates required, but we we do what we can.

And again, we've we we used to see them early on in the ACA, we would see them in the individual small group, and we've addressed that with the carriers.

And I don't I don't think we've had any I we certainly haven't had any material rebates in for the individual small group markets um in the last few years, and I I don't think we've had any.

Okay.

Alrighty.

Um some questions uh to follow up.

Yep.

Okay.

Uh Commissioner Woods, you talked about captive insurance in your testimony as DCA essentially interestingly, destination um in terms of uh captive insurance pieces.

Um you testified that it brings in more than four million annually for the um is there more we could be doing there to uh make us even more attractive?

I I'm not sure uh how robust the captive insurance market is uh nationwide, but are there some additional plans that you all have that you want to try to pursue or achieve in in FY27?

So I would say that each year we we look at how we can make our captive insurance program more robust.

Um I know over the years we've been very active in marketing the district um as a ideal jurisdiction for um any captive.

And um we have seen year over year those numbers increase.

Um I would say that we are one of the premier destinations nationwide for for captives, and we've seen that in the types of companies that are locating their captives here in the District of Columbia.

Um I will say that uh we've tried different methods to market, whether it's through the business journal, um, whether it's through marketing and other jurisdictions.

Um and so our goal is to continue to market and promote the program.

Uh we have an annual conference here, the captive insurance um uh uh conference takes place here in DC every single year, and we have been promoting that more uh as well, particularly for local companies and companies in the region as well uh to learn more about the district's captive program.

Yeah, I guess sort of speaking about that from the the public affairs and marketing piece.

It's not just you all paying in terms of marketing uh to residents about products and things, but also marketing outside to uh firms and businesses around what services we can also provide for them as well.

Yes, so the program is primarily um for businesses.

Um so we would be marketing two businesses to consider the district's jurisdiction to open their captive program.

Okay.

We have 21 now, or we carry 21.

Um for the fiscal year.

Okay, those are the new captives that that have been licensed.

Overall, I believe the number that was was shared was 230, 230.

Yes.

Okay.

Um in the FY25 performance oversight um hearing responses, and uh this is a follow-up from I can't remember when I saw you, but I know it was it was cold outside.

Uh February, January, February.

Okay.

Um you all shared that um there had been an audit that was an external audit that was completed for um one of the programs, the opportunity accounts, and that had been completed.

Um of the questions that we had as a follow-up is that the audit was only conducted of one year of program activities.

Um is that traditional that we only do a one-year audit as opposed to looking at the lifetime of a program I don't know if that's been traditional for the agency per se, but this was an internal audit that that we conducted.

And so our goal is to conduct this audit in this fiscal year, if I'm not mistaken as well, um, and most likely in FY27 as well.

Okay.

I guess I'm my question is you did an audit that was sort of looking at FY24.

The program has been in effect since FY 19, I want to say.

Um, with the highest amount of money I think it received in 23, um, which also included some federal dollars as well.

If there were can if there are concerns about the program, why not look backwards?

Why are we just going to audit just going forward in terms of the future?

I I think we took that approach mainly for budgetary purposes.

Um that would be one more money, and I believe what we had allocated in our budget would not have afforded us to be able to look at conducting an audit that would go back to 2019, but it is something we could take into consideration, but we would need to find out the the cost around that.

And if I'm not mistaken, I know we did um uh do some research on on how much it would cost to conduct the full audit versus just within that fiscal year.

Okay.

If you know what the price structure breakdown is, that would be helpful.

Um are there other are there other programs where you have a traditional audit cadence?

Meaning every couple of years you're looking at X program just from a compliance and oversight standpoint that you all internally are just want to make sure everything is on the up and up.

So none immediately come to mind.

It doesn't mean that we do not, and I'm looking at our AFO to see if he could could address that question.

Sure.

So there is a bi-annual audit for done by insurance regulatory thrust fund, only pertain to HMO and insurance company, so it's paid by the insurance regulatory thrust fund.

That's biannual audit.

Okay, biannual.

Yes.

Okay.

But council member, it it sounds like your question is about some of the programmatic functions of the agency, and so for programs like opportunity accounts and others, we have not traditionally conducted ongoing um audits of those programs.

Okay.

Um this is I think kind of goes back to a little bit of the OIG risk assessment, not just for your SPR, but for others, is that if we're not looking at them in sort of a semi-regular cadence, that does leave space for risk.

Um, and so that's just something that I'd ask for the agency to consider.

Um just a couple of additional questions that came up from the public witness testimony.

Um so as you know, we had a representative from one of the union or one of the collective bargaining agreement um collective bargaining units uh within Disby.

Um is the last time that a classification audit was conducted at Disby, looking at position descriptions and salaries.

So I I did have an opportunity to listen to the public witnesses um in particular Mr.

Slade's um testimony from the union.

Um and overall, out of the 154 FTEs that we currently have, uh 50 positions have gone through reclassification.

Um seventeen of those reclassifications have occurred in FY26.

So part of our hiring and promotion process entails evaluating and updating position descriptions that are aligned with our current operations.

And we do that in collaboration with DCHR.

So any position that is older than three years must be reclassified for personnel action, particularly during the hiring process.

That is a new requirement that DCHR has in process.

Um what we are not able to do is unilaterally reclassify um all of the positions at Disby.

Um I know that even for the positions that we currently have posted or hiring for, each of those positions had to go through some form of reclassification, and the process takes extremely long, primarily because DCHR is reclassifying positions for all of DC government.

And so to unilaterally conduct reclassification of all of the department's positions realistically, I don't see that necessarily happening because it has to be done through DCHR.

I I hear you on that, but I guess then the question is if the only time that a position can get reclassified is through the hiring process.

Because even though you've been in the agency for a long time, you know, at a certain point, modernizations happen, regulations change, and so a position changes.

So how do we have those types of conversations with long-term employees?

I'll speak to my own.

Yes.

Okay.

I'll speak to that.

So you could just introduce yourself for the record.

Okay.

My name is Catrice Purdy.

I am chief of policy and administration for Disney.

Um I'll say there have been cases where we have done that type of analysis.

For example, in our banking bureau, um, as part of even our review with our accreditation process, they observed that we did not have different layers to our um our examination positions.

So recently, I would say in the last year, we did an evaluation to determine some of our examiners were actually at a senior examiner level.

So some of those folks were promoted.

Um they were they're in their positions, but there was a re-evaluation and agreement that they would apply for that promoted position.

But what we can't do is while someone is sitting in the position, just change their PD.

Um, the process for that is usually either a position review that can be requested by the employee or the agency with DCHR or a desk audit, which I'm aware that the collective bargaining unit has requested for some of the positions at that they're concerned about there being additional duties or a change in a position, and that's actively in process with DCHR.

So that's the process for doing it.

Um if there's a concern that there are more duties or the position has changed over time.

Okay.

Okay.

I I hear you in terms of doing this with DCHR makes it cumbersome to try to do it as a we're just gonna review everybody's position all at once for no particular reason.

I think there is a concern that if we're not on some type of cadence, you could get into a situation where someone has been there for a long period of time, things have changed, but the position hasn't changed, nor has the classification.

But it sounds like you all are trying to address those.

Yes, and one thing I will say over the last, well, actually actually, since Commissioner Woods has been in place, we have actually made um intentional efforts to review PDs and see if and we've had a lot of turnover.

Folks are retiring, folks are moving on, and so we've had an opportunity to update a number of our positions.

So while we note 50 in the last three years, under her tenure, I'd say over um half of our positions have been reviewed as we've had changes, as we've made shifts with where folks are sitting, even if they stay within the department.

There's a lot of internal promotions, um, which kind of slows down our uh recruitment process but gives folks an opportunity to move on to other positions within their areas.

As they move, then we're updating that position that they're coming out of.

So that's two positions that are that are updated.

So we're only at 154 staff, so that's really an ambitious effort.

It's moved us along pretty quickly with updating most of our positions.

Okay.

Um while you're here.

Uh what protocols does the agency currently have in place to protect employees who participate in protected activities from adverse retaliation.

Um we don't retaliate.

Um, okay, you say that I know that that is a position of the agency, we don't retaliate, but obviously there are instances of retaliation that may happen and occur.

Um supervisory or individuals who are in supervisory positions provided um training on hey, this is a protective activity.

So one thing we've implemented in the last couple years is we have regular management meeting with all management staff, and we train them on a number of labor issues.

We've had OLRCB to come to those meetings, we've had DCHR to come to those meetings.

We also um worked actively to to provide issuances to our management and full staff on different policies and procedures.

As we hire new managers, we support them with educating them on the collective bargaining agreement and different parts of the DPM, which aren't pleasant to deal with, but we have to.

That's progressive discipline, performance management.

So there's a lot of effort to train our managers.

We're actually planning a new segment of training to finish out this year in collaboration with the vendor to make sure that we're giving the managers the support, understanding that you know how things function, the cadence of the agency is really dependent upon how well they're prepared.

Okay.

Um of the other things that the union has requested is that the agency produce an SPR report on how funding is used to strengthen core regulatory functions.

Now I'm not 100% convinced on that, but I will ask the question.

Because I know that this doesn't necessarily always occur, but I think if it's a uniqueness of your agency in particular, where so much of your funding, almost all of your funding is coming from SPR, that employees have some basic understanding of how the agency is funded and what are the various funds.

Um how much insight is provided to employees on the funding structure of the agency and and and where the money is coming from.

So we haven't necessarily had a formal meeting with all the employees to explain the breakdown of the department's budget.

Um I have been intentional about keeping the staff abreast year over year of our budget, how much is in it, what we're proposing, um, uh the number of FTEs, if we're hiring new employees, that information has been shared on a regular basis.

Um I'll also add that um we make the we've we've made it clear that our budget is public.

Um you can go and look up all of the information that's in Disby's budget.

Um, and we we share that continuously.

Um I know that prior to today's hearing, we've let staff know that I'll be testifying to chime in to look, look at the the hearing to learn more about the budget and the process and what we're presenting for the upcoming fiscal year.

Um so those are the steps that we've taken, and we do encourage staff to uh look at the budget documents and if they have questions to let us know.

Okay.

Um as you may know, uh Commissioner Woods, um, there's a workforce investment fund uh that is across government-wide, it's a pot of money for collective bargaining units that are going through the bargaining process.

Um the mayor has proposed um eliminating that.

Um, and so we're trying to get a handle of how many potential employees this could impact if it is not restored.

Um how many collective bargaining units are within Disby?

There are three.

Three.

Okay.

Um there any outstanding expi uh are there any expired contracts amongst the three?

No, the current um the master contract with um ask me is under review under negotiations right now, but there's nothing that has expired.

Okay.

Um so I'm sorry, the one with Ask me, you're at the table, you're so the full district is at the table with ASME.

Okay.

Are there any that are expected to expire in FR27?

Not that I'm aware of.

Okay.

Okay.

Um finally, uh, Commissioner, there was a witness with two witnesses, uh, public witnesses who testified about um the feasibility of a public bank.

My understanding is that the agency conducted a feasibility study back in 2020.

I feel like 2020 was a lifetime ago.

Uh particularly in regulation, um, certainly in financial services.

Um have there been any conversations of exploring this in the future or I don't know, even sort of revisiting the old study to see whether or not it still has relevance for today.

There have been no conversations to date about exploring um this in the future.

Um, honestly, um, I was pleased to hear the public witnesses' testimony, but um the public bank study, its outcome has not been brought to our attention in in many years, and I think realistically uh the feasibility of moving forward with the next phase of it.

I just don't see that being feasible given our current budget.

Given our current budget, in order to do that, it would require additional funds to our budget and staffing in order to conduct any additional work around that.

Um through our regulatory functions.

All right.

And we are back with the team from the Department of Behavioral Health.

Um, Dr.

Basaron.

Uh, before you begin, I need to swear you and your folks in.

So if everyone can raise their right hand.

Do you swear our firm under penalty of law that's a testimony you brought to provide to the council of the district of Columbia and this committee is the truth, the whole truth and nothing but the truth.

I do.

Great.

All right.

Um, Dr.

Basaran, I understand you have slides today.

Or now I have what?

You have slides, a PowerPoint.

Great, just a few.

So and I'll I'll tell you when when to start them because they're uh mid mid through the uh okay.

I'll just say slide.

No problem.

Okay.

Okay, go ahead.

Always trying something new.

Okay.

Good morning, Chairperson Henderson, Council members and council staff.

I'm Dr.

Barbara J.

Bazron, Director of the Department of Behavioral Health.

With me today are Adrian Reed, Agency Fiscal Officer, and Michael Neff, Chief Operating Officer.

I am here today to testify on Mayor Bowser's proposed fiscal year 2027 GROW DC budget and how the Department of Behavioral Health supports her vision to preserve core services, protect robust health care for DC residents, and grow our economy.

Mayor Bowser's proposed FY27 budget for DBH ensures that residents who rely on the public behavioral health care system have access to the care and supports they need to lead healthier, longer, and more fulfilling lives.

Under the leadership of Mayor Bowser and the guidance of Deputy Mayor Wayne Turnich, DBH supports healthier and stronger communities by working to prevent the onset of mental and substance use disorders and providing a range of community-based treatment services and recovery support services, primarily through DBH certified providers.

DBH provides crisis services, operates adult and child care clinics, and manages St.

Elizabeth's Hospital for those who require inpatient psychiatric care.

As the State Behavioral Health Authority, we are also responsible for addressing the behavioral health of all district residents.

Despite the challenges, despite the budget challenges, Mayor Budget Mayor Bowser's proposed budget for DBH makes available a full range of treatment services for residents of all ages by phone, at home, in school, or in the community.

It maintains critical services that support treatment and sustain recovery and funds projected increases in Medicaid costs due to enrollment growth.

The budget also creates a new local benefit for behavioral health services, consolidates crisis services within DBH, and places limits on community support services to strengthen clinical care and to better prevent waste, fraud, and abuse.

I would now present an overview of the proposed FY27 budget for DBH and highlight key adjustments.

The proposed FY27 gross operating budget is approximately $360.5 million, which includes $270 million from local funds.

The proposed FY27 capital budget is $10.8 million to relocate the CPEP or comprehensive psychiatric emergency program to the adult urgent clinic site due to the development of the stadium process project.

The proposed budget maintains funding for core services that support our mission to prevent, treat, and support sustained recovery for residents and behavioral health disorders, including increased numbers of individuals being served who are forensically involved.

The proposed FY27 budget includes $63.3 million for outpatient behavioral health services for Medicaid eligible residents, which is an increase of $13 million to fund projected enrollment growth and a $25 and a $10.5 million for a new benefit plan supported with local dollars only, referred to as the local only benefits program.

In addition, the proposed budget anticipates $37.7 million in the federal state opioid response grant and 10.6 million in the opioid abatement fund to support substance use disorder treatment and support.

The proposed budget includes $98.6 million to operate St.

Elizabeth's Hospital, the district's only inpatient psychiatric facility.

The proposed budget also includes 20.5 million for crisis support services for children, youth, and adults.

So people experiencing psychiatric or emotional support can get immediate help on the phone or in person.

I want to highlight that our budget includes $32 million in supported housing.

Access to safe housing is essential to maintain recovery, and the district remains a leader in providing supported housing.

DBH offers a variety of housing options supported with federal and local funds, including transitional housing for youth, supported residences, rental housing vouchers, and housing for those in recovery from substance use disorder.

During our FY25 performance oversight hearing in February, I testified about some of the major challenges facing DBH and our progress in addressing them.

These challenges are strengthening the clinical platform across the provider network, rooting out improper billing and fraud, ensuring network adequacy and providing appropriate oversight of the provider network, leading the shift in school-based services to a model that provides behavioral health access to every student, and addressing staff and operational challenges at St.

Elizabeth's Hospital.

To ensure the proposed FY27 budget provides the resources needed to address these challenges, we had to make some tough choices.

The key reductions include $8.5 million in mental health rehabilitation services, primarily community support services, $956,000 reduction in operations contracts for the DC stabilization center, which we believe will be offset by Medicaid billing.

$1.3 million primarily through consolidating crisis services in-house and eliminating contracts associated with crisis beds and the children's mobile crisis service.

One-time local funding of $950,000 for targeted outreach programs.

$14 million from St.

Elizabeth's Hospital, and I'll discuss this in more detail later in my testimony.

$40 million in vacancy savings, which shows a 26% reduction across the board in all areas.

I want to take a moment to explain our rationale for such a large savings, a large vacancy savings, which would be challenging to meet.

In short, we expect to adjust vacancy savings as we anticipate the need for a lower than projected amount for the local match for Medicaid payments.

We expect the decline in expenditures for community support services to continue.

In addition, the dramatic increase in the use of substance use disorder recovery support services in FY25, primarily by two providers, drove up the match amount.

We have stepped up our oversight and are imposing guidelines to support appropriate use of this service.

I would now like to share information regarding how our budget addresses the challenges we identified.

The first three challenges are interrelated.

One, strengthen the clinical platform across the provider network.

Two, root out improper billing and fraud, and three, ensure network adequacy to meet the needs of residents and provide appropriate oversight of the provider network.

Addressing these three challenges hinges on using community support services as it was intended to support, not replace clinical services.

As the first chart shows, chart slide, please.

The use of community support rose steadily over the past five years to a high of 152% in FY24, far outpacing the use of non-clinical services and out of proportion with the increase in the number of consumers.

The next slide also illustrates this matter.

Next slide, please.

Third slide, please.

Because of controls put in place in FY25, we changed the trajectory of increased spending on community support.

Next slide, please.

Community support services accounted for 69% of all mental health expenditures compared to 76% in FY24.

In January of 2026, monthly expenditures were $11.3 million compared to $27.2 million in December of 24, a decrease of $16 million, which is reflected on the slide.

Our multi-year plan to ensure the appropriate use of community support services includes limiting utilization to 200 units or 50 hours per 180 days.

This is equivalent of nearly two hours of community support services per week.

Limiting audio only telemedicine to six units per 180 days.

A provider may bill an additional 20 units of audio only for collateral contracts per 180 days.

To increase the chance for the best outcomes, this service will only be provided to those whose scores indicate they need this service level of support.

Individuals who are higher functioning are best served by office-based clinical services, and those who are in the lower range are best served by ACT, the highest level of care, and mandating a prior authorization for services which require a provider to attest that they have completed a functional assessment within 90 days and have a current treatment plan with required signatures.

I will now address the challenges of shifting the school-based service model to every so that every student has access to behavioral health care services.

Thank you for showing the slides.

After carefully listening to feedback from our CBO partners and community stakeholders, we have made meaningful adjustments to our implementation approach for the school-based behavioral health plan.

We are extending the full implementation timeline timeline through school year 28-29, an additional year, and are retaining five to six CBO partners up from the original three to four plan based on performance, existing partnerships, and the needs for special populations.

We are moving forward with our plan to increase access to school behavioral health services for all students within the District of Columbia.

Discussions with remaining schools that do not currently have a DBH funded resource will be completed by April 30th.

By August 1st of 2026, we will have hired an additional 56 staff to deliver services to 112 schools, including schools that do not currently have a DBH funded clinician and those transitioning from CBO service delivery.

Engagement with our CBO partners has been central to shaping this work.

Given the compressed time frame we are working within, we did not have sufficient opportunity for the level of front-end engagement with CBOs that this work deserves.

We have taken that feedback seriously, and the adjustments we have made, including the extended implementation timeline and expanded CBO retention reflect our commitment to get this right.

Our remaining school leaders will be brought into the process by April 30th with sessions that include updated information on the environmental scan, the school strengthening work plan and utilization data.

The service delivery model decisions will be made collaboratively with direct input from the schools we serve.

Our retained CBO partners will work alongside DBH and school leaders to deliver the model that best meets the needs of each school.

Additionally, a case study to inform practice across all participating schools will be completed by April 30th.

The last challenge we identified was addressing staffing and operational challenges within St.

Elizabeth's hospital.

The proposed FY27 budget for St.

Elizabeth's Hospital is 98.6 million, which supports 793 full-time physicians, more than half of whom are in nursing the nursing services.

The proposed budget supports the workforce required, which will allow us to maintain a safe therapeutic environment and provide timely and high quality service.

The net reduction is 14 million, which reflects 3.3 million to align the budget with revenue projections that have changed due to the change in the hospital population, $2.4 million from restructuring programs, the removal of one-time funding of $9 million.

However, the funding was replaced with $6.8 million in recurring funds, which in fact represents an increase to our base budget.

We expect to see reduced use of overtime with more rapid hiring as we have prioritized the housing and with fewer employees and non-duty status to stay within this budget.

6.9 million in vacancy savings.

However, I am committed to hiring staff at St.

Elizabeth and expect that vacancy savings would be realized across the agency.

The budgets for nursing and security were not reduced.

Along with the deputy mayor, we continue to meet regularly with union representatives to resolve staffing and operational issues at St.

Elizabeth's and to improve performance.

Your representative also attends the meetings.

Implementations of an electronic inventory management system and the work order system, which was of interest to the committee, is on track for implementation this fiscal year and will not be impacted by next year's budget.

As we say, focus on moving to person-centered care.

We are guided by what consumers tell us about our service.

And each year, DBH conducts a customer satisfaction survey.

Last fiscal year, 541 adults and 384 parents or children caregivers of children and youth responded to the satisfaction survey, which includes eight domains.

The targets for each domain is reflects an 80% satisfaction score.

You can see these data on the slide that's presented now.

Participation and treatment planning and the appropriate appropriateness and cultural sensitivity of care received the highest scores among respondents.

Responders receiving substance use disorder services, rated functioning and social connectedness as exceeding the target, while close care outcomes and general satisfaction with service delivery did not meet the target.

Among all adult respondents, 74 expressed uh general satisfaction, while 69% of caregivers expressed general satisfaction.

Among the adult mental health respondents, 69% reported satisfaction with their improvements in functioning compared to 77% of substance use respondents.

For caregivers of child and youth mental health consumers, 69% reported satisfaction with improvement in functioning.

While we are mindful that national outcomes of care and functioning are typically the lowest scored domains, in part because many respondents have not yet completed treatment.

We are listening and taking heed.

We expect that our continued focus on whole person care will lead to improved satisfaction with services.

I want to end my testimony as always by recognizing the leadership of peers and their integration throughout the system of care that is supported in the proposed budget.

The proposed budget includes about five million dollars to support consumer advocacy and peer leadership and employment opportunities.

Three peer specialist certification trainings are scheduled each year to enhance drop skills and peer support.

Peer specialists now work in the provider network with treatment teams in community hospital emergency rooms, in our consumer and family affairs office, our emergency care facilities at St.

And at St.

Elizabeth's Hospital.

DBH also funds four peer operated centers.

In conclusion, Mayor Bowers Bowser's proposed FY27 budget for DBH maintains core services, strengthens whole person care, and supports our commitment to provide the opportunity for residents with behavioral health needs to live healthier uh lives.

Madam Chair, we appreciate the work of the committee and look forward to our continued work to support the health and well-being of all district residents.

I, with my team, am ready uh to answer any questions.

Thank you.

Um thank you, Director Baseran, and thank you to your team for um.

I know this was a quick turnaround in terms of um preparations for this budget hearing, and so we appreciate the responses to some of the questions we had.

Um I think your AFO spent three hours with my staff the other day discussing some of these issues, and so um we certainly appreciate it, and I want to say that on the record because you know lots of conversations happened behind the scenes.

Unfortunately, they can't happen that three-hour meeting, while interesting to both Adrian and Marcia probably would not have necessarily been the most uh riveting conversation for the rest of the public.

So um, but it certainly helps um us to gain an understanding of um what is being uh proposed uh throughout the budget.

Um I want to start uh with questions around the Medicaid local match.

Um now I know that this is sort of a shared workflow, if you will, um, be between you all as well as um the Department of Health Care Finance, but you you have a part in your testimony that I I want to unpack a little.

So um on page four, you say, quote, in short, we expect to adjust vacancy savings as we anticipate the need for a lower than projected amount for the local match for Medicaid payments.

So you know, based on what you have provided and what we have seen, spending on local Medicaid match for behavioral health services decline.

Um man, I wanted to use a Wayne Turnage word, but I think I will pronounce it wrong, so I'm just gonna say significantly.

Significantly from 70.5 million in FY 2025 to 42.1 million approved in FY 2026.

Um, of that 42 million to so far to date in this fiscal year, you all have only spent 18.2 million of that.

What is driving this sharp reduction in spending?

Um and to what extent is this attributed to decrease in utilization versus the policy changes that the department has made.

Uh, first of all, I think there are several reasons why we're seeing the decrease.

One is the policy changes that I talked about in my testimony, um, limiting the number of community support units uh to 200 over 180 days, making sure that people who need community support are getting them, getting that service, and those who don't need it, for example, those who need ACT need a higher level of care.

Those who are more functional should have their services in an office-based situation and don't need uh community support.

So I think those two things.

The other thing is we have instituted an authorization process.

And I think here again, that is so that uh valid claims of service can certainly be paid.

But in addition to all of that, we've worked very closely with uh uh the Department of Healthcare Finance uh to really address fraud.

As you remember from uh Deputy Mayor Turnage's um uh testimony, we have done a number of things.

One, we are tracking uh uh the utilization.

If we see things that are out of order, we are then doing uh uh on-site audits of those uh providers, and in instances in which it appears that there is fraud, uh working with the Department of Healthcare Finance, uh payment suspension has been put in place, and then we have moved to decertify them.

And so I think that this is a way of getting the bad actors out of uh the system, and I think that that's very important.

We also uh I I will I I think uh with the authorization process that uh their CIO, CoMagin uh is uh instituting, we are ensuring that a consumers know what services they are receiving, and they have uh actually uh agreed to those services, that the uh provider has done what they need to do in terms of developing appropriate treatment plans and so forth, and that the services are consistent uh consistently used.

Um Michael Net uh may have other things to include.

Well, let me I I have some more further questions on this.

So the proposed FY27 budget increases the local Medicaid match um to 63.

So you've just outlined to me all the ways in which we're um limiting, but yet we're adding some additional funding here.

So what's the what's the rationale betwe behind the increase?

You want to speak to that?

I'd like to speak first about that.

Okay.

So the local match budget does propose $63 million, and the local match is often referred to as the local match, but it's also a program code in the budget book, as you know.

Yeah.

So that program code and that $63 million, two million is for the Comagin contract.

So I just wanted to clarify that.

So the match budget itself has been increased to $61 million.

And and the purpose of that increase is to approach budget formalization conservatively.

We do project that there are going to be lower costs because all of the things that Dr.

Basmond has put into place, but we will not know what those projections are until quarter one FRP for FY27.

So until that time, we have to make sure that we uh budget there so that we can make do on our agreement with health care finance.

Okay.

Is there a particular reason why you all have funding for the co-imagined contract and that's not included in the Department of Health Care Finances budget?

Or is it double funded?

It's so I'd say and I let Michael add, I'm sorry.

Yeah.

Healthcare finance has money in their budget for the co-magin contract as well.

That's DBH's portions who fund co-imagin contract.

Right, okay.

That is to address our claims.

Okay.

The contract is held by the Department of Health Care Finance.

We then um funds to them to cover our portion for the prior authorization process.

I would also note that when you do a budget projection, it has to be in a point in time.

Yeah.

And right now, we're still at the point where we are registering care, and that's a requirement to provide it.

In May, we'll begin a prior authorization process that looks at two different things.

It's going to look at uh an assessment score on the DLA 20 and slot where somebody will land in terms of numbers of units, could be 200 and 180 days or 100 and 180 days.

That hasn't happened yet.

That will cause a further reduction in community support as well as reviewing diagnostic groupings.

Well, this timeline doesn't really match up with our budget timeline of if you're not going to do this review until May.

The reviews start with the providers for community support in May.

They are currently registering all community support in order to receive it.

Now got it.

Okay.

All right.

Okay.

So I guess to go back to your line of we expect to adjust vacancy savings as we anticipate the need for lower than projected amount.

If utilization does not increase as projected, does DBH anticipate underspending in FY27?

We're like reallocate the funds?

Yeah, we will have to do some reallocation, and we are really going to track uh our expenditures very closely.

I have been having uh finance meetings with my whole financial team every Friday morning at 1030 so that we can review uh not only the expenditure data but also any revenue generation data that has come in.

And and with that we can determine you know what we need to do.

Okay.

Does this uh feel a little like whack-a-mole to you?

I think I had this conversation with the fraud uh uh division director at healthcare finance, but last year we made some changes um to limit usage on a completely different service line where we had seen a spike.

I think it was telehealth or audio only.

It was audio only telehealth, yes.

And then now this year we got to go back to community support.

Is there anything else that we feel like perhaps we should address now before it becomes uh the new target of uh uh aggressive usage?

Yes, one of the things that we are currently looking at is recovery support services, okay, which are within the the SUD um uh framework.

Uh and we are tracking that very closely.

We've already um uh taken some action uh to um do some audits and as a result of that one of our RSS providers who we saw huge utilization being done uh has been uh removed.

That they have I mean they are being they're in the process of uh being uh uh leaving the system, let's say.

Okay.

Um when we are making some of these changes, whether it be community support services, recovery support services.

I mean, I think you mentioned that the limits on cons uh community support services would amount to someone I think getting what two hours approximately two uh a week.

Right.

Um what kind of conversations are you all having with providers to ensure that these changes are not limiting medically necessary care?

Well, first of all, I'd like to say that uh the institution of the DLA 20 as a Can you say more for uh for the public of what that is?

Uh the daily living activities uh functional assessment, which is DLA 20.

And so what it does is it it really assesses the person's needs in terms of their ability to function effectively within their home, their community, uh, and the environment.

Okay, and so um actually that particular framework was developed in partnership with the provider community, and so uh we had many, many, many meetings talking about the DLA 20, and uh we now are at the point where we're implementing it.

Okay.

How are you all monitor uh going forward to ensure that these reductions are not leading to an increase in crisis utilization on the other side?

Well, we do uh look at uh our data, our crisis data, both uh in terms of uh inpatient utilization as well as outpatient utilization, and now that we are really um uh bringing those things in house, we will have uh uh even better uh uh ability to uh look and see what's happening, and if we see that, then we need to make whatever adjustments we have we need to.

Um Do you guys have the staffing in terms of like a like a healthcare finance, they've got their data guru team.

Do you have the data group uh a similar sort of that can look to not just sort of in general utilization, but to be able to identify for say a particular particular consumer.

We can track you had X amount of consumer or you in the past you had X number of hours of community support work.

Now I've seen you in the hospital for crisis admissions three times.

Okay, this is a particular person.

We need to highlight and pull that out, as opposed to just sort of looking at it in aggregate, which I feel like can sometime mask some of the issues that individuals are having.

Yes, we do, and actually uh Dr.

Shepard uh who is our chief medical officer and his team uh actually tracks data uh for those individuals, and we do provide um uh clinical uh review meetings uh for those individuals and determine what the best strategy is for moving forward.

Okay.

Um we've been joined by Councilmember Zachary Parker from Ward Five.

Um Ashley, if you just um put five minutes on, I'll just finish this uh one um chunk on overtime and then I'll I'll turn to Councilmember Parker.

Um all right, so I want to talk a little bit about overtime.

So what does overtime look like at the Department of Behavioral Health?

Now I can understand what overtime looks like at the hospital.

We'll put that to the side.

I but in in terms of overtime for everyone else within the agency, what type of activities are we doing on overtime?

Um we have very uh our overtime is uh you wanna speak to that?

Okay.

The majority of the overtime and the and behavioral health authority is uh approximately three million dollars, and that's mainly in the crisis services division, which is inclusive of uh CPEP CRT and Access Helpline.

Okay.

So why then I'm seeing a proposed overtime budget for $8.2 million?

Which is a $2.2 million decrease from FY26.

Yes, that's because that overtime accounts for the recurring budget increase that we received for overtime in St.

Elizabeth's.

Okay.

So it's all together.

Yes, yes.

Okay.

Um that doesn't sort of get past the part that actual overtime spending.

And FY25 was three 13.

Um, and so far, so let's see.

So far you guys have spent already 7.1 million in FY26.

I yeah, this is a trend across the government in terms of everybody budgets less to be hopeful, but your hopefulness is not realistic in terms of our current actual spending in terms of overtime.

Well, first of all, I mean, is eight if you are already spending today in time, 7.1 million.

How possible is 8.2 million next year gonna be enough money?

If I can start if I can start um preliminarily, there's a relief that paid family leave, and we have to confirm has been driving up overtime or the use of the paid family leave benefit.

Uh, when more employees use f paid family leave, then there's less uh staff attendance.

So it requires those who are there to work more overtime.

There's a proposal to reduce the paid family leave benefit and concomitantly the overtime should be reduced as well.

Okay.

But realistically speaking, the overtime issues at St.

Elizabeth's is not tied to paid family leave.

It is tied to you don't have enough people.

That's correct.

And that's when I was uh Madam Chair, one of the things I was gonna say that is one of the reasons why I've prioritized uh hiring at um St.

Elizabeth's hospital and um the CEO at the hospital can really share uh how many staff we've been able to bring on board um uh fairly uh quickly, and we think that that's really going to not only address overtime, but it will also address other uh management related issues.

Okay.

Let me ask this then um Adrian.

Um so you talked about part of it is related to C Papper and Crisis Response, part of the budget for overtime is related to St.

Elizabeth's hospital.

What's the breakout amongst the two?

Do you have I can get you that number momentarily?

Okay, could can I add to something that you said uh we are working with uh HR uh so that HR can more aggressively uh recruit for those positions at St.

Elizabeth's, but I want to put on record that because of the hospital environment, there's going to always be a certain level of vacant positions.

Uh we looked in previous fiscal years and our vacancy rates uh still existed um somewhere around 11 or 12 percent when we when there were no freezes, there were no stagnations in hiring as far as budget constraints.

So I just wanted to put that on the record as well.

Yeah, no, I hear you on that.

I just sort of um there has been a trend across the government where we say, oh, we only need a million dollars for overtime, and then at the end of the year you have spent twenty-seven.

Yeah.

Right.

So we just need to be a bit more realistic about sort of meeting those goals, but I think it would be helpful because overtime is encompassing of the entire agency, including a hospital, which I think a hospital function is a little bit different.

Councilmember Parker Councilmember Parker you're on mute still can you hear me now?

Yes okay I think you can hear me I'm having some challenges with audio and so I'm trying to multi-tast it's good to see you Dr.

Bazron I um I wanted to just start at a very high level um you know it strikes me that the overall budget is uh declining by roughly five percent while demand for crisis services continue to grow and how how do you uh square those two things that our need for crisis services are expanding while we are flashing the budget in such a significant way first of all I think that's why we have had to do some restructuring of our crisis service system you may recall uh last year we actually made sure that we had or a couple of years ago uh we put all of the crisis services under uh one leader and and and develop that uh crisis service uh uh continuum the other things that we've done this year is we are bringing the crisis beds in-house uh which will uh uh help us significantly uh we are also bringing uh the uh child uh mobile crisis services in house and our CRT will also address that and so what we've had to do is we've had to look at the services that are contracted out and see how we could restructure to bring them in-house uh utilizing the resources that we have so that we can address that uh that need and we also are bringing in the uh the bed the crisis beds it's okay on that note on the bringing champs in house or the youth crisis team can you elaborate what that might look like the scale and scope of services sure uh first of all we um uh change the um the responsibilities for champs I believe it was a year ago uh where champs uh has only been uh operating eight in a in the morning to eight p.m in the evening and our community response team has been responding from eight p.m to eight a m to ensure that there was 247 coverage and so our community response team has experience already um responding to uh child uh and youth related issues and we have uh uh trained staff on that team and we will be uh actually hiring additional uh trained staff um to uh create to you know to do that uh particular task how many how many staff I think we are hiring um uh in terms of special special specialty staff for children is that what you're talking about yes yes yeah I think we are beh uh hiring and Jenna Burho our our chief I'm gonna have her come up and respond to that and uh while while she comes up I'm just noting here that there's an increase of about 46 FPEs um and I'm assuming that's because you're moving a lot of these programs in-house while we're seeing an expansion of FTs it seems like there is a reduction also in personnel costs okay yes to respond to your question uh you got to turn your mic on you go sorry about that um to respond to your question about uh the staffing adjustments that would need to be made made we do have some um capacity and capability within DBH with independently licensed clinicians in the child and youth division that we would leverage both as responders during the day but as trainers to CRT to make sure that our staff are brought up to kind of the maximum practice let practising to the top of their license or to the top of their training if you will um but the pro proposal is also to add independently licensed clinicians inside of CRT on evening shift on overnight shift and on day shift that can be paired with a paraprofessional as a full team that could respond then to any requests for child and youth responses.

We know that currently sounding I'm sorry, just jumping in for the fixed time.

So that's sounding like a similar model as the nursing uh suite program.

Is that fair?

Uh I think that's a fair description.

That's kind of how CRT operates anyways, in paired teams with response to calls.

Um how many how many uh staff total are you anticipating for that youth CRT division when fully staffed up?

Uh I think it would six, six to eight.

And no longer will you be operating eight well well, let me ask.

What are the hours of operation for that team?

24 hours in three shifts.

In three shifts around 24 hours.

Right.

Okay, so six folks citywide will cover the city for 24 hours.

Do we anticipate that that's going to be sufficient?

Well, it's the cross-training pieces of that then, that those are specialty teams with that kind of top of license high degree of expertise that also supports then the rest of CRT, because the rest of CRT is in fact already responding to these calls in those hours from 8 p.m.

to 8 a.m.

So it's adding that expertise into that team and through cross-training, spreading it more broadly across the entire program.

Okay, one more question here.

Do you have a sense of how many team members uh there were with the champs unit?

Oh, I don't have that actual staffing in front of me, but I could certainly provide that.

Yes, it would be helpful to just have a comparison since we are making the argument of bringing this service in-house, like what are the trade-offs that we're making both in terms of personnel but also services being provided.

Um let me ask this.

How many of those six FTs do you anticipate are already um within DBH and they all just switch over versus you have to hire and bring someone on board?

Potentially four.

So four more new people will have to be brought on to the team, is that right?

Potentially, yes.

Okay.

Thank you.

Um relate to this, Dr.

Bazaran.

The just in light of the conversations um that we're having about youth.

Um if we want to pop up mental health services for our young people to meet them where they are, what division, what team, what resources do you have at your disposal that we could deploy such a team?

Uh first of all, we do have um uh multiple resources.

We have the team that uh Dr.

Berhoo um uh actually supervisors, the CRT team, but in addition to that, uh we also have uh teams within our child uh and youth um uh division, and we have our school-based behavior health clinicians who are trained also.

So not not school-based behavioral health, but I'm saying, like if I said Dr.

Basron, can you meet me at the NOMA Metro stop with with professionals and we're gonna just roll up on young people and try to meet them where they are?

It would be that CRT team that you would deploy.

No, there are two teams.

The CRT team is one resource, and we also have another resource within uh the child and youth services uh division within BBH.

And they typically will go out uh when there are trauma uh related issues or other kind of crisis issues, and they have been doing that for years.

And how are those two?

You just spoke about the CRT team and uh I'm clear on that, but how is that other unit funded for fiscal year 27?

That is a part of our our child and youth service division, and it reports to uh uh Erica Barnes, who is the director of child, youth and family services.

Those are DBH employees.

Okay.

Um I only have a minute uh left.

Let me come here to the opioid abatement funding.

Uh the budget seems to not put any new special purpose revenue uh from the opioid settlement fund in fiscal year 27.

Uh, there's about a million dollars in personnel and about four million dollars in subsidies.

How what impact will that have on our work to address opioid abatement across the district?

Hi, Councilmember Parker.

I want to uh just go on record and provide a little clarity.

The budget puts uh 10 point six million in for new red revenue for the opioid abatement settlement in FY27.

Okay.

So I'm saying that there's no oh so how would that 10 million support our opioid abatement uh work?

Oh we will uh continue to uh to support our our grant funded activities that are addressing um substance use and opioid um uh issues and if I could just okay that was a um I know we passed legislation making the pilots that I've been appreciative of permanent um and there's just uh uh challenge around um the team needing to hire FTEs for that work.

Who manages that work currently within DBH?

Dr.

Orlando Barker.

And is the anticipation that Dr.

Barker will manage should those programs become permanent uh moving forward?

Yes, that would be under his purview.

Okay.

Um I I will leave it there, but if I had a follow-up question, I would just be asking if you could just justify the need for an additional FTE and the funding for such uh for work that is already going forward, and if you could just fill that out.

But I want to honor the clock.

Thank you, uh, Councilmember Henderson.

Uh thank you, Councilman.

If I I'm sorry, I just wanted to um uh also add something, uh Councilmember, and that is in terms of um the uh crisis services and supports uh that you talked about for youth.

I also uh do want to share that we have our SUD prevention teams that are also out there, and so in some instances uh they may also be able to help support.

If I could just say, Dr.

Basseron, and you're one of my favorite people and favorite directors, uh so I have a bias, I'm acknowledging the bias.

Um, and I t I take this with the respect that I mean it.

Uh-huh.

Uh I don't see I don't see DBH.

I don't see I don't see the work, although I know the work is happening.

And as we are having and as we're having these conversations about youth, one of the conversations I had more explicitly with the mayor's team is uh working more directly to bring DBH out in the community um in a more preventative way, like I said, in Metro stops, or even at these team takeovers.

And so I will follow up offline and I'm glad to hear that you have all of these teams.

I just want to see you.

I want to see these folks out in the community and be clear that they are with DVH and they're actually doing the work.

Yes, we have some jackets and some uh uh, but uh in some instances, um we you know, like the lettering is not huge because sometimes that does have an impact upon how people uh respond to people who are out there to help them.

Okay, one last quick follow-up.

I'm sorry, Councilmember Henderson.

Uh can your team just share some of the rate of the member community.

You could stay.

I okay, I'll leave.

I have to I was gonna say I was gonna say if you could just share like some of the community outreach your team has done, and I will follow up with you on it.

Okay, thank you.

Okay, thank you.

You're always welcome to stay.

I know I have to jump.

I have to jump to another hearing.

All right.

Uh well, thank you.

Um Dr.

Bosan, I see um Mr.

Tasting uh here, so I want to hit some questions on St.

Elizabeth's so the proposed FYI 27 budget reflects some significant reductions across multiple hospital divisions, including clinical services, administration, housekeeping, engineering, nutrition, uh relying heavily upon uh vacancy savings.

Um of my concerns is that you know every agency has vacancy savings, but it doesn't seem as though any of those were reinvested to meet some of the critical needs of the hospital.

So you know, are there not any concerns about staffing, safety, etc.?

Well, I can tell you that um from uh where I sit, I have prioritized uh hiring at St.

Elizabeth's Hospital.

Um and we have really made some real uh gains there in to and uh Mr.

Tassin can uh share uh the list, it's a very long list of people that we can great.

I would love to hear how we got uh updates from January.

Yeah I think at that point we'll be able to share that with you.

Uh and I think that um that's really a positive thing.

We are also gonna be tracking what's happening in terms of the hospital is a priority.

We are still having those meetings um routinely uh at the hospital, uh in the Deputy Mayor Turnich and I, so that we can track in real time what's happening and make adjustments as needed.

Okay.

All right, Mr.

Testine.

So in January, there were 82 vacancies.

Um six were for clinical psychologists.

How are we doing?

Uh we're making we're making excellent progress.

Uh good morning.

Uh so our and and I'll send you this uh via email if you like in detail.

So since we met last, there are uh 13 staff on duty, new hires, the uh six psychiatric nurses, two psychiatric nurses' supervisors, locksmith, housekeepers, bHTs, social workers, and at this moment there are 15 nurses in various stages of recruitment, 10 psychiatric nurses are in the pre-employment background check, meaning they received offers, accepted those offers.

They're going through fingerprinting, drug testing, which is required in in healthcare organizations.

Um 13 BHTs are in various stages of recruitment as well.

Uh three are in new higher orientation as we speak.

Uh four nurse managers are in various stages of recruitment.

Uh two nurse managers are in new hire orientation as we speak, meaning they are at the hospital learning the ropes.

Uh the good news is that uh one of the two isn't actually actually been at the hospital for decades uh and has gone through progressive uh promotion opportunities, which we love to do.

Uh one assistant director of nursing has been selected is awaiting approval from the mayor's office.

So they're f four new nurse managers.

Clinical psychologists, there are two supervisory clinical psychologists in various stages of recruitment to uh clinical psychologists is also uh in various stages.

So they're managers and clinical psychologists.

When you say various stages of recruitment, does that mean as just posted?

That means in the instance of the nurses I referred to, ten of those nurses had been made office, accepted those offers, and are now going through the background check and finger printing, as is required.

As soon as that process is completed, they will come on board and go through orientation for 60 days.

Okay, but uh I had originally asked you about the clinical psychologist, you said various stages of recruitment.

Yes.

That means uh one of these two individuals, I think actually has already just in the last day accepted and is on board.

The other is uh either going through background checks or perhaps or in negotiations.

One of the two clinical psychologists supervisors is on board and is being promoted.

Okay.

And we're just waiting for final approval.

The locksmith is on board, uh, the social worker I reference is on board.

Uh a pharmacy technician is selected as and is just waiting internal final approval.

A security officer is on board going through hiring, uh going through orientation on site.

Uh there are four housekeepers that are in various stages of recruitment, two are in orientation, two candidates are in the final selection cert approval process, and then they will move to orientation.

Okay.

So let me ask you this.

Um there are 82 total vacancies in January.

If you separate out people for whom are in various stages of recruitment, i.e.

we've extended an offer, they're going through onboarding, etc.

Where are we at today?

Approximately 40 remaining.

You said 40?

Uh yes.

Okay.

So assuming everything goes successfully completed in the various stages of recruitment as a reference.

There are a few fallouts all the time.

There are few that don't make it through, don't make it through background checks as an example.

Okay.

Um there were several critical areas, including housekeeping maintenance and nutritional services that saw reductions uh in the proposed budget.

Um, again, you guys keep saying that vacancy savings, vacancy savings, but still concerned that these were some of the areas that uh were pointed out in January as some of the operational challenges, particularly in housekeeping around supplies and those types of things.

Um and then in nutritional services, um, you know, Mr.

Justine, I know you say the food is excellent, and yet we continue to receive complaints about the quality of the food.

So, Madam Chair, just in terms of keep in mind we had a major event in dietary.

Right, I know the the the kitchen.

Yes.

Yes.

That had a major impact.

We have remedied that through three million dollars invested in remedying that fire incident.

We are almost back to full operational pre-fire status.

Very shortly we will be.

And so we'll be able to address the efficiency, the consistency.

Because you were contracting out during the renovations and so when will you feel like you will be back to full in-house preparations?

Within the next 45 days, we will be, if not sooner.

Okay.

Yeah.

All right.

Um security soft services saw, I wouldn't necessarily even call it a modest increase.

Um, one of the things that folks keep bringing, even up in in these meetings is around not having enough uh security personnel on site, even as the patient population is is changing over and to more forensic.

Um, why did you all feel that there weren't additional resources needed in security?

Uh security is always a challenge.

Uh if resources were available, we would certainly welcome them and use them efficiently.

Uh we have 50, just to a little bit of background, we have 52 security staff on duty.

Uh half of those are permanent full-time special police officers that man the hospital and the patient units where assaults occur.

Um the other half uh are in uh observe and report status and/or checking in employees, very much like when you enter this building, you go through magnetometers and the staff there.

That function is what we have at the two lobbies in the hospital to make sure no weapons, uh no items that can be weaponized are are brought into the facility.

And so that's our security resource and team in terms of people.

Mr.

Justin, you said if quote, if resources were available, but you have vacancy savings.

So why don't you all ever use vacancy savings to address real need?

Yeah.

So we we address we address security matters.

Yeah, let Michael uh do the vacancy savings piece.

Yes, councilwoman, I like to provide some clarity on the vacancy savings.

You asked a question earlier.

Uh are they being reinvested?

And the gist of it is the vacancy savings has been taken as an even distribution across the agency.

So each program that you see in the budget book has a 26% impact.

That vacancy savings has been reinvested for the local match.

Because we believe we will save that amount, that vacancy savings will be go back to each program when that amount is realized in quarter one of FY27 once we complete the FRP.

So the vacancy savings isn't available for spending anywhere else.

Why does it sound like you all are creating a slush fund out of your local match?

A slush fund?

Well, a slush fund is inappropriate.

Let's call it uh a uh a l uh a mini general fund within the agency.

Uh yes, a mini general fund within the agency.

It I understand that you just want to come back and tap to later if you need to.

I understand that that the local match has actually um we have not budgeted the correct amounts for the local match in the past.

So to make sure that we budgeted the correct amounts in FY27 and that we were conservative, we budgeted the projected amounts that we received from um health care finance.

And but you all just said though, Mr.

Neff and others, that you feel like the given the policy changes that you have made and the oversight controls, that you don't believe that the amount that you have currently in the book for local match is actually going to be necessary.

We don't believe it, but we won't see it until quarter one of the FRP because we really need the data from CoMagine uh starting July.

So that's the issue.

You mentioned earlier that it seems like Coimagin, the timeline is not aligning with the budget.

Correct.

Your point was accurate.

That's exactly why we budget it for it that way, because the timeline whereby we receive the data would be later than the budget submission.

So if we receive the data and it does not show that the match is going to trend downward, then the local match is budgeted correctly.

And we receive the data that the match is going to turn downward, then we know that we will be able to redirect those amounts back into the vacancy savings.

You see what the trouble is is that then you guys get to redirect it and you take the actual appropriators out of the process.

So I just got to hope that y'all gonna put it in an appropriate spot in a reprogramming.

I mean, yeah, we can have that debate when it comes to a reprogramming, but also we get reprogrammings that are um expertly tailored so that it's exactly two to three dollars under what is necessary to come before the council.

I understand that.

I think though, I do understand your point.

I think though a reprogramming at large will have to go to council.

Okay.

How much have you spent on overtime this far this year?

How much?

Do you have that number?

Excuse me, yes.

The overtime expenditures are five million roughly for the first half of the fiscal year.

Okay.

That's not for everybody, that's just for St.

Elizabeth's.

Yes.

Okay.

Um just to check in on a couple of other things.

Um, Mr.

Chaste, while you're sitting here, so um Dr.

Bazaron said in her testimony that the um inventory system was in progress.

Can you give a some more details about that?

The what the inventory um service now?

Yep, you said it's on track.

It is on track.

Uh service now is on track, and um we've uh had all of the planning meetings, uh, the system is now being developed, and uh the uh expenses the fund finances to support that are in this year's budget, and so we hope to have that and I believe August 1st, but basically, um I would frame it a little differently.

Okay, um it is funded by capital dollars, and those funds are available.

Um DVH is working very closely with Octo because they hold the master contract for service now, which is what we're implementing, and we're trying to see which vehicle will be the quickest.

It will happen this fiscal year.

Uh to say that it's gonna be August 1, couldn't do that to date.

Um we know who the subcontracting vendor will be.

Okay, we do have the statement of work has been completed.

Okay, staff at the hospital.

Um so I would like to leave it as yes, the money is there.

Yes, we're in the process, and it will be completed.

Okay, so there's enough money in capital for FY26 to meet the need for this particular contract.

Okay.

Um what about for inventory management?

Same system.

So ServiceNow can do both work order and inventory.

Right.

And working with Okto.

Is it considered the same contract?

Or it is a combined contract.

It will be a combined service contract with Service Now.

All right.

Um, what about the system for glucose monitors?

Yes, I have an update.

Uh great progress.

So the vendors working with the hospital technical and reference technical staff.

Um it'll be completed within the next 60 days, if not sooner.

Excellent progress.

All right.

Okay.

I I want to go back to crisis response or crisis services, rather.

Um so Dr.

Bazaran, DBH is planning to bring crisis stabilization beds in-house and phase out uh existing contracts.

Um I understand that there are currently 32 beds total.

16 are operated by CPEP, and 16 are operated through contracted providers.

What's um what was the average daily census at FY26 for these beds?

Uh Dr.

Burrhaw will respond to that.

Okay.

uh existing contracts um i understand that there are currently 32 beds total sixteen are operated by c pep and sixteen are operated through contracted providers what's um what was the average daily census at 526 for these beds uh doctor burha will respond to that okay uh could you ask the question again sure so uh for um crisis stabilization beds you all are planning to bring it in house my understanding is currently there are 32 total so you have 16 at CPEP and 16 through contracted providers let me ask it in uh a different way is the idea that um we're gonna keep all 32 is that the plan for there to be 32 at the end of this transition it wouldn't technically be all 32 beds because if you're eliminating the beds in the community those beds are gone it's the absorbing the capacity into CPEP as part of that I know but are you not gonna absorb the 16 that you have in community that's what I'm asking from a regulatory standpoint the beds at CPEP are a different unit from potentially 16 crisis beds so yes the we received um about ten point nine million dollars to um move CPEP and to expand that unit to include crisis beds but they're two different functions okay my point still stands though we've got we have 16 beds at CPEP you have 16 beds out in the community when you get rid of the community providers are we still gonna have 32 total or are there going to be less this is um our chief medical officer somebody needs a chair a mic a phone go right ahead come with our Michael don't go away oh okay good morning everyone oh you're turn your mic on there you go good morning everyone Jonathan Shepard Chief Officer Department of Behavioral Health so I understand your question in regards to the number of bids and so we're gonna be reallocating and reassessing to see the number of beds so we recognize that that yes the the bids uh may uh uh require a reduction from 32 to 16 because right now at uh CPEP we do have 16 right but we also are looking at a new location so that the new location that we have we will also assess to see can we increase that capacity to see if we can match that 32 so again we're I thought a new location was identified in my right it has been so what I'm saying is that as we uh build out that location I see we're going to be rebuilding and repurposing those rooms so we can make sure that we can meet the demand for that service.

Okay.

So then my other question was in FY26 what was the average daily census for these beds uh I know I have the average daily stay I don't have the uh I don't have that I have to get that back to you we can get that for you okay um I would love that to understand the different in utilization between both DBH and what you were contracting out um because while there may need to be adjustments to meet the uh capacity restraints or maybe not of a new space I think if we're halving the number of crisis beds that's significant um regardless of where it's sort of located but who has what is important um so CPEP is moving you said because of the stadium project yes CPEP is moving to 35 K Street.

Okay and uh that building is being um uh reha rehabilitated I should say to uh accommodate CPEP is the as well as the crisis fits.

Is the construction happening now?

No the cut construction is not happening at this moment uh but uh it will be uh happening uh shortly so that we can okay yeah um will the modernization slash construction of the new CPEP site at 35k Street be online by October 1 if you are stopping the contracts with our in-community provider oh look at Tia is raising her hand behind you phone a friend come on down like Bob Barker up here you go in the prizes I get to answer.

So I just wanted to put a point on the 32 versus 16, because I can hear the concern and I would be concerned too.

Councilmember Parker raised it as well.

Yeah.

CPEP isn't use utilizing their beds.

I know there is the perception that the need for crisis isn't being met, but we are not seeing that volume of uh patients presenting for care.

Would that be helpful if I had the data of how many?

That's why I asked.

The data is zero.

The utilization of the 16 beds at CPEP is zero.

So we're gonna be even by bringing it in-house and utilizing our funds more efficiently.

Now, why was the utilization of CPEP at zero?

Is it possible that people feel more comfortable with your community-based providers than they do feel comfortable at the CPEP site?

I think that the anything's possible, but I think the utilization patterns have shifted for CPEP over the years.

And the community-based providers, you're not getting uh FIMS dropping people off at Woodley House or some.

That usually happens at a CPEP.

So it's a different mix that you're seeing.

Also, I think where it's located and the difficulty with getting there has really impacted uh the utilization at CPEP.

Um you know there's lots of construction going on there right now.

Yeah.

Um we uh used to actually have people who uh were walk-ins who needed that service.

We really don't get that anymore.

And and so I think that the location really has been a limiting factor.

And putting at 35k street, we uh anticipate that it will make it more accessible to our community.

And I'd I'd like to add something.

Um CPEP's utilization is not zero.

Um, not the not the she was talking about the beds for crisis stabilization, not the utilization overall.

From a regulatory perspective, you can't have a unit with more than 16 beds.

Right, right?

Can't do it.

So CPEP is between um a 24-hour stay, 32-hour bed and a 72-hour bed.

After that, if the person isn't able to uh continue care, they need to be moved to a hospital or discharge to a program.

That's that's just the regulation.

Same with a crisis bed unit could not go over 16.

Crisis stable crisis beds can go over 72 hours.

They're two different services, and we shouldn't be mixing them and saying these are the beds.

So that's one thing.

I think the second thing is there have been I can appreciate that, Mr.

Neff, but I feel like you guys are mixing the services by saying we have the capacity to absorb these other beds that exist in community within CPEP.

So now you're mixing the two, no?

No, I'm not mixing them.

It's very important that they're kept separated.

That a the plan is to build a unit for additional crisis beds where it will be co-located in a unit next to CPEP.

CPEP okay, but at the end of the day, you still can't even tell me how many beds you're gonna have total.

So let's say the unit for CPEP is required at 16, which is you said by regulation, each unit is required at 16.

No, no, no.

You license 16 beds to be able to offer the services that's your capacity.

Fine for one service is 16.

Then for the other service, I have been asking how many are you gonna put there where you currently have 16?

16 out.

But that's not what you guys said.

You said I we cannot guarantee that there will be 30, there will be 16 and 16 at the end.

You can it's a question of the utilization.

I'm sorry.

Let's back up because literally 10 minutes ago you told me that the design might not be feasible for you to put 16 and 16 in one location.

It's not true.

We actually are working with uh DGS to lay the plan out.

We haven't, and and they're in the process of kicking off uh a meeting with us so they can start doing design work.

Wait, okay, so DGS hasn't even started design.

So then it goes back to my question.

If if you can't guarantee that you're gonna be done by October 1, what's your contingency plan?

Because you're taking 16 off the street.

You're can't if you're canceling the contracts with Woodley House and some, which by the way, I think it's really really odd that we don't give folks a heads up that they have to hear about it when everybody else hears about it in the public, but let's put that to the side.

But let's put that to the side.

Well, well, that's not accurate.

There's no that's not accurate either, because I okay that's what they said.

But nonetheless.

That's not accurate.

Okay.

If we're canceling those contracts effective September 30, right?

End of this fiscal year.

The documents that you all have provided us zero out these contracts for FY27.

So how are you gonna pay for it?

If there's a transition plan, you haven't budgeted for it.

Or at least you haven't budgeted and provided the information to us.

I've got a spreadsheet where y'all look slashing and dashing.

So let me address that from one standpoint.

So when we're bringing the uh crisis bears in house, yes, we are going to have some savings, but we're also looking at the revenue that we're gonna be bringing in because those particular services were able to bill for those services.

So it is uh looking at a model that where we're gonna be generating more revenue to be able to balance out what the uh what the startup cost would be to bring that service in-house.

I don't know, I have those numbers for you directly.

Yep, but but that is the model in July.

So if people didn't want to go to CPEP before, how are we gonna generate revenue?

Sorry, not CPEP for the purposes of the other programs and services, but for the purposes of the stabilization of what as you said, some beds are 24, some beds are 32, X, Y, or Z.

If folks weren't coming for that before, what's our plan to redirect folks such that you can even get revenue generating activity out of those beds?

Well, like I feel like we I feel like we don't have a plan.

We have a concept of a plan, but we don't have a plan because the plan would include a timeline of not just we're in we're in design conversations with DGS, but it would also include, and we believe construction will begin here.

We will be able to finish out the punch list here, we will then be able to transition or at least tell the community hi, we're open for business here, but in FY27, we're gonna hold on to a little bit of our CBO contract so that come October it's just not anything for right now because when you start the construction on the new C on the uh at 35K, you won't be able to receive patients at the same time that you're constructing, right?

That's correct.

So um the CPEP site and the build out needs to be completed before the end of June of 27.

It's the current CPEP is due to become a road.

Um yeah, I mean, yes, that part is fact, we know that.

And we have been actually working with DGS.

Um, they've been incredibly helpful for over a year, you know, looking at sites, what's available, you know, how much space do we need and all of that.

Um we are about to kick off work with them probably next week.

Okay.

Um, and and they've been very involved in this and done tours of all the sites, what are our needs, measurements, all of that stuff.

Um they're very familiar with the 35K Street because they also worked with us to put in the stabilization system.

Very very clear of what the that that building can handle.

Um, so we have a longer timeline.

Now, I believe uh and know that the budget accounted for a million dollar reduction in that area for the contracts.

The contract limit for each one is $750,000 each.

It is not totally eliminated, and the services can continue until we have the site built out.

Uh, but madam chair, I I can tell you that we will not be without crisis uh beds, and we will assess the need and get back to you specifically with our plan with the with our concrete plan so that you have that data.

Okay.

Um I I okay, let's follow up on let's talk more about that.

Yes, absolutely.

Um your contractors believe that they have been completely eliminated.

So, whatever conversations in terms of that, because we yeah, we we should have some more of that.

Okay.

So as Mr.

Neff said, June of 27, got to move anyway.

Gotta move.

So gotta go somewhere.

It will not be there.

So we it will be mowed down.

We have a year.

So all right.

Okay.

Um now let's talk about champs or child and adolescent uh psychiatric services.

Now my documents say that you are eliminating this particular contract.

Is that accurate?

Correct.

Okay.

That is accurate.

Okay.

Can I can I just go back for a second?

In terms of uh bringing crisis stabilization beds in house.

Um were you unhappy with the service delivery from community providers?

Quite frankly, uh, here again.

Remember, I said we had to make some tough choices.

Okay.

Uh by bringing it in-house, we know that uh it will help us in terms of our ability to continue to provide the service in two ways.

One, we can use existing our you know uh in-house uh uh staff, and two, we'll also be able to bill for that service.

Okay.

Is 35K Street um your only additional asset beyond your building?

321 Howard Road.

Okay.

I was just wondering, we all not it seems like we're putting a lot at 35k.

Uh-huh.

Um that's all.

Yeah, we have we have 821 Howard Road, which and uh 35K and CPAP, those are the facilities that we have.

Okay, as well as the hospital.

Right.

Okay.

Um so we've reduced in the well, we the district.

Um councilmember Parker covered this a a little bit in terms of the hiring of particular pediatric or folks who have particular um expertise in terms of pediatric.

How is that going?

Um I think well, first of all, I know that the team has as uh Dr.

Verhoe said, uh, has been trained.

They have been providing that service already uh from 8 to 8, 8 p.m.

to 8 a.m.

And so they're not unfamiliar with that, and she plans to hire six additional uh clinicians uh that are specifically child trained.

Okay, but then now that that crew CRT will now have to handle everything from um 8 a.m.

to 8 p.m.

But they do it already, it's a 24-7 service.

Yes, and also I mean, like how many times has CRT been called to a school?

Usually schools are calling champs, are they not?

Uh but also remember we and within the schools, we also have clinicians there uh who can uh provide that kind of support, and they often do.

Yes, and then also they are still getting phone calls from the schools where you still even have DBH clinicians because sometimes there is an advanced something.

We had uh uh somebody who testified about this on Monday.

Even at the school, you know, like clinicians are great, and then they even have some limitations where they might need some additional support.

But if they're only six person six six people, six additional team members to the existing team.

No, no, she said six per shift.

Is that accurate, Doctor?

When you said to council member Parker six per shift to cover the city.

Is that not in is that am I wrong?

Total around 24 hours a day, but to that point, it's about 567 calls a year that are already absorbed by CRT, even in champs, they're doing about 17 in-person um interventions a month.

Yes, so it's 17 a month that need to be absorbed into that team in with the support of child and youth that has additional clinicians that are already doing that work with the support of the clinicians that are in schools that are also responding to that crisis response.

But I feel like you guys are using the data of the number of calls that champs was actually able to respond to and not the number of calls that they received, but unfortunately weren't able to make it to.

Well, it's not unfortunately unma unable to make it to.

It's that most of the the calls that they're receiving can be resolved in the phone call, that it doesn't have to have an in-person response.

That the that data reflects that most of the calls that are coming in, even to champs, that 90% of that work is being resolved on the phone without the need for an in-person clinician response.

90% of the calls that champs is getting can be resolved over the phone.

Yeah, they're all they're only responding in person about 17 times a month.

Okay.

I um we ask a more random question.

It's gonna seem random, but I promise you there's a point.

When's the last time you've had a conversation with someone at MPD?

Um the types of calls that they are getting.

Oh, about well, types of calls, yeah.

I guess you'll need to clarify for me what you mean by MPD.

I did a ride along recently with 4D.

Yeah.

Yeah.

And a veteran officer who've been on the force for 22 years.

Now I'm thinking, okay, is it's eight o'clock in the morning.

It's gonna be quiet.

Hopefully, for the four hours that I'm gonna spend with him.

I don't need to see a lot of action, just a little to make it interesting, but not a lot to make it, you know, dangerous.

And first call we got was from uh a parent had called 911 because their daughter wouldn't go to school.

Now I was confused.

And we look further in the notes.

Um mental health, okay.

MPD, they don't have the ability to just call you back and talk to you on the phone, they have to go.

So we went.

And there are two other officers who are there.

It it felt like a situation for a social worker.

Essentially, you had a young person who had already missed over 80 days of school.

The mom was concerned.

She didn't know who else to call.

And in my head, I'm like, this is not a call for MPD.

They're not here to arrest anybody.

This would be a perfect call for either a champs or a CRT.

And talk to the officers, they would agree, but they said they don't they don't know if you're gonna show up.

So that's why 911 gets sent.

So when you guys are making staffing decisions in terms of crisis response, whether it be for adults or pediatric, based on the number of calls, it's not reflective of the fact of the possibility of the window of calls and the possibility of the need.

Because it almost sounds as though you're saying, like, well, we only need to absorb 17, so that's not that bad.

When in fact, you probably need to absorb hundreds more, but you don't know about them because everybody's calling MPD because they're not gonna get a response from DBH.

That's actually a really great example of some of the work that's happening in some of that redesign.

Because you're absolutely right.

Even our co-response teams that are embedded with MPD, a lot of what they're responding to, frankly, during the day, is exactly those kinds of calls of parents that have called 911 because they don't know who else to call to try to have someone come out and help them with their young person or their adolescent to get them to school is the example.

Yeah.

Um we're even hearing that when we sit down and do our kind of um teaming work with MPD with our co-response teams.

That that is a significant actually number of um calls coming to co-response.

Right.

The thing that's interesting about that is co-response is dispatched by MPD themselves, and it's a little disconnected from the CRT work and and dispatch process, and that's some of the work that we're in right now around even redesigning crisis services and realigning it with how do we best wrap our arms around that so that we have the right place for the community to call to attach to the right response for something that's a mental health response, whether it's for children and youth or for adults.

Um I'd like to uh also respond to that.

We've been working with OUC also in terms of how calls are then referred uh directly to DBH.

We have staff physically sitting in their offices right now in their dispatch.

And so the issue is um how uh do we address the protocol to make sure uh that those calls that are behavioral health related go directly to our staff so that they can connect them to the right resource to CRT or what have you as opposed to just automatically doing a 911 police?

Right, but the the point that I'm trying to make as it relates to the budget and as it relates to resources is that you can't do that if you don't have people.

And so we're we're we are uh reducing the contract for champs, which is a resource of people to then I think you say you're gonna hire six additional people, but there doesn't seem to be any sort of further expansion of the capacity of your team to meet the need, not just what the defined need is today based on the calls that are taken.

So, like for instance, on the the co-response team that you talked about, how many people we're talking about?

How many people are it's five staff?

It's five physicians.

Five staff.

Fully staffed?

Not fully staffed currently.

We've got three staff um that are backfills that we hope to have uh in place late next month.

And what are their what are their hours?

Uh primarily day shift.

Some of that staff is day shift, some of it is evening shift.

Could you use more people?

I I'm I'm not pausing because it's not necessarily a yes or no answer.

That's in partnership with MPD with a grant that they have as well.

Yep.

For the co-response.

So some of the limitation is around on the MPD side, what they've got to be able to pair the officer with the co-response team member.

Um ideally, once we're back to that five staff, we believe MPD may have another two grant funded positions where we can get to seven.

The idea is to have that co-response for seven districts.

Um, but it's a little bit of a developing a developing program.

Yeah.

Um so to answer that as uh yes, I need X number of additional staff would be challenging me for for me to respond to right now.

I feel like in this is sort of the thing is that I feel like in terms of the the crisis response piece, in some ways we need like two budgets.

The budget for what we got today in terms of what's in the money in the coffers, and then the budget for what's the vision for if the if if we want this to work seamlessly, such that I don't got three officers who's spending 45 minutes in a person's home doing activities that would be better suited by your staff for which they your staff is trained for, MPD officers are not.

These guys are just compassionate and they're and they're fathers and they're interested in in terms of making sure that they could provide help and service.

But if we keep reducing on crisis response, it's only gonna just impact the number of calls that MPD is taking.

Well, and some of it for me is the efficiency perspective, right?

That if there are workflows that can be made more efficient, if there's staff that can be utilized in workflows that make more sense, the answer isn't always I need more bodies or we need more money to make it work.

I think some of this work is around coordination.

Right.

Using the resources that we have more efficiently.

I I could 100% agree with that, but I think when we get to the transition point of even dispatchers or folks at OUC feeling more comfortable transitioning calls so it's not a FIMS or a 911, but they say, okay, no, DBH has it, is that they want to have the belief that you have enough people to respond in an appropriate time manner because if somebody calls, let's say the um example that we were talking about, you have a mother who calls at eight.

If DBH, because of limited staffing, you can't get to it until 6 p.m.

that night.

Then but some of that too is around the the assessment of the acuity or triaging the situation that there is a difference between an emergency response, which is a life-threatening, you know, you need sirens, it's a life-threatening event that you've got to get to as quickly as possible.

Sure.

Versus things that are urgent enough that you need a response within the next six hours versus things that are urgent enough that you need a response within 24 hours.

Yeah.

So some of that too is I think around not only how we think about our workflows, but then that communication and the work that we need to do with the community.

Yeah, well, when they call 911, they don't expect a 24-hour response.

Or when someone calls 911, they believe it is urgent enough for that moment, not for you will get to it in 24 hours when we have more time and sort of capacity, right?

So I think we still have to work on our pieces around again, and you know we passed a whole bill on the council, right?

We we believe in crisis response.

We believe in it as a tool that is more effective in terms of using our resources, but also more effective in terms of connecting people with um the services and the supports that they actually need without involving folks with guns, right?

And so I just I want us to, I want your team to be beefed.

I want you to have the staff at OUC.

I want you to have the staff to be able to ride along with MPD.

Um if we don't necessarily have all the pieces here today from a budgetary standpoint, I just want to understand what the vision is because I feel like we're just moving around decks on the chairs and hoping that we can maintain the level of where we're at.

Whereas with council member Parker talked about, like we got crises popping up all over the place, particularly as it pertains to young people.

And when someone looks at the budget, not necessarily knowing all the details, they see that you all are proposing to reduce in terms of youth crisis response.

Now I know it's in consolidation, but that perceptions are important.

Okay.

I I feel like I've talked about that enough.

But I'm gonna talk about school-based behavioral health because I'm not done with the young people yet.

So all right, so it's DBH has proposed 8.5 uh million dollars for school-based behavioral health, which I believe is the lowest amount of money that we've had in this program uh since its conception, uh, and in terms of our growth to grow it.

Um, you know, Dr.

Basaron, the 18.5 million that's in the budget is even three million lower than what you told me a couple of months ago.

What was gonna be needed?

And that was you told me 21.

And that was the 3.4 that was uh removed um for from pilot one, I mean the case.

Yes, that was the pilot one B program for three point four million.

Uh refresh my memory, what was pilot one?

Was this a that was that was the pilot where we were providing the resources directly to the um charter schools?

Recall that okay.

Okay.

Um I think I had what three, four, four charter school leaders who testified on Monday saying, like, we like this pilot, we like to keep it, especially if you are gonna apply for it.

Get rid of my clinician.

Um let's talk a little bit about the timeline though for informing everyone's involved here.

Now, I don't know if this year is wacky, but the idea that we're gonna tell CBOs in May, mid-May, whether or not we're gonna use them for next school year, would also imply that you're telling schools in May, mid-May, whether or not they're actually going to be part of the program for next school year or not.

Well, let's let's back up.

In an ideal world, is the environmental scan an annual activity?

The environmental scan is a living document.

And so uh what happens is uh data uh is included in the environmental scan uh over time, and so it's not like you do it once, you add to it.

And uh Erica Barnes, who is our director of child and youth services is responsible for that.

She's sitting right here.

But in theory, Erica, um, if we're using the environmental scan to make staffing decisions around who's gonna go where you would need updated information every school year.

So, what we've done over this um school year is our clinical specialists have gone out to more than 60 schools to participate in their mental health team meetings while they're there, they're getting that updated information, making sure the information we received last year was actually accurate.

Okay.

Additionally, our program manager has met with some of the bigger LEA charter schools, the friendship, KIPS, Center City, and updating that information.

Um, additionally, we'll be meeting next week with all of the schools that don't have a funded clinician right now.

We'll be updating that information um with them.

I also want to make the point that the environmental scan is really just one piece of the puzzle.

We're gonna be looking at utilization data over several years, not just this past year.

Um, what the school, how many referrals the school has had, how many cases they have, what kind of programming they've already done in the school, and then I think one of the bigger pieces is having the conversation with school leadership.

Okay, but if I've never had a clinician, how does utilization data will it negatively impact my score?

No, no.

And I think that's a very small percentage who have never had a um clinician, but will be working with them to also part of the environmental scan is who do you have in your building?

Is their caseload full?

Who are they servicing?

Are they specifically dedicated to special ed students?

Right, or are they um also servicing general ed students?

And also one of the questions on the environmental scan is um what are the other duties as assigned that take up those workers' time so that we're we're also looking at that.

They may have five people, but forty percent of their time is in meetings or doing recess duty or lunch duty, those sorts of things.

So one of the things the school leaders testified was a desire to be able to look at the data that you all have to determine A, is it accurate, or B to appeal?

What does that process look like?

We can always update.

I mean, they can always reach out to us if we're not having a one-on-one meeting with them.

I mean, we um I looked at the data in in some of the schools reported um like their principal was doing therapy.

That's probably inaccurate, right?

Um so we are trying to get the most updated accurate information.

We're trying to just chunk it into schools that need immediate resource right now, and then when we announce what CBOs will be coming on, we're also gonna be letting the schools know that it's not that they're not gonna participate in the program, their resource will just be different.

Um, and we'll be have scheduling meetings the two weeks after we notify them to have those conversations about what what are your school needs.

In uh in the future sense.

Should these conversations be happening in May?

Do you think that's late?

I think that's late.

It it it is.

I think part of what the um we gave the CBOs uh mid-year, their mid-year data and mid-year evaluation, and we're um wanted to give them a couple of months to be able to improve on some of the things that are um challenges for them so that we can be fair with them.

Um yes, it is late.

Um so in the future, in an ideal sense, when would what what would the timeline look like?

So again, I'm saying so um on with DC Health, for instance, in terms of school nurses, we had to put in a cutoff of like if you're if your school is not approved for existing by X date, then you cannot participate in the DC health funded school nurse program for school year XYZ because we needed to plan.

We need to know how many people we needed to have, how many people XYZ was the budget?

And it feels like you guys are more fluid when schools are asking for more definitive because let's say they're not gonna have a full-time clinician that's provided by DBH, they might want to use resources to allocate because they feel like it's so important for their building that they could go hire somebody, but trying to hire or make those staffing decisions at the beginning of June is near impossible.

I I agree with what you're saying.

I mean that's definitely weakness, and I think in a perfect world from the feedback that we've gotten from school leaders and um the charter board alliance is exactly what they testified to on Monday is that they're making those budget decisions in January.

So that's when we should be having those conversations, or even before January, having those conversations about what their needs are going to be for the next school year.

I I agree with you.

That's okay.

Um the new plan relies on hiring staff for both FY26 and FY27.

FY26, oh, I wrote it down, but I don't remember how many people you were supposed to hire.

Um we said 24, and what we decided, three of those positions were going to be monitors, and we've used existing staff for those.

So our target was um 21.

We have hired um 13 clinicians.

Okay.

We have the prevent in uh the rest of those positions, the eight will be prevention specialists, and we have um our first screening for the prevention specialist that was posted uh two weeks ago or a little over two weeks ago, and um the screening process is taking a little bit of time because we had over a hundred applications for eight positions.

What's the difference between a clinician and a prevention specialist?

So a clinician is a licensed clinician who has a master's and can provide clinical services.

Okay, a prevention specialist, we're asking for a bachelor's degree, and they're gonna be doing all of the um prevention in the classrooms, the evidence-based prevention programs in the classroom and possibly some early intervention skill building like ignorant management or some of the um lower level early intervention programming.

Okay.

Uh so for FY27, how many people?

Four.

Four clinicians we've already hired, and the way that we have set it up with HR is um Melissa Willis, who's the program manager of school-based and I meet with our director of HR once a week.

We have um I guess it's rolling applications where we're getting a screening every three weeks for those positions.

Okay.

Um, and it gives um Melissa and her team to interview the folks that are on the cert.

The last cert, I do want to say for the grade 11 position, we had um 28 people on the cert, and we were able to hire 10 off of that cert.

Okay.

So you're going to need some CBOs for FY27.

Right.

We said that we would keep five to six.

Okay.

For how many schools.

Um so again, we don't know which CBOs we're gonna keep, so it's a rough estimate, but it looks like 53.

A minimum of 53.

Right.

One of the other things that was brought up in the testimony was how I guess on the evaluation rubric.

Um if you have staff to serve specialized populations like English language learners, etc.

Um, it was the same uh point allocation as if you submitted uh annual report.

I feel like the whole point is to sort of make sure that the specialized population like that it should actually be a boost, not a not a yeah, we we talked about that after we heard that testimony because that was the first bit of feedback we received.

That one category has special populations and also if their staff is certified in a particular model therapy model.

Um so we are absolutely willing to weigh that area of you know more than the other components of the NOGA that they need to be compliant with.

Okay.

Not gonna lie to y'all, I I I this feels real squishy to me still that we're like we are building the plane as we are flying it.

And I think our hope from last budget was that we would have taken a year to have a super solid plan, and this plan still feels squishy to me.

So I want to also clarify something.

Um we're hiring the staff for FY27 and FY26.

Yep.

We're anticipating that um the supervisors will come on July 1st, get them trained up, and the staff, the clinicians and the prevention specialist will come on actually July 27th, because that's the payday, um, the Monday after payday.

Yep.

So um I think that folks were concerned that we were only going to be able to start posting positions in October.

And and that would have led us into not being able to hire until January or February or with the hiring process.

So I do want to clarify that we already are hiring people and and making offers for the July 27th start date or the July 1st or whatever that pay period is at the beginning of July.

And we anticipate that they will be our staff will be you know trained to do our go through our orientation, be available for pre-service in the schools, and then there will be a transition with the CBOs to transition the cases if if that is necessary, so that there is no gap in service and that students and families are getting the services they deserve.

Okay.

All right, I want to uh switch over to talking about MHRS local.

Um so the proposed budget includes the $8.5 million reduction to local only mental health rehabilitation services, um which serves residents who meet income thresholds, but they are ineligible for Medicaid.

Um Dr.

Bazaron, your testimony um references multiple behavioral health benefit plans for non-Medicaid populations.

Um is it possible for us to get an overview for each of these plans, including the services?

Certainly.

Yeah, we have uh we actually have that uh document.

Okay.

Um individuals enrolled in alliance or the basic health plan.

What do we call it?

Healthy DC.

Um eligible to receive ACT services?

Yes.

Okay.

What about um community support?

Community support in the basic and our basic plan?

No.

Okay.

What about recovery support?

Yes.

Okay.

In conjunction.

Hold on, you gotta turn your mic on.

Go ahead.

Go ahead.

Uh yes, RSS is available for the substance use benefit in conjunction with residential treatment.

That's a requirement for ASAM criteria.

Okay.

Right.

Okay.

What about for Alliance?

Same.

Same, yeah.

Except for and then maybe I um just to clarify, Dr.

Bazaran, because when I asked about ACT services, you said for the basic health plan, but you didn't say for the Alliance.

No.

No, you only said one, so I'm just I I'm confirming that's the case, or maybe you meant to meet mention both.

I so go ahead.

I I'm confirming the act is.

And then the smallest group, between 350 to 500 people that are entering the system and have not have been screened for eligibility.

So they need to go through the screening process through DCAS.

And of that group, 98% convert to Medicaid.

But so those are our three groups that fall in, and the benefit plan is the same services for all of those people for one of the decisions we made, one of the policy choices we made is that um people who need ACT, we wanted to make sure that they could continue with ACT services because those are the people who are most uh severely uh impacted by their mental health uh uh issues.

How many residents currently rely on local only for outpatient and maritures?

About 5,000.

Okay.

Okay.

And so you all believe that if these services are eliminated, it could be absorbed in other benefit plans.

No, the the service is not being eliminated.

We created a new benefit plan.

Right.

Um, and so the the area that it's it the amount available for that plan is ten point five million, and it's in two categories.

Um the way that the reduction was made, it looks like we have three hundred and forty-six thousand dollars.

It's not true.

We have ten point five million.

Okay, so there's ten point two million that's from H04311, which is adult mental health substance use disorders.

It's a category, and the one that had all the money taken out of it was local only MHRS, which is now left with 346,000.

So the two of those together is 10.546.

Okay, so I mean, at least from the documents I have and understanding, is that the MHRS local going decreasing by 8.5, eliminates outpatient services except for CPEP, the stabilization center, CRT and crisis beds.

Am I mistaken?

Um we have revisited that and expanded the services.

It's a clinically based model now, so it has therapies, diagnostic assessments, evaluation and management.

Um because even for people who lost eligibility, we don't want them not to be an ACT, but it it's uh a full clinically based service.

Okay.

I'm gonna ask some more details on that and follow up, but I guess I'm just trying to understand, at least also for the public too.

You're saying we're oh no, we're gonna have this full array of services, and yet we're taking 8.5 million out.

Yes.

So how do you get the decrease if everybody still gets to get community support, which is not clinical, right?

And that's about 6.3 million dollars alone.

Um, and then it's some other services will see lower utilization, um RSS uh not associated with SUD residential, for example.

Okay, so the bulk of this decrease are coming out of RSS and community support.

Correct.

Yes.

Okay.

Um let's talk about your federal grants.

You guys know I don't like to ever leave money on the table.

Y'all keep leaving the monies, and I don't think that this current administration is gonna let you keep rolling that money on over.

Um, so we reviewed uh your federal grants.

Um so we've got underspending and a lot uh several SAMHSA funded, including COVID Simplemental, ARPRA funding, our first now obviously in well it'll it'll be gone, but um so for example ARPRA substance abuse prevention treatment block grant.

Uh the last um amount that uh lapsed is about 4.1 million, which was 74% of the award.

The ARPA community mental health block grant uh lapse 1.1 million.

Um how are we gonna get better at spending our SAMSA money?

Uh first of all, one of the things we're doing with SAMHSA money is looking at how um that resource can be used to fund some of the requests that are coming uh to the opioid abatement fund.

Yeah.

So that we can coordinate.

Well, hey, so we can coordinate uh uh that and that is uh one way of doing it.

And the other thing uh is to look at our grant making uh process to see how we can speed it up so that we can get the grants out sooner.

Council Winner, we've also increased our uh cadence of our financial meetings so that we can um alert everyone who is responsible for spending uh more frequently and we've also preloaded funding um in anticipation of any carryover that we may have doing that in the past has uh brought us three or more months of operational time to execute.

Okay.

I mean, are there and you guys have grants management people out the WAZU?

So I know it's not a staffing problem, might be a communication problem in terms of the staff to your grantees, but if someone, a grantee, is consistently not able to meet their mark while we have such appreciation for what they do in the community.

Sometimes we gotta let them go.

I agree with that.

And I want and I want to clarify two things, um, not for you but for the public and others.

Uh when we speak about grant spending, um, sometimes people think that they're just the grants that we award to the public.

No.

But it's also internal spending on personnel services, contract supplies, and things like that that contributed to the uh underspending.

So I wanted to uh clarify that.

And on the grantee side, we're working with the grants director to do what's similarly done on the uh contract side.

If we see that uh grantees are underspending or that they're not in compliance but submitting their invoices on time, then the grants director is working with legal so that they can uh provide them a letter and that they'll have no claims against the district for that payment, which gives the agency time to redirect those funds to another purpose.

Okay, Mr.

Neff, how's that grants management system going?

Um your mic's not on.

It's going.

I wish it were going better.

Um we are still having issues with the transfer of money fully to Department of Health.

They are working and have hired staff to be again setting it up to move it to fresh news, they got their first payments.

I have better news than you over.

Good news.

So yeah, that that's been so um the the holdup there is you know, you have your system, you're they're working diligently because it has to be able to be transferred to us.

So it has to have certain configuration done.

Right.

They've been working on that.

Um so let me get this straight.

You guys are doing an interagency transfer to DC Health to pick you back on their contract, or is their system to piggyback on their system?

Already set up to run grants.

Interesting.

You would think if it's because you guys are within the same government, this would go faster.

So when now that they've received their payment, when will you get the product?

Phone a friend.

Omar, come on.

Come on to the table, Omar.

This is an excellent professional development opportunity.

If you want to introduce yourself for the record, uh good morning, you gotta turn your there.

You go.

Good morning.

My name is Omar Newland, and I'm the chief information officer at DBH.

Uh we're targeting to have it complete by the end of this fiscal year.

It's current fiscal year, actually.

That's that's months, Omar.

That's months, Omar.

Wouldn't it be great if we could have this in place before the start of the next year's grants?

That would be great.

However, we would like a system that not only meets the standards and thresholds with DBH, but something that will scale and move forward for the next 10 to 20 years.

So it just it takes time to do the transfer.

It takes time to do the various implementation work with respect to um having a go live that is within this actual fiscal year.

And not to mention to port the data out of Excel sheets and other things to load the system.

It's paper now.

Yep.

Okay.

But it's coming.

I just want to though, like, note for the record, right?

Like we've been talking about this for like a year solid.

Not with you, Omar.

This first time I'm seeing you.

Hello, welcome.

But they know the rest of them sort of know.

Is there anything that we could do to help be helpful in getting our colleagues at DC Health to speed up the process, or are you feeling fairly confident that we're moving in the right direction?

We're actually on track.

Um so we've had um ongoing sessions over the past two months.

Um just to give you some background, the MOU with regards to actually migrating their system over was signed this year in January.

Okay.

And then um recently, as of this week, I've been engaging with the CIO at DC um at DC Health in order to start moving this along.

So this is as stated before, it's on track.

Okay.

Um Director Bazaran, and sort of going back to some of that conversation we were having about um uh some of the grant activities that have come to the opioid abatement fund sort of going on to SOAR.

Have we done that analysis to make sure that um some of these are the same allowable uses?

And are there any grants that should be moved sooner to SOAR funding as opposed to getting an another round of opioid abatement funding?

Uh we looked at uh yes, we looked very closely at that and did do some analysis in terms of uh because remember SOR has very specific right our grant requirements to kind of do a crosswalk to see uh what we're currently funding that could be more appropriately funded uh in SOR and our director of the opioid abatement fund and our director of FSUD of the SOR grant have really worked together to do that kind of crosswalk.

Okay, in the future we'll be able to uh really move things forward.

So there's one um thing that we've been funding through opioid abatement.

Um it's in the office of the chief medical examiner.

It's the um opioid surveillance work that they've been doing.

I don't know if that fits the SOR criteria because it's not directly dealing with patients or consumers.

I don't think that was one of the things that we could move over.

But we do have that funded through the is that something you all can share with us the crosswalk piece, just so we kind of have some knowledge around like what are the overlapping activities?

Or you know what?

Better no, that plus also I guess allowable uses for SOAR under federal under this new administration.

I know has changed.

So if you guys have an updated document on like what you can actually spend the money on, that would be helpful.

Yes.

I know that changes.

I know.

I don't need to share.

Yeah, I know.

Okay.

I know, I know.

Um sort of in the substance use area.

Um stabilization center, you have the first one that's open.

Um, maybe we aren't seeing it, but maybe it's there, but the funding for the operations of the second stabilization is that included in the FY27 budget?

Isn't it in 26?

Uh the opioid payments.

I mean the uh license center payments it in 26.

The one in Ward 1.

It's currently under construction.

Well, um due to open in January and we're looking at the current contract who and see if we can get savings from that to start the second one.

Um right now there isn't set aside second money for the the contract.

Um but that program has been very very successful, and they've done very well at being able to fill for services and bring in revenue, which then offsets the amount of the contract.

So we're we're looking at what might be available for that.

So is this suggesting that you all would want the same vendor who is doing the first stabilization center to do the second?

No, actually, it will be competitive.

It's a competitive bid, and uh whoever provides the um the most effective uh uh submission will get the good.

Have you guys alerted the council member from Ward 1 that there is not funding for this operation of the second stabilization center in the budget?

Uh I have talked with uh first of all that also the date uh for operations has moved, and I have been in communication with council member Anadot.

We have not specifically talked about the funding.

Okay.

So January is the new timeline.

Oh I perhaps I I would tell you, I was over there a couple of weeks ago, I didn't get something from the giant, and I was like, mmm, it's a lot of there's no windows on that building.

Yeah.

A lot of con active construction, yeah, but not um in sort of punch list.

We're still very much in putting up walls.

Yeah, it it was a total rehab.

I mean, it's a building that hadn't been occupied in almost 50 years.

Yeah.

Okay.

Um the um and sort of speaking about grants, but on the opioid front, um, we've been contacted by numerous grantees um regarding delays in administration of the opioid um abatement settlement grant funds, as well as some concerns about shifting policies.

Uh some of the grantees awarded or um stated that their awards were made in the summer with anticipated start date of October 1, 2025, but that even for grants that were awarded last summer, the contracting process on those grants have not yet been completed and funds have not yet been dispersed.

So, what's the delay on releasing those funds?

Because I know you have them.

I know they've been loaded, so um why aren't we able to sort of wrap this up?

Well, I I think and this is uh something uh certainly that that um I am aware of, and a part of it is that um a grantee received an award letter.

Yep.

Saying that you have been awarded this grant for X.

Then there is a process of going through their budget to make sure that their budget uh and the allocation is appropriate and consistent uh with uh our requirements, and and that back and forth has taken a long time for a lot of these um uh grantees.

A long time, and that has been a part of the delay.

Should it not be the reverse?

Um like shouldn't I have that conversation with you of pre giving you a letter saying you got the money?

Yeah, I don't disagree with that, but that's a process that that's in place right now.

Okay.

Um so how many grantees who were awarded last summer haven't yet gotten their money?

Uh I don't have the data, but I can get that to you.

Okay.

I just think that's important.

If are we launching a new round this summer?

Uh well, it depends on whether or not uh we get uh the funds that um we have been alerted, we might get verbally, but I don't have anything in writing.

If that happens, then yes.

Who would know that?

OAG?

Yes.

Okay.

All right, we could follow up with OAG to figure out what that is.

Um all right, so I was pleased to see you guys are saying, yay, you see the value in the court urgent care clinic.

Yay.

Um proposed to find through the opioid abatement fund.

Right.

Um beyond this one, are there any other programs or initiatives that you all are proposing to be funded using that money?

In terms of what's being funded through opioid abatement?

Yeah, for FY27.

Uh for FY27.

Is there anything else beyond the court urgent care clinic?

And here again, I can I'll can get you that information.

All right.

Um the district's overdose data to action grant, uh, which is administered by DC Health has been significantly reduced.

Um it was 12 million um in FY26, it's gonna be 6.5 million in FY27.

Uh, given DBH's reliance on overdose data and across agency coordination.

Um do we think that this 5.6 million dollar reduction is going to impact the abilities the dis the department's ability to monitor uh trends and target interventions?

Um I don't know the answer to that question.

Okay, we could ask DC.

Um because you're telling me that that's happening.

Oh I'm I'll have to follow up.

All right.

Um I want to ask about housing.

So um DBH housing vouchers.

Now we had a whole we we had a whole conversation about housing and whether or not you all should still be in the housing business.

I didn't really get the traction that I wanted on that conversation, so we'll we'll keep it open with uh DHS, but for today, um your levels are set lower than um comparable to the housing uh for others.

They are we still able to meet the need.

Well, I think that the people who are in housing right now have been there for some time, yeah.

And uh and so uh we haven't had people have to move, however, it numbers the choices they have.

Okay, and so I can tell you for example, if you look at a one bedroom um for uh with a DBH uh voucher, it's uh 1,230 a month.

If you look at DHS, it's it's 3,020, and if you look at DCHA, it's 3845.

And so there's a big difference uh in that um can you say those numbers just again?

Because I I don't think I and I can kind of I can send them to you.

Yes, I can send them to you just to understand the breakout because I don't think that even some of my colleagues appreciate that a DBH voucher is half of what someone would um achieve if they were in a DC HA program or in a DHS program.

Um one of the things that we did as an initiative this year, um which I think has been going well, uh has been this um the work of community connections that have been physically in the buildings.

Yes.

Now in the documents that we have, I have I've got two contract line items for housing.

I've got um I don't have the spreadsheet open, but um one I'm assuming is for community connections, and then there's another one that looks almost identical, maybe has a different um amount of money.

Are you all expanding this program?

It like are we proposing to expand it in FY27 or something else going on?

The the the line items that are within uh the housing program include um the uh 8 million six uh seven three five five for rental subsidies.

That's for the rental subsidies program.

Oh, you're referring the contracts, the contracts, yes.

We have Wayne Place at uh 455, and then we have uh 13 uh one that 1.3 for housing case management and support with community connections.

My apology.

I thought she was asking for more.

So it's 455,000 for Wayne Place, and that's the 32-bed uh facility that and now we have 25 of our young people there and the 1.3 for the housing support case management program.

That's what it is.

Okay, so um okay, so in the contracts attachment that you all sent, there is a contract, there's no vendor listed, but you all indicate that this is for quote housing case management services that the agency anticipates.

There are two different lines.

There's one contract for about 1.7 million, and then there's another contract for 942,000.

You didn't list a vendor, so that's why I'm asking is this the community connection?

Community connections.

All right, but why are there two lines?

Because the Wayne place has is for another vendor.

Yeah.

But it wouldn't be two.

It wouldn't be it wouldn't be that much.

No line 56 and line 57.

If you're looking at the attachment that I'm looking at, or at least the FY27 contract.

We'll have to we'll have to follow up on that because it certainly would not be that amount for uh targeted outreach for supporting supported housing.

Okay.

I was that's uh that's what we're asking because I was like, oh, maybe they're doing some vast expansion that we don't know about, or maybe this is a typo, but those are the two contracts that I'm aware of.

Okay, Wayne Place and uh housing support case management, which as you said has been growing very well.

All right, so we'll follow up on that one to get um some further details there.

Um how many buildings is community connections working with at this point?

Um they're working with nine apartment buildings, okay.

And I just met actually with one of the um chairs of one of the boards um last week uh to really get a sense of what's happening on the ground.

All right.

Um we're rounding out the end here.

I'm gonna do my best to get you out of here soon.

Um my rides.

Uh so my rides is the transportation program.

Um it provides free transportation for individuals traveling to and from substance use treatment providers.

Um prior to the program being paused, how much did you all spend on the program?

I don't I have to get the the actual information for you on my ride, so I don't have that at my fingertips.

Okay.

Um now I know why we paused it.

Uh when did the agency first become aware of the problem?

I think right before we paused it, actually.

So the program was operational from 21 to 25, so that's why I'm like, okay, we went four years and nobody said, hey, somebody is not using this the way that they should.

Yeah.

Well, I I I do know, as I've told you, we really are be are closely monitoring our contracts.

And I think with that increased uh monitoring, we're finding and learning some things, yes.

Okay.

Um do you all plan to reinstate the program or is it permanently discontinued?

We plan to reinstate it, but but with a different vendor.

Okay.

Is there funding in the FY27 budget for this program?

I will have to check the budget for that.

I think that's out of SOAR.

That is a SOR grant funded uh effort.

It's a SOAR grant.

Okay.

I hope we have some stronger operational controls given that this is federal funding.

All righty.

Um okay, we've talked about these two issues before, but I feel like in light of some recent activity, we gotta talk about it again.

So um first uh hoarding.

What?

Hoarding disorder.

I'm sorry, I can't.

Hoarding.

Oh, hoarding.

Hoarding, yes, okay.

Um do we have particular providers that we can refer families or individuals to who can help some of our seniors who are experiencing this hoarding is a disorder.

It is.

I went yes, I think.

No one chooses to live.

Um I I do know that there is a uh a hoarding uh group that that really involves representatives from various agencies, uh, but we don't have a particular provider that specializes in hoarding.

Um all of the uh certified providers uh address it when it as it comes up, but we don't have a particular certification for hoarding.

Okay, so if somebody called, like if I called you in health issues, my aunt is having an issue.

How would you how would you help me?

How would you refer to me?

Uh I would refer you to uh one of our core service agencies uh that would uh work with you around uh hoarding as a part of uh your mental health uh treatment.

Okay, so uh fire and AMS gets they see a lot.

Just say that they see a lot, they they go into homes for all different types of reasons.

So have I um if they went into a home where they went in for a particular medical reason, but observations suggest that it's unsafe.

How would they refer it?

They would they generally would contact me at my agency um so that we could uh have our mental health professionals um you know go out to support that person because we know it's a fire hair.

I mean it's all it's a hazard.

We know I just I feel like we need a bit more in terms of our evidence-based treatment.

We have we have a lot of seniors who live in the district, we have a lot of seniors who um are aging in place, which is great.

We desire that for them.

I want them there.

I don't necessarily not everybody needs to be in an institution or a nursing home facility, etc.

Um, but it poses some public safety challenges significantly if a fire were to break out, well, you know, that but also there have been some calls where EMS can't even get into a a person's home.

Um and I don't know, it just feels weird to just refer someone just to a core service agency as opposed to someone who is more specialized in that in that work.

Well, actually.

Oh, go ahead.

Um I know uh Dr.

Burho looked into this because prior to uh I I can at least answer pieces of this because some of it is coordination with DACL as well.

Okay.

Because DACL is the kind of agency that supports seniors that when they're experiencing cases of people that are hoarding, then they're sometimes referring to us, particularly in the integrated care division around support for people because actually hoarding is one of those interesting things.

Yes, it's a disorder, but from a DBH perspective, we'd be looking for another major mental illness diagnosis that's more the the wheelhouse of the CSA, but those referrals still come to us from DACOL with I don't think this person has anything else as a major mental illness, but the hoarding is significant.

We do partner with them either through a CSA or through that intensive care coordination to try to help resolve the hoarding issue.

DACL actually has the resources around it to pay for the cleaners for the storage for like actually cleaning up the environment resources where we're providing the treatment resources if that makes sense.

Yes, right.

And then through FEMS right now, even in crisis services, one of the things that we're working on with FEMS is they've set up uh uh a community task force with a lot of different agencies around people that they are responding to consistently um frequently as a familiar face to us then kind of um case conference those across multiple agencies and and DBH is involved in that where we're then supporting FEMS in their concerns around look, we we see this person ten times a month or more.

Um what can you do for us health care finance?

What can you do for us, DBH?

What can you do for us, DACL?

How often do those case conferences happen?

They're happening monthly right now.

Okay.

Because I I I do know that they're um uh uh frequent uh callers, particularly for 911 and others.

Um need more than just that single service call um because sometimes their calls for service is not a real call for service, if that makes sense.

Okay.

Um similar, nope, stay there, similar, but a little bit different.

Um which we've kind of seen a heightened problems around, which is gambling disorder.

Um and uh in the past, former colleague, Councilmember McDuffie would transfer money around gambling disorder.

I think it was like $300,000 or in price current fiscal year.

For that, okay, go ahead.

Uh yes, uh actually uh one of the things to note you're right.

Um we had $300,000 in our budget uh several years ago.

We did provide training to our core service agencies around gambling, uh specific intervention strategies.

However, uh gambling services are currently available uh within our SPA, our state plan amendment, okay, and our Medicaid uh billable right now.

Um we have actually 19 providers within uh our system that are actually billing for gambling um uh addiction and disorder services.

Uh most of them are uh FQACs, we have MDs and addiction counselors also, um billing for that.

The services that they're getting are screening services, diagnostic assessment, counseling services, therapy, uh inpatient hospitalization, and also one of the things that I want the public to note is there there is a uh hotline number for people with problem gambling, and that hotline number is 800 6978.

The other thing to note is that within the District of Columbia, similar to Maryland, uh there also is uh self uh self-exclusion uh program for DC lottery and sports and wagering.

And so what that means is if I know that I have a gambling problem and I need some support so that I don't do that.

I can get myself excluded from uh from those facilities and those activities.

Uh for example, if uh if I wanted to go to the casino.

As I approach the casino, uh I know particularly uh the one that's in Maryland, they can identify you right there, they turn you around and and they give you uh, you know, uh uh connections to support.

But in terms of our providers, Mary Center, which is one of our providers, family wellness and district health, everyone billed for those services.

However, this it's limited.

Only a few people are getting it, but it is available.

Well, I well, I think it's the availability part.

Correct.

Um I watched like a little snippet of uh the NFL draft last night.

And even then on you know, MBA playoffs is going on.

I I know this is hard because now we have these leagues themselves who are promoting all different types of gambling, right?

Like, oh, you could just gamble on a play, you don't even have to gamble on the whole game, or like these little snippets here or there, and then add in poly market and cal she and some of these others.

I um we've seen sort of the impacts on uh from the athlete and player perspective, particularly student athletes who are getting threats from people because like they miss their particular gambling mark.

People get ex and so um it's coming at people from all areas, but there for some people you shouldn't be gambling because you it is an addiction for you.

That's why voluntary exclusion works.

Are ready to recognize the addiction and you are ready to do the work.

I want to make sure that we're able to provide the services to those individuals.

Yes, and also um, you know, when when I was in Maryland and also since I've come back here, uh I I certainly have re outreach to the uh National Center on Excellence in Gambling, which is in Maryland, actually, and they are the ones who actually provided the training for our uh our providers.

I think it was either a year ago or two.

Um do we provide ongoing training?

Uh I have not provided additional training.

I think that was one-time money, maybe.

That was one time money.

Okay, all right, we'll look at that.

Um, Dr.

Bazaron, is there any I ask you a lot.

Thank you to your team.

I asked you guys a lot.

Um sometimes budget it feels like a cavity search, but it's out of love.

We want to make sure that the public dollars are being spent well.

Um is there anything I haven't asked you that you want to mention for the record?

We'll obviously follow up with your team on some of the things we'll follow up on.

Well, okay, go ahead with your update, and then I'll do my close.

Thank you, Dr.

Basron.

So I did want to confirm for you that the contracts for housing case management or for community connections, it's on two different lines because the contract calls its fiscal years.

All right, we'll follow up on that.

There was no vendor listed, so those are the only two I knew about.

Okay.

All right.

Uh, but uh one of the things that I would like to say is I I I really want to uh applaud uh my staff uh for uh the work that they do every day and also uh the work that we have done together along with your staff in terms of preparing for our hearing.

We thank you for your support, and certainly we uh are very appreciative of the support of our mayor in ensuring that uh individuals with behavioral health care services get the services they need.

It's been my pleasure to really be a part of that.

Great.

Uh well, this concludes my qu public questioning here.

Um I want to thank you, Dr.

Bazaron.

I want to thank Commissioner Woods.

Um I want to thank uh the teams from Department of Behavioral Health as well as the team uh from the Department of Insurance Securities and Banking.

Um so we'll certainly reach out to you folks as we um careen towards our our deadline here later in May.

Um this does conclude today's hearing, and so it does conclude the total hearing for both um Department of Behavioral Health as well as Department of Insurance Securities and Banking for uh this budget cycle.

If um the public record is going to remain open until Friday, May 8th, so until then, written testimony can be submitted on the council hearing management system site at DC Council.gov backslash hearings.

Uh the next budget hearing for this committee will be on Monday, April 27th at 9 30 a.m.

We'll be in room 412, and that hearing will be for the public witness testimony again, only the public witnesses for the Department of Health Care Finance as well as the Deputy Mayor for Health and Human Services.

The time is twelve thirty five P.M.

and this hearing is adjourned.

Thank you.