2025-04-07 00:00:00 - Joint Committee on Ways and Means
2025-04-07 00:00:00 - Joint Committee on Ways and Means
(Part 2 of 2)
SPEAKER1 - Okay. Next up, again, this is panel number 4 of 10, so members understand where we are timing wise.
I'd stop around 6PM to accommodate a school committee meeting just down the hall. So, while we do that, if anybody wants to stay for that school committee meeting, it should be a lively, debate tonight. Welcome, commissioner Doyle, you and your team, and I will turn it over to you. The floor is yours.
SPEAKER2 - Thank you. And I am joined today by Steve Bernard, who is DMH's chief financial officer.
Good afternoon, Chair Feeney, Chair Bill. It's a pleasure to be here today. To members of the Joint Committee of Ways and Means, thank you. We appreciate being here. I'm gonna start today just by, you've you've already heard some of the background information and in the interest of trying to help stay on schedule, I'll do my best also to answer80 some of those other questions
so for those of you who I have not yet met, my name is Brooke Doyle. I'm the Commissioner of the Department of Mental Health and I have been Commissioner since 2020. This year, as we've heard other people say, has forced us all to think about105 things that honestly many of107 us never imagined we'd have to109 think about. We've had to111 make a lot of really hard choices. We've had to weigh a lot of considerations. The most important thing, though, that as we were beginning to look at this fiscal year, 1 of the things that was really critical to us is that we made sure that in in balancing all of these really difficult choices, as Secretary Wall said, that we were considering how to make sure that we're taking care of DMH's priority areas, delivering the services that are needed, and making sure amongst all things that we're thinking ahead as well. Given that this is budget testimony, a lot of what I'm gonna talk about today is about fiscal issues, business processes.
But it shouldn't be lost that underlying every 1 of these points are people. People rely on the Department of Mental Health. Mental health is health care. And as we heard earlier as well, health care, not just public sector health care, health care in general, is really struggling to find a way the path forward to balance all of the fiscal priorities, all of the priorities of care that we all value, and to balance all of these things in a time when there's so much uncertainty.
With the federal funding uncertainty that's looming, I also just want to acknowledge the challenge that you all are facing. It's really difficult to balance all of these priorities with the uncertainty that's looming all over all of us. So I also just want to pledge221 my commitment to continuing to partner to look for ways forward. It's going to take all of us together. The Department of Mental Health serves the Commonwealth's most vulnerable adults and youth with the most complex mental health needs. Typically, we're serving people who require specialized care. This is different than the care that's traditionally available through what we often think of as, like our traditional clinics,252 those things that we access through our health plans. The things that DMH is responsible for are the things that go outside of that largely, and they're ways of providing services that are very unique and very specialized. And over the past few years, the population who's needed those types of very specialized services has grown both in the volume of people who need it, but also in the acuity, the complexity that people present with. We've had the privilege this year of serving about 29,000 people.
About 4,100 of those 29,000 are youth. And the governor's301 budget for f y 26 proposed DMH's budget at about $1,275,000,000 almost $1,300,000,000 This is actually the largest budget we've ever seen. That's a 7% increase over last year's budget.
In addition to DMH's budget, the governor's budget, as we also heard, Assistant Secretary Levine talk about, also supports the continued funding for the community behavioral health centers, school based mental health, and the behavioral health helpline. And these are really important earlier intervention, earlier identification opportunities that help kids and adults get access to mental health treatment earlier in the course of seeking help, which ultimately for all of us, I think, helps us imagine a way for people to need the kind of intensive services that DMH offers, hopefully less. Ultimately, we wanna be able to help people earlier. But we also recognize that there382 is always gonna be a need for some of the types of services that DMH offers. And so that's where some of the prioritization comes in. The Department of Mental Health, and some of you may know this, some of you may not. We actually are the largest operator of inpatient services in Massachusetts. We provide a different kind of inpatient services with the exception of 2 small units, Pucassid and Corrigan. So I'll talk a little bit about Pucassid in in a few minutes as well. But the units that DMH operates, these over 700 beds primarily serve people whose needs, for a hospital level of care often are accompanied with the need, for example, from the court for a competency evaluation. We receive transfers from Bridgewater State Hospital. In fact, the Bridgewater is from trans The transfers from Bridgewater State Hospital have actually increased in the last few years. In fact, this year, if the trend continues as it looks for this early part of the year, We're probably gonna surpass every other year with about 226 admissions from transfers. This is a good thing. We wanna be able to take people out of471 strict security and help people to enter a DMH hospital. The challenges we're seeing people entering in earlier in their course of treatment, which means they need longer periods of time in our hospitals to stabilize and ultimately, once their core proceedings are resolved, return to the community. This means we're occupying495 beds for longer. So all of our beds, literally 100% of them are occupied, And that level of care is actually over occupancy and has been for almost 2 years now. We're we're operating over occupancy, more demand, more need, again, emphasizes the really critical importance of reaching people earlier in their course of treatment. Some of the people who've ended up in our hospitals, we've been able to reach them at an earlier point. Perhaps we might have been able to change their course. And ultimately, that's that's good for everybody. That, however, is the reason why these units had to be the priority for DMH to think about how to make sure we're advancing, the operation of these units, covering the full cost of operation, maintaining our safe, effective treatments that we're offering there. The priority for us in focusing on these units as full funded, cover the cost, meant that we had to look at other areas to help with how those costs are actually gonna, be balanced. 1 of the things that were really important to us as we were looking at all, again, all of these factors,
our costs as we've heard other people talk about today are going up. So even though DMH's budget 7% over, the cost of doing everything that we currently do exceeded what that could cover. It's hard to believe that 7% over last year's budget can't cover everything that we do today, but it can't. And that's primarily due to all the things that we've heard about. It's the cost associated with personnel. It's the cost associated with utilities, leases. It's all the same things that we hear from other health care organizations. It's the same for us as well. So as we looked at at how we're going to balance all of these priorities, We wanted to make644 sure, that again, as we face all of648 these difficult decisions, we're keeping the needs of people, how we operate, how to balance all these priorities upfront, and make sure that we also look at on our contracted services side. That's another way in which the department of mental health costs go up. We have a very large volume of contracted services as well. Chapters 2 57 rates go up at each rate review, and because our services are so specialized, many of them are quite expensive to deliver.
The written testimony that you have goes into great detail about how our cost structure and how all of the different ways that we've addressed coming into balance with this cost structure have been contemplated and proposed in, in the House House 1 budget. I'm gonna highlight a few of those areas, specifically answer some of the questions that emerged as well. I'll start first with the state operated side, and then I'll move into723 the contracted side. So that way we can keep the issues as clear727 as possible. So on the state operated side with house 1, we proposed a couple of ways to address our increasing costs and the need to prioritize the area of treatment where we're serving people with the most intensive needs. That brought us to looking at other areas. So the as you might imagine, with over 700 beds, and plus we operate a 20 section 35 beds, with all of those services being 24 7 operating, that's actually a pretty substantial number of DMH staff just by themselves. And that led us to look at where are some of the other areas where DMH is either doing some work that is similar to work that is being done elsewhere or also how we could make adjustments and still provide effective services. So that led us to Pacasset and, to the case managers. With Pacasset, the 16 beds that are operated on The Cape are acute care. So this is, you know, think McLean or or,803 South Coast Hospital. It's the same type of level of care. It's different than the services that I described that are the continuing care. These these these 16 beds are doing, standard acute care. Generally speaking, the Pacassa unit at 16 beds, because of the size, actually has some natural limits to the level of acuity that can be safely treated in this unit. With 16 beds, again, thinking through what's required for 24 7 operation, evenings and weekends, you have lighter staff than daytime, when your professional staff are usually around. That means that we have to think about that the patient acuity that we can take. Generally speaking, who we take into this unit for, treatment are the group of people who I would describe as having a chronic illness that's in an acute stage of treatment and tend to be people who don't have a high tendency or high risk of aggression. When we have people who may have other risk factors like aggression, or their symptoms might be more, complicated in other ways, medical or or other. Those individuals today are admitted off cape as well. And so I just wanna identify that there's a natural,
required selection process for safety. The the unit is operating, so it is fully operational today. Admissions and discharges are occurring with accordance to standard operating procedures. So what is, pause mean? You know, as as you identify, representative, the governor923 did request and direct us to pause any action and then to establish a working group. And that working group, it's not yet started, and we'll be working with the administration to set it up. But the purpose or focus of that working group will be to look a little bit more broadly at access to mental946 health treatment on The Cape broadly as well. So we wanna make sure that we're using this opportunity to look not just at how that Pacasset unit956 fits into the fabric, but also what are the needs and how do we best meet the needs of people962 on The Cape. The case managers. Senator Commerford, you had a question earlier about how how we were thinking about the case managers and what it was that led us to thinking about, the case managers. So, again, this is where what we needed to do is to look at balancing all of these difficult decisions and priorities. Case management is a service that people do benefit from, and what we wanted to do in this instance is to reduce, not eliminate case management. We will continue to operate all 27 site offices. We will continue to have a site director and case management supervisors are not1011 part of this 50% reduction. With the 50% case manager reduction, we believe that we can effectively continue to deliver case management1023 by restructuring. And in that restructure, we would be able to do a little bit more with flexible approaches than in using the existing approach today, which pairs a person with a person. And so by moving the approach to a more flexible open access model, as secretary Wall said, it would actually1050 allow us to be less bound1052 by authorization requirements, by the way in which sometimes people wait for assignments or they're wait listed. By moving toward an open access model, we would be able through the operation of our site offices, through using high visibility locations where we know people1073 tend to gather, to be able to mobile out to those locations. And we would be able to work with people right then and there. We wouldn't have to wait for an authorization or wait for an assignment. For people who are already enrolled, what we would do is to look at each person case by case. As secretary Walsh identified, some people have existing services. We would wanna make sure that we're getting maximum benefit out of all of those existing services for people, and all of that group of people could still use the open access as well. So to the extent that a person they may have, for example, movement out of an assigned case manager, they would still have access to the side office to the team, and they would still be able either to drop in. Or 1 of the other ways that we are, considering a more flexible approach would be to have, a proactive call list. And that would allow us to keep track of people who may have other, tendencies sometimes toward isolation or toward disengagement. So we would want to make sure that we're keeping1149 up with how people are doing. We would also, prioritize a more solution focused approach. And the solution focused approach in DMH terms is called critical needs case management. And we operate critical needs case management today. What we would envision is doing more of that approach and scaling down that more extended or standard approach that we use today. That's not to say that there aren't some people who may need that, and so we would still be able to provide that on a case by case basis. So that that's actually the vision. And the idea of being able to use the resources that we would have available in a more flexible way does require that we think differently about how we approach case management. It also requires that we engage differently with communities and help people understand what could be different than it exists today. So we have some responsibility as DMH to make sure that we're making that clear for people and that our intention is to provide service to people when and where they need it as flexibly as possible. And that's again, we we believe we can be very effective in doing this, and there are other models of case management that operate today in this manner. In terms of the contracted services, our contracted services and we have a very large array of contracted services. Earlier today, there were a lot of questions about IRTP and CIRT, and I'll speak to those issues. Before I do that, I wanna touch briefly on the adult services. I've heard some people have asked me why why we were so focused on the youth continuum and and why was that the area that we applied cuts to. What I wanna offer is we had the1281 benefit, through all of you in the1285 past couple of years to have some expansion opportunities in the in the adult continuum. So our adult community clinical services and respite programs had expansion funds, pretty substantial amount of expansion funds. And what we're proposing to do is to go further expansion in light of where we are that, just seemed to be a necessary action to take. By foregoing further expansion, our budget as proposed will be able to cover the expansion achieved to date. So we won't lose any of those gains that we made, but we will slow it down. We will forego, and that will help us to achieve some of the savings that we need to achieve. Then we had to look at underutilization in our youth continuum. Our youth continuum had a number of areas of underutilization. Each 1 has a little bit of a different background to it. So I'll give you some of that detail information as well. I'll start with the 1 that was of most concern to people, the IRTP and the CIRT. So IRTP is the adolescent intensive residential treatment program. CIRT is the clinically intensive residential treatment program. IRTP is for adolescents. CIRT is for younger kids, 6 to 12. These are all statewide programs. So, just purely from context, important to know that as statewide programs, we admit into every single 1 of these areas. So it's not geographically based necessarily. I say necessarily because the CIRT, the the youth program, is located in Belchertown, and it is the only program of its kind. And being in Belchertown and being a service serving young children, there actually is a fairly extensive decision making process that parents and guardians face, particularly those who may not be geographically located close to that program. It's hard to think about having a young child that far away, and so we find that the decision making process can take some time. I know, when I've said this before this way, for people who live on Western Mass, they face that same problem with decisions about going into Boston as well.
Process being problematic, taking too long. I wanna just acknowledge that DMH's referral process did need to be refreshed to better match realities1472 of managed care, to make decisions in a more timely manner.1476 And honestly, if that was the only barrier to admission, this would have been a much easier situation. It isn't. These programs have been very difficult to maintain adequate and safe staffing within. They've been understaffed for extended periods of time and that has contributed in large part to why we had difficulty keeping all of the beds filled. The1507 programs do provide a specialized service need, and the reality is that we haven't been able to operate them fully today. So what we're proposing to do is to right size the IRTP, reflecting the volume that does get utilized, hopefully will mean that staffing can be maintained and that those beds can operate full and and meet the needs of the Commonwealth. The the1539 younger child's program, the CIRT,1541
In addition to having, staffing challenges, that leadership turnover, and it's been difficult to keep those beds filled. What is also occurring at the same time, and again, this is a positive. And so I just wanna reflect that some of the reasons were related to staffing referral process. Some of them are actually a reflection of positive change. As I talked about earlier, being able to reach children at earlier points in their course of treatment helps. It helps us to be able to make sure that we're doing as much as we can with school based, with wraparound services in the community, helping kids stay at home with their parents, in their communities, in their schools. That goes a long way toward improving that child's course of their recovery efforts and treatment overall. So we're seeing1609 some success with home based wraparound services as well. This gets to how the community behavioral1617 health centers fit in, how mobile crisis fits in. If we can respond more1623 rapidly with home based services, that helps for some of the kids who might otherwise have needed these very intensive programs. So we're seeing it's a combination of factors and not just 1.
With regard to how all of these different factors fit together in the IRTP and the CIRT as a level of care, as as secretary Walsh pointed to, collectively, they've all been underutilized. They've been paid in full, so we pay with a flexible accommodation rate. That accommodation rate gets paid in the full amount regardless of the number of beds occupied, which makes it not sustainable to continue to pay for 50% utilization. So that really forced us to have to look at how to right size this level of care.
I wanna just1686 touch very quickly on 2 other areas, in the youth services. 1 is flex, DMH flex services. So we did have a reduction in that category, and that has historically been how we've paid for ED diversion services and some other home based services. The reduction here will be applied primarily to some of the ED diversion. We will continue to have ED diversion just at a reduced volume. And that reduced volume is actually a reflection as secretary Walsh said of boarding going down. This is a good thing. Youth who are boarding today often are waiting for a hospital bed and need a hospital bed. And so what we see is by continuing to provide the ED diversion services, we will be able to even at a reduced rate to continue to provide those services to youth and families where it's needed and to be able to operate the other youth services through flex. The other areas that are reduced are reduced in a very small amount. And, again, these reflects more rightsizing than anything else. Some of these areas have been, areas where we've reverted in the past. So this just brings us more into a right sizing. YouthPact is the other area where we had to make some reductions. YouthPact is a new service that we rolled out a couple of years ago. And as a new service, understandably, there was confusion. There was a lack of trust about it as well. It took us a while to be able to educate families about what youth pact is. And we've seen in some of the pack programs, they've actually had more success than others. We, started with 7 teams and we'll be able through what's proposed in house 1 to continue with 3. This is not just a reflection of state funding reductions. This is also 1 of these ARPA wind down issues. We supported the stand up of these teams with ARPA dollars, and those dollars are going to wind out. And so the reduction in the teams is a reflection of ARPA wind down, lower utilization, and we'll be able to support the 3 teams that have shown promise. They've achieved close to full utilization and they're working really well. They're showing promise. So we didn't want to eliminate it. We really wanted to make sure that where it was showing promise that we were able to continue it at a at a rate that was sustainable.
And the last area that I will touch on, because this this, rep Scarzil, you raised1866 the question of jail diversion, and I'm sure other people might be hearing about, the jail diversion reduction as well. And this is another ARPA wind down issue. So our state appropriation that is proposed in house 1 is actually a reflection of the pre COVID amount of state appropriation. We've been able to supplement and expand substantially with ARPA dollars, and we saw that communities really embrace this. It was something we had hoped with the grant funding earlier that we would see that, it would take hold and that local communities would would want to sustain it. These are 1 year grants. And so we we issue whatever where appropriated. And so this year, what was proposed is $3,800,000 and we will prioritize coresponse to the extent that we have funding to do so. Coresponse has emerged as 1 of the most promising practices out of these grants. It also these grants have also covered things like training and, technical assistance. But again, with with limited dollars, we would want to prioritize the areas that have shown the most promise and that communities have very clearly said that they have an interest in.
So last thing I just wanted to briefly mention, I mentioned the behavioral health helpline and, anybody who knows me knows that I any opportunity I get to promote the behavioral health helpline, I do. So holding up my pen, we have free pens available. We'll get them to you if you want them. And, just to know, the behavioral health helpline is available 24 7 in 200 languages, is payer agnostic, doesn't require any prior auth of any kind. Anyone can call anytime, the person themselves, family members, supporters of the person. And this started as part of the road map for reform for behavioral health. These are some of the most substantial structural changes in the behavioral health delivery system than we've had truly in decades. And, we've handled a pretty substantial number of calls since it started in 2023. We've handled 75,000 calls and 23,000 check texts and chats. So I just wanna let you know that the behavioral health helpline will be continuing and it's really making an impact. And with that, I will close out my, my remarks and welcome any questions that people might have.
SPEAKER1 - Great. Thank you so much, commissioner.2037 Reminded to all members, 1 minute, 1 question, so we can get through all of them. I will start with, Senator2043 Olivera.
SPEAKER3 - Thank you, commissioner. Thank you for mentioning McCutchen's program as well. Belchertown is located in my district. I know that, representative Pease asked the secretary earlier today about some of the cuts into the programs into CIRT and IRTP. I share similar concerns with many of my Western Mass colleagues, including senator Commerford, who's here, representative Sabadosa, obviously, Representative Pease with this program. And I have to say, when you just said that because a program is located in Western Massachusetts, it might not be viable, that's insulting. That's insulting to2089 any Western Mass legislator who might be sending people halfway across2093 the state hours away to get the programs to utilize them, particularly in light of the fact that I have right in my inbox an e a letter from you in 2021 when Cochins was moving their program from Springfield to the Belchertown location in support of the move and in support of supporting them budgetarily and through referrals. So my question is, commissioner, what what caused this change over the last 3 years, number 1? Number 2, how can we strengthen the referral process right now? You mentioned part of it in your comments about the need to reform the referral system. You know, I was meeting with Cutchins just recently. And a lot of our hospitals, and they've met with the Mass Hospitals Association. And they're hearing from people within hospitals that these hospitals don't even know about CUTCHINS. How is how is your department better streamlining that referral process? So number 1, hospitals know about the programs that exist. And number 2, if you are making changes in referral processes based on location, then we need to know about that as a legislature as well as we begin to prioritize our budget. But looking at the Cutchins program in particular, a program that I visited their campus several times through the construction process, helped them, work with neighbors in the neighborhood when this program came in, which was a little political risky at the time. And now to turn our backs on this program, I feel as someone who represents Belchertown and various communities in Western Massachusetts, where we send our residents East continuously or to different states, How can we better inform hospitals about these programs that we have existing in Massachusetts? I heard from 1 of the providers that they were sending a kid out of state all the way to the West Coast because they didn't know about programs in state. So I just have to say I'm a little bit frustrated by by the answer, particularly saying that Western Mass programs aren't viable. I'm hoping that you'll have an opportunity to clarify.
SPEAKER2 - Thank you for the opportunity to clarify.
And I regret if my comments came off in any way disrespectful. I don't mean them to at all. And we appreciated the support, to move the program. When it had been in its previous location, that building was actually in disrepair and we needed a different location. We appreciated the support. It's it is in a building now that is a better building to deliver this treatment in, And I agree that it isn't that the department views the location as problematic. It's it's more a matter of that we have to weigh parents' requests and parents' priorities as well. So it's it has always been a Western Mass located program. It's not new. And and what we're seeing is that it is getting, a bit more2289 challenging, particularly with workforce constraints that when we don't have full staff operating, it requires that the department have to make decisions with parents about the whether or not their child can be safely treated in that environment based on the staff that are available at that time. Cutchens, like some of the other IRTPs, has had workforce instability. They've actually more recently stabilized a bit and as have some of the other programs. The challenge is that it has they haven't been able to sustain staffing over a period of time. So that has also contributed back, you know, to the department's role and responsibility. I agree that we have a responsibility to manage the referral process with more efficiency than we do2344 today. And I have actually made some changes. Some of this is, you2350 know, looking at the whole system broadly and having to take all of these decisions, what forced us into looking at this right now is our fiscal realities and trying to look at how we balance all of these priorities. So that's how we end up looking at this particular program. In looking at it, it also forced us to look at the referral process. And, admittedly, it's takes too long. It's too2379 clunky, and
2381 SPEAKER42381 -2381 we2381 need
SPEAKER2 - to do a better job with matching managed care requirements. So I've actually made some changes to that referral process. Gonna preview with stakeholders this month with a goal I've planned for May. We're gonna continue to operate the IRTP services, and so it2399 it is essential that we continue to work at improving that process as well.
SPEAKER3 - Thank you, commissioner. And I know you should be receiving in your inbox as well a letter from representative Saunders who represents Belchertown. And I I failed to mention another Western Mass colleague that's here, Representative Smola, who borders Belchertown as well in our advocacy for these programs being located in Western Massachusetts. Thank you.
SPEAKER5 - Thank you, Commissioner. Our next question comes from the Assistant Vice Chair of this committee, Representative Kip Diggs.
SPEAKER6 - Thank you, Mr. Chair. Commissioner, you said that there's a lot of confusion, and and I'm seeing why I mean, I'm feeling confusion because of you know, mental health is such a big issue. I live on The Cape, and
traveling to go see your child wherever the child is, to go to Western Mass, to go we need to me, it seems like we need smaller venues, but having them in separate several places so that we can have something like this so that workforce can be obtained. Because, of course, if you have to travel to get to Western Prodome Mass, if you don't live there or wherever you live and you, I saw I think us being, needs to be more2483 communication, I feel, because, you know, these groups, we need to figure out where the groups are, where where we can help, where we can get these, I don't care, adolescents or everybody. If if anyone has mental health issues, we need to be able to help them in in various ways, and by all means necessary. But to have them so far away that, I think we're giving doing a a disservice to everybody instead of being more technical and where we work and where we put these these sites at. So maybe we can I feel that's what we need to do is kind of get get to a spot where, okay, let's have something here, smaller unit, whatever? So but just something that's gonna make us more proficient and and more professional and, to take care of our people that need to be helped. So thank you.
2543 SPEAKER22543 -2543 If2543 I may, just a brief response back. There are some efforts underway that are actually doing exactly what you've just described. What we really wanted to focus on, with the investments that are going forward, I mentioned the community behavioral health centers. Those investments are not just clinic based. They also include mobile crisis, and they they include what are called crisis stabilization units. And this was also a newer resource added with the reforms of behavioral health. We never had youth crisis stabilization units in Massachusetts before. We do now. And those are more locally based. And so the idea is exactly what you just said. Bring2593 services closer to where people are, make them available at earlier points in2599 their seeking help journey so that we can help people get the help they need closer to their communities and earlier. So we hear you a %, and that is part of the investments that the Haley Driscoll administration is supporting as well.
SPEAKER1 - Thank you. Next question comes from senator Kelly Duna.
SPEAKER7 - Thank you, mister vice chair. And first off, thank you to my colleagues for listening to me talk about this probably every single week. But, the community of Middleborough, you mentioned school based mental health. And 1 of my communities
SPEAKER8 - at
SPEAKER7 - the February lost a2643 grant that was supporting student social,2645 emotional learning, behavioral, and mental health, for $73,000 in the2651 schools due to noncompliance2653 with the MBTA Communities Act. And, obviously, that kept me up at night and honestly made me sick to my stomach. While I know it wasn't your department's decision per se, I know whose decision it was. Can your department commit to just being a resource for my communities that are now very fearful that they may lose mental health funding for their schools and any other programs within the town?
SPEAKER2 - Yes. We do wanna be available for support, and DMH actually has a staff member whose entire job is to do exactly what you just said, to be the liaison between the department and DESE, the department and other, state agency sources of funding. And there are other sources of school based funding as well, and we can, you know, definitely work with your community to see how, potentially there might be other ways that your, community could could be funded for resources.
SPEAKER7 - Thank you. We didn't have that partnership with Middleborough, so moving forward, it would be great if they could make, you know, a real strong effort to be there for those communities because mental health funding is something that should never be threatened or pulled or removed, especially when it comes to school systems and communities who very much depend on those grants. Thank you.
SPEAKER2 - I understand. And and my colleague from DPH, DPH actually also funds some school based mental health services. So we can definitely, connect and collaborate and and just learn more about what's possible. Thank you.
SPEAKER5 - Thank you, commissioner. Our next question is from representative Rodney Elliott.
SPEAKER9 - And thank you, mister chairman. Thank you, commissioner, for your testimony.
You know, at the outset, you mentioned the need and the complexity of the services that you provide, DMH provides to to the Commonwealth. You know, the 27 years that I've been elected official representing Lowell, over those and throughout that time, we've seen a significant decline in mental health services. Seeing the closure of Lowell Treatment Center, Sullivan Mental Health Center, which had 41 beds. We've seen the closure of the psychiatric unit at Lowell General Hospital also in my district, closed 37 beds. And thanks to the the wisdom of the legislature, say the access to better care act is making improvements, in terms of access and care. However, you know, providing these services and the complexity associated with it, Commissioner, your FY 2026 budget, and you alluded to it a little bit, reduces Department of Mental Health case managers case for caseload managers by 50%. To me that we're moving in the wrong direction. And I I did hear you mention, open access, which to me is walk ins. But to me, you know, people that are in a mental health crisis, I understand, and this is somewhat of a signal. There are 75, 70 7000 people calling hotline. I don't feel that they're gonna be walking into a bricks and mortar building looking for care. And we all know there's a dramatic increase in mental health illness, whether we see it on the streets of law with with homelessness or or not, quite frankly.
You know, given that, can you can you explain, how and I understand it's a reduction of 12,000,000. And the big and the big scheme, we know case work manages helps. It it attracts people that sometimes, to me, we it might agree or disagree. They need to be tracked.
Why are we continuing this trend knowing that walk ins, perhaps, in my opinion, are not the solution given case work loads that will increase? And and how can these 340 case work case load workers, how they can how can they double their workload essentially and and carry all those and carry all those workloads from the employees that will be laid off?
SPEAKER2 - Thank you. I appreciate the concern you're you're raising. And if it's okay, I'd like to just start by, highlighting some of the context because, actually, there were a lot of different levels of care that you just identified in your questions. And so, for example, the behavioral health helpline actually is different than a crisis line. It's an access line. And so we encourage people to call before they're in crisis. And most of those calls are, in fact, people seeking routine care, which is a good sign. And part of the reason that I emphasize that is that that's part of a network of services that we rolled out in 2023 that help with that identification earlier. This community behavioral health centers have urgent care capacity. So that in addition to mobile crisis and the crisis units and standard appointments, they also have urgent care. And so part of what I I wanna highlight is that some of what has developed, excuse me, over the years has developed in isolation.
Meaning, we've added things, because a gap was identified or there was an emerging need that couldn't be accommodated in another way. And so as we rolled out the the behavioral health road map excuse me. Sorry.
We wanted to make sure that we were also building a sustainable behavioral health system. Excuse me. Case managers are doing a different function than crisis work. We now have a full array of mobile crisis teams that are in communities that are also able to mobile out and meet people where they are. The case managers are an important part of our fabric, which is really why we're focusing on modifying or adjusting the delivery model and so that we can get as much effective use out of that resource and maximize all of the other resources, including as secretary Wall said, those that are associated with the their accountable care enrollments as well.
SPEAKER9 - Just a follow-up, or or another question. So you also alluded to in your remarks, you plan on ex do you plan on expanding private sector contracts, the current vendors to come cover some of these services that was now being performed by state3123 employees?
SPEAKER2 - No. There there will be no expansion contracts. We will be maximizing existing resources. And, and I3133 appreciate that you're bringing that up. I also just want to bring us back to the fact that we're also foregoing further expansion of the adult community clinical services to achieve some savings, and we're foregoing further expansion of respite. This is going to allow us collectively to prioritize all of our resources to effectively meet the needs that people have.
SPEAKER9 - And lastly, Mr. Chairman, just lastly, so this reduction of employ of of employees case managed workload, will that result in some of the less acute,
that subset less less DD, clients not being able to act access those casework managers?
SPEAKER2 - No. In fact, anybody will be able to use the open access design, And our intention is to match the open access with, as I mentioned, office hours, mobiling out to high visibility locations to be available where people might be more inclined to show up. But also we will be able to use outreach calls. So we will be able to identify people who might be less inclined to follow through on their own, and we will proactively outreach to them as well. And this is why I just wanna emphasize that, yes, the proposal does reduce the case manager workforce. We will continue to have a full complement of supervisors. We will continue to have our site directors, and we will continue to operate our site offices.
SPEAKER5 - Thank you, commissioner. And just as a reminder, to all of our colleagues here, we're on panel 4 of 10 with the hard stop. So I just wanna remind everybody, 1 question, per per member. And with that, we will, turn it next to Rep Kilcoyne.
SPEAKER10 - No problem. Thank you, commissioner, and thank you for your thorough testimony. Earlier, I know that it is a very difficult budget cycle for everyone, and and the issues that you deal with are, particularly of concern. And I know you touched on this in your testimony, so I will be brief. But I know, you know, since I've been elected I was elected in 2020, fall of '20 '20. And since that time, all I have heard from my constituents and I'm sure from people or my colleagues here similar from their districts as well that mental health is on the rise, that it is a continuing crisis, and that it is more important than ever to make sure that our, those that need these services have access to them. And, I know it's something, again, that you've addressed, but I I can't help but just still be concerned that, the prospect of cutting 50 percent of caseworkers will leave a huge void in in many of the patients that are reliant on the critical care and services they provide. And we have heard, in addition to having a mental health crisis issue, that we have a health care, crisis workforce issue, that it's harder than ever to find individuals that are going into this line of work, particularly in mental health services. And I just would like to hear from you just what is your plan to ensure that those that are reliant, that are continuing to receive, care from DMH case managers, that they will continue to get the quality care that they should be receiving and that they expect, and how you are planning to avoid any shortfalls in services or making sure that those that individuals are not falling through the cracks with a significantly reduced staff. And thank you so much for your3377 time today.
SPEAKER2 - Thank you. It is something that we've given considerable thought to. And what we've tried to think about is how how we would monitor the, the use of these open access and our solution focused options and to track how well or not well the currently enrolled group are responding to them. We would also have the ability to flexibly move people in or out of 1 particular case management approach or another. So we as I mentioned, we will continue to have the availability of what is our more standard or traditional way of doing case management today. Our intention is to reduce the volume that are getting that more intensive approach. We will still be able to provide that for the people who need it. So we will have to both address the needs that people have, as they're seeking the use of this newer approach. And then also, like I said, to through proactive engagement to be able to make sure that we understand if something's shifting for them. The proactive engagement model is something that is in use today in other case management teams that are quite similar in terms of the way that they work. So, for example, health care for the homeless, teams use a very flexible engagement focused approach. It's very much inherent and and natural in the way that they deliver case management services. So I have confidence that because this is a design that is in use in other types of teams that we have, we believe it can be effective here too.
SPEAKER5 - Thank you, Commissioner. Our next question comes from Representative Jim Hawkins.
SPEAKER11 - Thank you, commissioner Doyle. My question's about the jail diversion grants, and I appreciate you bringing that up in in your comments. My district is Attleboro, and Attleboro Police Chief reached out to me about this because they've been long time supporters of users recognizing that mental health is part of what they're dealing with when they go out on a call. And they've been using taking advantage of this program for 3 years and understanding that COVID funding has gone away. But it is part of police reform. And not just to dot the i's and cross the t's, but they actually reduce arrests that way. They reduce repeat calls for service, and they get people into treatment instead of being locked up. I know you said that you support continuing to keep the caseworkers, the licensed mental health professionals, but the training, it sounded in your comments like you're reducing the training. And my very simple understanding, I have never been a police officer. So in in reference to my colleague down the down the row from me here, I'm thinking that when the police go out on a call, it's a very dramatic situation. It's not a simple call. It's not just, hi, how are you doing? And it requires that they be a team, which would require training as well. Not just the mental health professional to go along, but they have to be a team. They have to be coordinated when they approach a a chaotic situation, which I'm assuming most of these are. I'd like your comments about that.
SPEAKER2 - Thank you, representative. And, your I I think your comments are spot on that it does require a sensitized approach to policing. And we've seen that in recent years, the training has improved the way that our, police teams, our first responders are able to respond to behavioral health calls. And so my point here is that with limited resources, we are also hearing from our police partners that they would appreciate the continuity of their core response. And, again, this isn't to say that, the training that they've received isn't of importance or value. It's just a way of prioritizing limited funds.
SPEAKER5 - Thank you, Commissioner. Our next question comes from representative Zaros.
SPEAKER12 - Thank you again, Chair, Madam Commissioner. First of all, thank you for supporting the men and women of law enforcement and the co response. It's amazing how good that is. And thank you for addressing Percasset in your remarks. 22 veterans kill themselves every day. You know, I wear a 22 kill ring. First responders do as well.3664 It's such a battle. Some of them3668 live on The Cape, and some could be at Pocasslin.
So I heard your remarks. The question would be, at this point, do you have any more information about the working group? Like, when will that happen? Who will that be? And will it be done before the end of the budget season? And is there money in your new budget to keep Percasset open, in the next budget?
SPEAKER2 - Thank you for the question. There isn't a date certain yet for when this will start. We're working with the administration to set it up. In terms of the budget and what would happen if this went into the next fiscal, we would have to work with a and f, to to try to identify any resources that are needed. At this point, it's paused. The closure is paused.3720 But the budget, did not contemplate3724 this, and so we would have to work3726 with a and f if we find ourselves in a situation going into a fiscal year without the approved funding.
SPEAKER5 - Thank you, Commissioner. Thank you. Our next question comes from Rep Howard.
SPEAKER13 - Thank you, Mr. Chairman. Commissioner, thank you so much for your testimony. My question is also on mental health support. With the proposed, proposed cuts, to services for our young people. In your testimony earlier, you stated that you want these services available to them in their community closer to their community. So with this proposed this proposed cuts in FY26.
How many centers are we talking in numbers? How many cuts of centers across Massachusetts are we talking here? And as you know, we are still recovering, I don't think, fast enough from COVID. And so the mental health, the crucial mental health, especially for our young folks, what data, the the proposed cut, what's the what what's based on what kind of data did you use to propose these cuts? Because our young folks, if they are can't, you know, can't get to these services right away immediately within their own community, then it's it's, you know, they can't get.
SPEAKER2 - Thank you for thank you for the opportunity to clarify. These are actually 2 different types of services. The services that I described that are closer to communities where young people and their families are living are part of the community behavioral health centers. And there are, 31 locations. And under that contract, which is actually a MassHealth contract, under that contract, the community behavioral health centers are responsible for providing a full continuum of crisis care. And so part of that crisis care is inclusive of these what are called youth crisis stabilization beds. So those are available and they're not subject to DMH's budget. And those are continuing. So that's funded through House 1. And that's actually something that, assistant secretary Levine alluded to the continuing, funding for the the behavioral health community behavioral health centers. So those were part of of that, priority. The services that DMH is reducing are specialty services separate from those services, and these are statewide programs. They're actually not located in every community. These statewide programs, we would be continuing to operate, 3 of the IRTPs. And if the3916 proposal goes forward as it was, proposed, we would3920 be reducing by 2 IRTPs and the CIRT.
SPEAKER13 - 1 quick question. The 988 helpline, I think it was launched in 2022. How many calls, texts, online chat have you received, and how many, crisis train counselors manning the the 988. In my community, we lost 2 young folks to suicide and 2 too many. And so how so the since it was launched in 2022, how many calls, texts, online chat have have you received? Thank you.
SPEAKER2 - Sorry for the loss of your community members. I agree with you. Any loss to of life to suicide is tragic. And we can get back to you with the 988 numbers. 988 is actually overseen by the Department of Public Health, but we can get back to you with that.
SPEAKER5 - Thank you. If you could provide that information, that would be helpful. Quick question. Over the last few fiscal years, DMH has received funding for loan forgiveness and tuition reimbursement programs through closeout supplemental budgets. How have these funds been implemented and used for these purposes? And do you envision, what would you envision for any future of potential loan forgiveness or reimbursement needs?
SPEAKER2 - Thank you. Yes. We were, very appreciative of getting funding for loan forgiveness, and it did we had a dedicated source of loan forgiveness for DMH, and we were able to authorize over 2 I think it was close to 250, individuals were eligible and received the loan forgiveness. It has been a useful tool for us with regard to recruitment and retention. And, and there are other sources of loan forgiveness that have also, prioritized behavioral health. So there was this 1 that was specific for DMH. And then there actually is, there was an announcement, actually, I think last week of another wave of tuition, the, excuse me, loan forgiveness that was authorized.
SPEAKER5 - Thank you. Also in the queue, we have Representative Russell Holmes.
SPEAKER8 - Thank you. My question comes not to the actual programs that are being, eliminated, but the number of people. Can you tell me us how many people are you looking to cut with these cuts? And then I know you've mentioned several times around retention. Are you internally trying to transfer some of these people from the jobs that you're looking to cut to other spaces internally since you're having such a retention problem? And my concern around it is more these folks, if I recall, are the same people who we call the essential employees on the COVID. Now I can tell you we all learned the difference between who's essential and who's not in COVID. And I think almost everyone learned that even trash person, the grocery person, there were a lot of folks we all learned were not, we thought we were essential, but we truly learned who the essential people were in4133 COVID. So these were part of our essential people through COVID. And now when all of us are back at work and all of us non essentials are now back here too, how is it we're cutting essential people,
that were essential to COVID and then now all of us non essentials are back. So how many people?4157 Are we gonna do something internal?4159 And how is it we're cutting essential people at a at really the time when all of these things,4167 when COVID and all the other stuff is really going to start to really raise its ugly head with mental health, we're now cutting those essential people. It just doesn't make sense to me. I'm just not understanding that.
SPEAKER2 - Thank you. The number of positions that would be reduced with this proposal is a 33 case managers.
The the people who you're referring to, who would be impacted would have bargaining rights. So we would follow the collective bargaining agreement with regard to, any position offerings that they may have. And, yes, the department does have some open positions. And so there would be, in accordance with the collective bargaining agreement, any, access to those open positions or any other collective bargaining rights that they may have. And just to the to the issue about how we identified which staff would be impacted by this reduction. I just wanna go back to the prioritization that we shared with you earlier about needing to fully fund our inpatient continuum of beds, which are operating over 100% occupancy. And these are critical services that quite literally are doing work that nobody else can do. And so in using our resources to prioritize the needs of the peoples who whose needs cannot be met in any other ways, that's really what went into this.
SPEAKER8 - I'll make sure I have it right. All 33 we had deemed part of the essential employees to COVID. Right?
SPEAKER2 - Yes. All of DMH workforce is essential.
SPEAKER8 - So you understand my logic there. Right?
SPEAKER2 - I understand you.
SPEAKER8 - There are a lot of nonessential people now working, but we're getting4300 rid of the people who are most4302 needed in the crisis.
SPEAKER2 - I understand.
SPEAKER8 - Okay.
SPEAKER1 - Thank you, Representative. Thank you, Commissioner. Commissioner, just 1 point of clarification on a on a subject matter that's been brought up a few times from my colleagues. The jail diversion program, you talked about the the federal funding that was a part of that. What is the gap? How much is that? What what are we losing to that program this year and with this proposal?
SPEAKER2 - This year so it is a 1 year grant cycle. So each year, it's dependent on resources that are available to us. With the ARPA funds, we actually were able to do substantially more grant making than we've ever done. So, this year we were able to authorize a little over $16,000,000 in grants.
SPEAKER1 - Okay.
SPEAKER2 - And the state appropriation by itself is 3,800,000.0. So clearly, that's gonna go down substantially.
SPEAKER1 - 12 plus million is out to Delta the Redneck. Okay. Just a a bit of commentary on that because hearing from many of our local law enforcement agencies, it works. This is something that works. And when you talk about prioritizing, we all see, a budget as a as a statement of our priorities and our values. And And when we hear from law enforcement that some of which candidly were very reluctant to a core response model, I talked to some of them the other day That's true. That said, you know, Senator Feeney, I never would have thought that I supported something like this, but then we did it, and it works. And and to give them the answer that while we were hoping the municipality would actually pick that up, they're facing enormous pressures again this year on education costs and and other general government costs. I don't think that they ever knew that that was a part of that. Right? That it was just the appropriation kept coming. They have these programs4409 that worked. Now they're faced with these4411 cuts on a program that is hugely beneficial in many of our communities. And I, you4417 know, I I just back to 1 communication, making sure that municipalities kind of were able to forecast for this. But number 2, understanding that when we talk about priorities, something that, this core response model that works in our communities, the front door to this crisis, we should be prioritizing that as well. So thank you.
SPEAKER14 - Thank you.
SPEAKER6 - And
SPEAKER1 - I wanna thank you for your time today and for, you and your team for all the prep, and for the continued discussions that I know will happen over the next few months and the rest of the fiscal year. Thank you so much. Thank you.
SPEAKER2 - All right. Thank you. Well.
SPEAKER1 - Okay. With that, we'll move on to our fifth panel. We're going to hear from the Executive Office of Aging and Independence. I would like to invite up to testify, Secretary Robin Lipson.
While the secretary joins us, I just want to remind everybody we do have a few more panels to go. Anybody that's testifying, feel free to keep your comments brief as well. And to those asking questions, keep the, preamble to your questions as short as possible, 1 question per person. We will get through this. Secretary, welcome.
SPEAKER14 - Good afternoon. Can you hear me okay?
SPEAKER1 - We can hear you. Great. Loud and clear.
SPEAKER14 - We greatly admire your stamina today. Good afternoon, everyone, to Chairs Feeney and Beal and to all the members of the Committee. I am gonna be so brief. You have my written testimony. You can go back to it for all the details. But what I'll do is I'll drill down on a few things that I know are on people's minds this afternoon. For those I haven't met, my name is Robin Lipson and it's my honor to lead the newly named Executive Office of Aging and Independence. And with me this afternoon is Sheila Tunney, our Chief Financial Officer. I think as most of you know, everything that our agency does is focused on supporting older adults in their communities. And that starts with funding 350 councils on aging across the commonwealth so that the communities can make investments in their local senior centers and invest in programming that makes sense based on what their local needs are. Most of the balance of the budget, the rest of the budget, finances the services that help approximately 70,000 of our most vulnerable older adults in this state continue to live at home. That assistance sometimes comes in the form of help with a daily task that is simple for you or I. Something like preparing meals, doing laundry, keeping your house in order, getting help bathing. Those kinds of services and supports are very often the difference between someone being able to live in their home and needing to live in a nursing facility. The balance of our budget,
supports other related services. We receive over 40,000 allegations of elder abuse, neglect, and financial exploitation each year. We investigate those and we provide remediation services to those who are victims of abuse. We certify nearly 270 assisted living facilities. We provide support to thousands of family caregivers.4636 We assist people4638 with care transitions from hospitals and nursing homes back into the community and we provide over 10,000,000 meals to improve poor nutrition for older adults and to bring food to homes where people don't have access to food in any other way. The governor's budget for this coming year represents an approximately 21% increase over where we were this year. This funding level is necessary to continue to operate all of our key programs and to maintain our investments at the municipal level to all councils on aging. But a very tight financial climate and uncertainty about federal funds coupled with an increased demand for services requires us to sharpen our focus and make a few decisions that will ensure the long term stability of these critical programs. Let me just pause here for a minute and talk about our federal funding. Most of our federal funding comes from the Older Americans Act. It's about $40,000,000 a year. The agency that disperses that funding to us was disbanded last week. We have been told there is money there. We don't know who's exactly writing the checks. It's a situation we're watching very, very carefully. We get other federal funds for nutrition programs and for some employment programs, all of which we're watching closely. So just wanted to put that out there that there are still a few pieces of our budget as we look forward in the next 12 months that we're not 100% certain of. So 1 of the decisions that we've made in order to deal with an increasing demand for our services and a limited,
and the and the limited fiscal resources available to us, is to manage intake and caseload for 1 of our4751 home care programs which is the home4753 care program that is fully state funded. We have another program that draws down on federal reimbursement through MassHealth4761 but I'm talking about the4763 program that's 100% state funded.4765 And we have decided that we will, for this budget, we will manage caseload as people enter that program, and we will, manage the numbers of people that advance from a basic program into a more enhanced program that costs us about $1,500 a month for each person4786 that we serve. But I wanna4788 emphasize that even with these changes, we will not be, changing services for any of our current home care clients. No 1 will be disenrolled for the program. Everyone who's in the program will continue to be in the program as they are today. And4804 the people going forward who need the most support will not have to wait for services. These are hard decisions to make but4812 every decision we made is based on 4 principles. The first is I want to acknowledge and respect that even small investments at the community level reap very very large dividends. Something as simple as a community meal at a senior center contributes to overall health, reduces the negative impact of isolation, has people engaged and socialized and connected with other services. So, we are very much trying to preserve those small investments that we know make a very, very big difference in people's lives. The second principle is that we want to prioritize services to those most in need. And I'm thinking specifically of those who are most at risk of nursing home admission. The third is to be laser focused on efficiency, program integrity and strong business practices so that every dollar we spend goes as far as possible. And the fourth principle, is 1 that is very important to me and I think to many of you since you were instrumental in this. We want to preserve the important gains that we've made over the past few years in aging services infrastructure and workforce capacity so that we don't create access challenges as we move forward. Our state is a nationally recognized leader as a in, excuse me, we're a nationally recognized leader in age friendly practices and in having an innovative portfolio of home and community based services to support our older adults. We'll continue to be a leader with this budget which establishes a $1,000,000 new line item to fund local mini grants to further our age friendly initiatives and local communities ability to better support older adults. I think we all understand that aging can sometimes be an unpredictable journey, but the programs and the supports and the services available should not be. This budget enables us to ensure consistent, high quality, reliable services to the older residents of Massachusetts and their care partners. I want to thank you all for the opportunity to testify here today and especially thank you for your support of older people, their caregivers, and the organizations that serve them throughout the Commonwealth and
SPEAKER2 - I am
SPEAKER14 - happy to answer any questions you might have.
SPEAKER1 - Thank you, Secretary. Certainly a significant increase in this year's budget, but I appreciate you articulating exactly why, I think that makes sense. Open up to questions to members of the committee. I will start, Madam secretary, if I could. 1 of the things that you know, is on my mind constantly and talking to people throughout my district and throughout the Commonwealth as a chair of financial services, I've been working closely with my, house, co chair representative Murphy and identifying, the, the, alarming rate of scams that older adults seem to, you know, be victims of. And we're trying to figure out ways to do that. Right? Working with the financial services sector that if somebody comes in and wants to take out you know, they usually take out $50 a week, and all of a sudden they wanna go in and take out 10,000, that there's probably an issue going on there. We're trying to identify all all different ways in doing that. I know that as part of, you know, the work that you do and and and under your portfolio as well. Are we seeing more scams as you assist anecdotal? Do we see data of it? And what are you all, doing to kind of help that? And is there something that we should be doing more of to support you on that?
SPEAKER14 - Thank you for that question and for lifting up that issue. Scams are not on the decrease. They are definitely on the rise. We see a lot of that. Our protective services, program and staff across the state, work very, very closely with financial institutions. They do trainings with local banks. They work closely with the district attorneys. We ran a public service campaign, a little less than a year ago about scams, and we're about to run another 1 in May. So it's something very much, on our minds and that we're all very concerned about. I I do think though just from my own community and my own personal experience that people are far more aware of these risks, and we have more work to do to kind of translate people's awareness into into the action that it takes for someone not to respond to that phone call. It's very, very easy to be drawn in if you get 1 of those calls. And so that's still a work in progress.
SPEAKER1 - Great. Thank you for the work that you're doing on that. It it's we hear soul crushing stories from people that lose every Absolutely. Everything. And it it crushes me that that people have to go through that. So to the extent that the legislature can partner with you in that work and devote resources, please, please, please, let's work together on that.
SPEAKER13 - Thank you.
SPEAKER5 - Representative Beal. Thank you, mister chairman. Thank you, madam secretary, for all the work that you do. You mentioned earlier the uncertainty, happening down in DC and how that impacts the work that you do. Would you, would you elaborate on that a little bit and talk about, the biggest challenges facing your agency as we turn to f y 26?
SPEAKER14 - Sure. I think the biggest challenge facing our agency is actually not about our federal funding. I think the biggest challenge is the 1 that secretary Walsh brought up early this morning about the growing demand for services as our population gets older and as we have more people over the age of 65, 70 5, 80 5, etcetera. And it's really the folks, it's really the growth in that 80, 85 plus population that's putting more demand on us. So so I think our biggest challenge is to manage caseload5167 growth. From '23 to '24, we had5171 a 10% growth in our home care caseload.5173 That's just not sustainable. So the biggest challenge is to manage within an appropriation, giving demands. The challenges on the federal side, the money that comes in from the federal government, we, for the most part, nearly all of it goes back out to local area agencies on aging. They use those funds to support nutrition programs, to support legal assistance for older adults, to provide support to caregivers, to provide respite, and the list goes on and on and on. So they're very local services, usually very unique to each area. And that's that's what's at stake if federal funding were to be pulled back.
SPEAKER5 - Thank you for that information.5222 Are there any other members of the joint committee who, have questions? I don't see any in the queue, but wanna make sure that we give everyone an opportunity before we close out.
SPEAKER1 - Very good. Okay. Thank you, madam secretary.
SPEAKER14 - Glad to get you back on schedule.
SPEAKER2 - Thank you.
SPEAKER1 - Thank you. Okay. Appreciate you, secretary. And next, we have, health policy commission, HPC. I believe executive director David Seltz is here and will be joining us.
I believe director Celts has a slide deck as well, so we have hard copies that'll5271 go out to the members. And then if you5273 can pay attention to this monitor on5275 stage right, that'll have the5277 the slide deck as well.
Executive Director, welcome. The floor is yours.
SPEAKER15 - Thank you. Thank you. Good afternoon. Good afternoon, everyone. Yes, we, I do have a presentation. I can't help myself. We're passing out the hard copies for you right now, but also we'll be available on your monitor to follow and track along. I'm David Seltz. I'm the Executive Director at the Health Policy Commission, and I'm joined, here today with a colleague of mine who can introduce herself.
SPEAKER16 - Hi. I'm Hannah Klumach. I'm the Chief
SPEAKER17 - of Staff for the Health Policy Commission.
SPEAKER15 - Chair Feeney, Chair Beal, committee members, thank you so much for the opportunity to be able to testify today. I also wanna recognize at the start, all of the incredible work by your staff, in setting up today's event, and to helping guide you through this budget process. Hannah and I are both, former staff members of a Ways and Means Committee, and we know very well the challenges that you are all facing, in this very difficult budget process. As Secretary Walsh and many others have said today, including you, Chair Feeney, the budget, is a statement of values, and it is probably the most important piece of legislation you'll pass this session, especially considering all of the context and difficult challenges that have been raised, multiple times today. And I just want to thank you for your leadership, and for your thoughtfulness, as you go through this process. And also to say at the outset that the Health Policy Commission, as an independent state agency, we are a resource to you as well. Any questions that you have on health care issues or related health care issues, We may not know the answers but we will try to help you and connect you with the right information and the right data. In Massachusetts we're proud to be home to a high quality health care delivery system with near universal healthcare coverage for all of our residents. We're also a hub for innovation in the development of new medications and treatments and cures. However, for far too many, and unfortunately an increasing number of Massachusetts residents across the Commonwealth, your5413 constituents are delaying or completely foregoing needed care, are splitting prescription drugs that help manage chronic diseases or not filling those prescriptions at all, are struggling with medical debt, all due to the increasing unaffordability of health care in Massachusetts. We can have a world class health care system that develops life saving drugs and treatments but if the people who live and work here, the employers especially small businesses who drive our economic growth here cannot afford to access this system then we are squandering our strength as a state and if we continue on this path it will lead to a less accessible, less equitable, less fair and ultimately more expensive healthcare system with ever widening health disparities. So recognizing this significant challenge the legislature in its wisdom passed landmark healthcare reform in 2012 that established a framework for measuring and moderating healthcare spending growth over time. This law also established, the Health Policy Commission or HPC and the Center for Health Information and Analysis or CHIA who you'll hear from directly after our, testimony as 2 independent state agencies to act as the policy hub and the data hub respectively for the state and for the system overall in achieving, this ambitious goal of moderating health care spending growth. A cornerstone of this effort is our health care cost growth benchmark, which is not a price cap but rather a target, and goal to motivate collective public and private action to work together to identify those areas in our system where we can reduce unnecessary spending and reduce costs. This annual growth goal also allows for our tracking of performance over time and a better understanding for the public and for policy makers such as yourselves on the ever changing landscape of the health care market, the5552 cost and spending drivers that are contributing to5556 our affordability challenges and to help us be able to identify data driven policy solutions that we can implement and put in place to continuously evolve and improve our approach. As noted on this slide
as noted on the, second slide, our overall vision and goal is better health and better care at a lower cost which is to say that it's not lower cost at the expense of those other values but really in coordination and in complement with those values. Just as, Massachusetts was a national leader on advancing health care coverage to all residents, Massachusetts is now also a leader, again on this approach for moderating health care spending. As you can see on this slide, there are a number of other states that have followed, the example put forward by Massachusetts in our approach and many have adapted, and gone even further and have more ambitious goals than Massachusetts. But today 1 in 5 Americans live in a state that has a healthcare cost growth benchmark modeled after the innovation here in Massachusetts.
Despite, some notable progress that we've made over this last 11 years and on the next slide you can see our performance, annual growth, compared to the benchmark, for the last 11 years. There have been some years where we've been above and there's been some years where we've been below. To me, it's always most interesting to understand why in any of these given years and help that information be able to drive our policies. But as you can see over the last 11 years, our average annual growth has been 4.1%, or just a half a percentage point above our initial goal initial ambitious goal of 3.6%. However we can see that in the most recent years that some of these spending and cost trends are accelerating and this is concerning about being able to ensure affordability for residents. You can see as you can see on the next slide we have, the cost of the family health insurance, is nearly $29,000 a year. For many residents, that exceeds that amount. That's just the average. We have 40 percent of residents here in Massachusetts in 1 of the most high income states in the country who said that they're not getting the care that they need due to the cost of care. We estimate that there is about 5900000000.0 dollars in, additional costs due to disparities. That's a billion, not a million. Sorry for the typo in your handouts. And we note that the, average cost of a branded prescription drug has grown by almost 70%, in the last few years. These are significant challenges that means that the work is still important and we must continue on this path even in light of some of the federal uncertainty, makes this work even more essential because there will undoubtedly be less resources for families, for businesses and for our healthcare system. And so we need to identify and implement those strategies to enhance value and efficiency that don't sacrifice our values of quality, access and equity.
1 of the strengths of our approach has been, our ability to use data and information to evolve our strategies. And it's with this that I am, I'm so grateful for the action of this legislature early this year in passing 2 significant pieces of legislation that tackle some of the major challenges facing our healthcare system today. I want to recognize this committee, the Joint Committee on Healthcare Financing, Senate President Spilka, and Speaker Mariano for their dedication to making sure that these bills got done last session, even on the waning days of December and January. These 2 bills, represent the most significant step forward for our healthcare approach since the passage of that original law, in 2012. I want to highlight, for you, as a preview to our budget request some of the new, important responsibilities specific to the HPC that the laws lay out and the law will be effective tomorrow by the way. The law establishes 2 new offices really focusing on some of those big challenges as I've noted. 1 is a new Office of Pharmaceutical Policy and Analysis which we're just going to call OPA internally just because that's a mouthful. But this new office, established within the within the HPC will be that expert hub for understanding the entire prescription drug sector from the manufacturer to the PBM to the wholesaler to the retail and independent pharmacies. This is a very opaque system with a lot of money flowing through each and every 1 of those different actors. And as we need and the public is demanding a better understanding of how those dollars flow through the system and how or how not they're not benefiting consumers when they're trying to fill their prescriptions at that retail or independent pharmacy counter. With this office, we are going to be able to have that mandate at the HPC to bring on some new expert staff that'll help us really be able to, have objective insights into what is happening in this sector, which is our major driver of healthcare spending. Healthcare spending and pharmacy rules has been 1 of the fastest categories of spending that we see in our healthcare system and it was noted earlier by, Director Levine, for MassHealth as well. We see this office as a hub for not just the HBC but for MassHealth, for the Group Insurance Commission, for all other state agencies that are buying and purchasing prescription drugs that this agency would be a partner with them in identifying those policies and opportunities and strategies and also to provide you as policy makers information about the objective facts about what is happening in this system where so often we hear different parts of that system pointing fingers at another part of the system and saying I'm not the problem, they're the problem. Let's have some objective truth and some objective facts to help drive our policy making. The second important new office, established by these laws is the Office of Health Resource Planning. As was mentioned earlier, the Commonwealth has faced a number of really devastating healthcare closures, over the past few years and, and frankly decades. And this office will revitalize an important public function of actually having a plan. Actually having a state plan that says, where do we need different healthcare services to meet the needs of our communities? Where do we need those facilities? Where do we need those services? And let's use this plan to proactively be able to consider how do we protect and support the things that we need, how do we incentivize our market to invest in the things that we don't have but do need, and more so than anything to create a blueprint so that we're not always being reactive when there's something terrible that happens to 1 of our facilities and we don't know what other services are in that area. We'll know that ahead of time and we'll know that and be able to put in place the right policies and supports to be able to ensure that the communities and patients have the services that they need. This is an exciting new effort.
As well as, so I wanna recognize the department of politics, the executive office of human services in thinking about, after those closures, how do we plan for a more rational system? I'll also mention that the law also, establishes a new task force, which is on the right hand side of the slide, as well as a previous, piece of legislation passed last year landmark maternal health legislation which was also quite significant. So we are co chairing 2 new task forces this year. 1 is around maternal health access. I think specific to what I was just saying, we have seen a number of closures of maternal health units, at hospitals, birthing centers across Massachusetts. This has led to, questions around our our access across the Commonwealth. This task force is going to be diving into what drove some of those past closures. What can we learn from that? How can we use that to prepare for the future? And what other policies do we need to have in place to ensure that all residents have access to high quality maternal health care that meets, their needs and goals. The second task force, here on the right hand slide is a new primary care task force. We released a report early this year called the The State of Primary Care in Massachusetts. Primary care is is the foundation for any well functioning healthcare system and yet here in this state we are spending less and less of our healthcare dollar on primary care. Overall in our commercial healthcare spending the amount that we spend on primary care is about 6 to 7¢ of the healthcare dollar.
We also know that this is a workforce that is increasingly burnt out and struggles with, an overwhelming burden of administrative burdens that is taking away from clinical care. By 1 estimate, for every 1 hour of clinical care of primary care providers, there are 2 hours of administrative work attached to that. How do we get this workforce to be strengthened and stabilized to get back to providing high quality clinical care instead of filling out forms and fighting with insurance companies over prior authorization or other management. That's going to be a big part of what this task force is going to be looking at as well as increasing our investment in this area that we know drives value. And again, you heard from, Mike Levine earlier today about MassHealth's commitment to try to get their spending to 10¢ on the dollar. Part of this task force will be looking at how do we set a goal for all parts of our healthcare system to increase investment in primary care over time. And finally, the law also establishes new oversight of some, novel, financing mechanisms, that we have seen in healthcare through private equity. This is a place again worth a lack of transparency. Many of these, private equity actors are already operating in Massachusetts healthcare providers and we may not know it. In all these cases, we don't. This law provides a greater level of transparency and oversight so we can understand when there is that private equity, investment or taking control of a healthcare provider so that we can understand when this is happening and be able to, ask questions appropriately of whether we think, these relationships are also in line with our goals of improving quality access, and health outcomes. And we know and I know that from our data there have been increasing activities in private equity in areas, such as skill, long term care, physical therapy, autism services, and infertility, services. So this new, mandate by the legislature in this law to have that level of transparency and oversight is a huge and important step forward. So, these are big new significant responsibilities for the Health Policy Commission and we're grateful for your confidence and trust in us being able to execute on these new mandates as well as being able to continue to mandate, execute on our existing mission. That is why we are requesting, a modest increase to our budget this year, to be able for us to be able to implement, the significant responsibilities in these new laws. I will note that the Health Policy Commission along with our sister agency CHIA we are a fully assessed healthcare account By that which I mean, what you appropriate for us in the budget does not impact the general fund. We assess, healthcare entities and providers for the the total amount of our healthcare budget thus keeping, the general fund as I said held harmless. Importantly with the new, laws, they they seek to expand, who is responsible for helping pay for these assessments. So right now it is a fiftyfifty split between acute care hospitals and ambulatory surgery centers and health plans on the other. The new law expands this assessment structure to be able to include both pharmaceutical manufacturers and PBMs and being able to contribute to both HPC and Chia's budget. And once those are fully implemented, those will, will cover the costs of whatever expansions needed, due to the other, new mandates in this law. As you can see, on this next slide, we have been stable at about the same FDEs for almost the last 10 years even as the HPC has taken on, considerable new responsibilities. And the way that we have done that, is through building, and, and cultivating an expert staff, and doing more and more with the same amount. We have reached that limit and that is why, we are asking today for that increase, requisite with our new responsibilities. Thank you, for your consideration. The challenges are great and we look forward to the continued partnership,
SPEAKER1 - with all of you in the work ahead. Thank you. Director Seltz, I gotta tell you, every time I listen to you, I learn something new. It's always enlightening to hear, not only your analysis, but your thoughtful remarks about, you know, what we can do to be better in the Commonwealth. So thank you again. You have delivered once again, my friend. I saw Rev Zaros got a little excited when you said OPA as the new, the new title of that program. I thought we were gonna start dancing. Thought we were gonna start dancing, rep. But thank you. I know we put you heavily into the pharmaceutical game now, and and I just wanna make sure that you have the resources, in your team to be able to, to delve into that. So with that, we can open up the questions from the committee. I'll turn it over to Representative Beal.
SPEAKER5 - Thank you, Chair, and thank you Director for your testimony. It's a highlight, every budget cycle. Quick question. If you could talk in a little more detail about how the recent healthcare legislation passed by the legislature, specifically enact relative to pharmaceutical access costs and transparency, and enact enhancing the market review process, have affected the amount or types of services that you're required to undertake?
SPEAKER15 - Yes. Thank you for, for that question. And those 2 new pieces of legislation, as I was describing, really do represent a significant expansion, in terms of our our scope of being able to look at all the different aspects of what contributes to health care spending. I would say I think this was this was an oversight in the initial law. We we the initial law, you know had a tremendous focus on our healthcare provider system our health plans not so much on the pharmaceutical sector and what we know today is that this is a critically important part of our healthcare system that we need to be able to understand And as a for example to that, the original law allows for the Health Policy Commission every year through our annual cost trends, hearing process to call, leaders of healthcare providers and health plans to testify under oath about their efforts to meet the Commonwealth's goals. But it did not include leaders of pharmaceutical manufacturers or leaders of PBMs. The laws that just passed earlier this year changed that. So to me this is about an even playing field across6576 the health care system. It's not about picking at 1 particular sector. It's about understanding all of the different sectors and how they work together. So to answer your question, representative, those laws, absolutely increase our oversight in that area, our oversight and understanding, the supply and distribution of services as well as our oversight in, financing models such as private equity and their growth in healthcare. So, that is, you know, there's other smaller provisions, but those are the ones I would highlight.
SPEAKER5 - Thank you. I appreciate that context. I have in the queue Representative Souza.
SPEAKER16 - Thank you so much. Thank you for all for your presentation and all that you're doing. So much of the work that you've done that you're continue to be doing. You've had to kind of address full blown crises in place, literally building the airplane while it's in the air. And the maternal health task force is no different. On Wednesday, DPH is gonna have a hearing in Framingham on their decision to close their level 2 a and 2 b community based maternal newborn service, our our special, care nursery and really maintain just their well baby nursery. For the community that we have in Framingham, that is tremendous, and I understand that things are still kind of picking up and literally still building the airplane. But is there a plan to address these acute crises that are literally happening in real time right now? How does that process goes when6675 you're as you're building the airplane?
SPEAKER15 - Yeah. Thank6679 you, representative. And it it's a great question. And I think reflective of a trend that we've we've seen over the past few years with some of these closures or reduction in services.6689 And to be able to understand,
not just from that 1 particular, instance, but, you know, within the region, within the state, how is this impacting patients? How is it impacting, their ability to access timely care, especially for something as important as maternal health care services? I think 1 of the exciting things that I see in this law, in addition to this new Office of6716 Health Resource Planning being able to do kind of this more comprehensive state health planning effort. It also, directs and authorizes the the office and the HPC to do rapid focused assessments. And so here's an area where I think we could, through this office, be able to say, okay, let's look at this specific community or this specific region of the state and understand what's going on with maternal health care, what's going on with pediatric health care, what's going on with oncology care. And to be able to do so, in a more, you know, more rapid sense fashion so that we have that data and information at our fingertips. As we build this office up, I I do believe that we'll be able to more quickly be able to run those types of analyses so that when we're faced with decisions about closures that we understand the context and what the implicate implications and impacts of that could be. And furthermore, to potentially put in place the policies and strategies prior to perhaps prevent that closure from happening in the first place. So, we are moving rapidly to put this forward. As I said, the law, is effect in effect tomorrow that has not stopped us from beginning this work literally the day after the laws were, were signed by the governor, because we know how essential important this is going to be. And I look forward to connecting with you on, on this specific issue as well.
SPEAKER16 - Thank you so much. It's quite literally the canary in the coal mine. They're, they're looking to close labor and delivery, but at some point.
SPEAKER15 - Yep.
SPEAKER1 - Thank you, Representative. Thank you. Question from Senator Olivera.
SPEAKER3 - Thank you, Mr. Chairman. Thank you, David, for your testimony, and also the charts in here. I think for us on the budget building side, we constantly face constituents' questions with growing revenue. How come we have less money to invest in priorities? And this chart clearly shows that healthcare is taking much more of that pie each and every year. And the growth in healthcare costs and the drivers that are growing, that cost growth, something that we need to look at. You know, looking at the data and looking at those healthcare growth areas, we understand that prescription drugs continues to be the area which sees the disproportionate increase in costs when we're looking at what is driving our healthcare costs. We're hearing anecdotally from a lot of folks and probably people that we know that the increase in rise in weight loss medications, particularly those that are advertised on television, I'm not gonna start singing any of the advertisements. We6886 all know them. Those6888 are growing at a rapid rate as well and having a strain on our system. As we're looking at some of our class containment measures, do we have any data yet? And is the Health Policy, Commission looking into any of the long term data on any of these weight loss drugs and also the potential savings it could have if we are reducing, you know, chronic diseases like heart disease and diabetes with people losing weight. And looking at the growth in that area, is there any data that you can share with us, about any cost containment strategies of either growing those programs or looking at any type of strategies in order to expand it or decrease it? -Yeah. Yeah.
SPEAKER15 - Thank you, Senator. If you like charts and graphs, I can get you a lot more charts and graphs. The, the issue of, what we call as a class of drugs, GLP-1s not to use their, their brand names. We are seeing that exponential growth in our data. We have a little bit of a data lag but so we have data, you know, kind of through mid-twenty 24. And every year it's doubling or kind of tripling in cost. And I don't see that I don't, I have not yet seen kind of the, the end of that curve, end of that trajectory. Right? We know that, these drugs are being indicated for more and more different types of clinical conditions. And the manufacturers of these drugs are also out with clinical tests to try to continuously expand, the different types of things that they could be very effective, at being able to treat. But that will just mean even a larger population that could be, eligible for these drugs. I think you're asking the right question, which is understanding, you know, how much are we paying for these drugs? What are the trade offs there? And are there potential benefits that we need to be calculating as well? You know, I would say in the studies that I have looked at so far and there have been some economic, work in this area. I think there is a large recognition of the potential for savings from, reducing obesity, reducing heart disease, reducing quality of our improving quality of life, candidly. But I think there's an economic challenge that comes with this, which is to whom do those benefits ultimately accrue? And if you're a commercial health plan, covering these drugs, do those benefits accrue, later down the road such that, you know, Medicare might be the beneficiary of these savings. And so that's something we call like a a wrong pocket problem in health care is making those investments. Who makes those investments? Do they also benefit in the savings? And if they don't, they're oftentimes not incentivized to make those investments. The last thing I've seen from the the studies in this area, though, is even with that that I think, very legitimate, promise and potential for for for savings across the healthcare system, the studies I've seen so far do not make it possible that the math works out at the price points that they're being charged. We are paying more for these drugs than any other country, sometimes at a much higher degree. If we were paying for these drugs at the same rate of other countries, that cost benefit analysis looks a lot different.
SPEAKER1 - You're on a 20 second clock, yes. I'm gonna
SPEAKER3 - Just wanna just wanna follow-up very briefly. It's my understanding. It's not necessarily the actual medication itself, but the delivery mechanisms that also cost so much. So what other the injectors7109 that people use far outpaces even the cost of the actual medicine that you're taking for a lot of these types of biologics.
SPEAKER15 - Yeah. And sorting through the mechanics of the drug, the delivery system, who is benefiting, these are, these are the right questions.
SPEAKER5 - Thank you. Next up in the queue, Representative Holmes.
7138 SPEAKER87138 -7138 David,7138 Senator is right where7140 I am on this too. Good to see you. As you hear, it's the same song for me all day. Sounds like we have PBMs. You're gonna, you have enough of that under control with the new law. Is that a yes? You're gonna be able to give me all my numbers of how they're racking up all this money on us?
SPEAKER15 - That I have been taking notes all day, Representative, and the questions you are asking are absolutely the questions that we're gonna be asking and getting the right data to answer them. Yes.
SPEAKER8 - Alright. So the other half of that question was, what about what are we doing about $3.40 b? You got that side? You're going to handle that for me too?
SPEAKER15 - I have some data and information on you as, on that as well. As has stated, it's a important program for funding our safety net hospitals. But we need to understand what the underlying dynamics there, how that's grown over time, and ultimately,
is this the best way to finance our drug system, specifically in the Medicaid program? Or are there other ways to get7199 greater savings? So, yes.
SPEAKER8 - And so7201 you're going to work with MassHealth, community health centers, and we're going to make this thing work that this, this formula is going to come out so that we actually benefit more and the folks who is intended for us, poor people, are going to start to benefit more. Right? That's what you're telling me.
SPEAKER15 - I can't guarantee7220 you that that outcome, but I can guarantee you that that is what we will be striving for.
SPEAKER8 - Thank you.
SPEAKER1 - All right. Thank you. Seeing7228 no other questions in the queue, David, thank you so much for being here.
SPEAKER15 - Thank you so much.
SPEAKER1 - Next, we'll invite up the Center for Health Information and Analysis, CHIA. We're going to invite up Executive Director, Lauren Peters, who I know has been with us all day.
Director Peters, thank you for being here and for hanging in, all day. The floor is yours.
SPEAKER18 - Well, it sounds like Director Celts is gonna solve all of our health care problems this year. So this can be brief. But in serious good afternoon or evening, Chair Feeney, Chair Beal, and other distinguished members of the Joint Committee on Ways and Means. My name is Lauren Peters and I am the Executive Director of the Center for Health Information and Analysis, otherwise known as CHIA. And I am joined today, by Nick Dancer, our CFO. It's a privilege to be here to present CHIA's FY 26 budget request, and to highlight a few of the agency's priorities in this upcoming fiscal year. As I noted, I will keep this brief, but would direct you to our, more detailed submitted written testimony. So, as noted earlier, CHIA is an independent agency that was created in 2032 under the cost containment legislation and really serves as the state's primary hub for healthcare data and information. The agency is charged with collecting, analyzing and reporting data on our healthcare system. This includes looking at costs, utilization and quality among other metrics to inform and advance data driven policymaking. We fulfill this mission through our multifaceted datasets and robust analytic resources, which enable the agency to carry out its core functions, such as measuring healthcare spending against the state's cost growth benchmark, examining trends in insurance premiums and cost sharing to inform and advance policies related to affordability and equity, reporting hospital utilization data to inform capacity and health care planning efforts, collecting and monitoring provider financials to support market stability. And an example you all may be familiar with, reviewing mandated benefit bills on behalf of the legislature to assess medical efficacy efficacy and cost impacts of these proposals. And while these are just a few examples of the work core to CHIA's mission, our data and analytic capacity expands beyond this list. And I would note that we are always happy to take ad hoc data requests, from legislators, whether it's in support of a constituent need, a hospital in your district, or policy development. We seek to really be objective thought partners and a resource to you all. Additionally, with the passage of 2 landmark healthcare bills that strengthen oversight of the healthcare system and address some of its largest cost drivers, CHIA is tasked with several new responsibilities. So under the Market Oversight Bill, CHIA is charged with collecting expanded financial information from private equity investors, real estate investment trusts and other interest holders affiliated with providers operating here in the Commonwealth. This will enable CHIA to provide a more complete financial picture of providers, which will improve the State's ability to monitor the financial sustainability in our hospitals and health systems. As noted earlier, the other recent healthcare legislation, the PACT Act, aimed at addressing pharmaceutical costs, directs CHIA to newly collect information from pharmacy benefit managers to provide greater transparency into drug pricing, utilization trends, and other metrics. So I commend the legislature for passing these significant policies that CHIA is well positioned and committed to implementing over the next year. In addition to the core activities and new statutory directives just described above, CHIA's other areas of focus for FY 26 reflect a number of our shared priorities with the legislature. And just to highlight a few, CHIA has increased its primary care data collection and reporting to do a deeper dive into primary care spending trends as well as primary care capacity from both a workforce and access lens. We also stand ready to support the newly established primary care task force set to kick off later this month. Behavioral health is another area we continue to enhance and expand our reporting pursuant to the Mental Health ABC Act, releasing new behavioral health focus metrics and stand alone reports, as well as collaborating with the HBC's new Behavioral Health Workforce Center. Workforce remains another area of focus. To better quantify workforce challenges, CHIA is building its second workforce survey this year. The survey captures key data such as vacancy rates, turnover rates across more than 10 health and human service sectors. Data from the 2025 survey that is currently being fielded will be available in early 20 26 to inform and evaluate workforce related policies and investments. Finally, in FY '26, CHIA will continue to enhance our analysis and reporting of provider financial performance. This includes quarterly reporting on hospital and health system financials and a consolidated 1 stop shop dashboard with their annual performance and financial data. Similarly, recognizing the important role that nursing facilities play in our healthcare continuum, new this year, we stood up a similar centralized dashboard for nursing facilities with key financial and performance data that we will continue to update and evolve as we collect more information from facilities and their affiliate management and realty companies. With respect to CHIA's budget, CHIA is funded through an annual assessment in the amount equal to its appropriation set by the legislature. Historically, the assessment applied to payers, hospitals, and ambulatory surgical centers, and within the recent healthcare legislation, expanded the types of entities subject to the assessment noted earlier, pharmacy manufacturers, PBMs, and other non hospital providers. For fiscal year 26, CHI is requesting an appropriation of $35,000,000 And this modest increase reflects the annualization of FY '25 collective bargaining increases. And it will also ensure the necessary resources to support and sustain the Agency's core responsibilities in FY '26 priorities, some of which I outlined today, including most notably the new legislative directives that expand CHIA's role in our collective efforts to strengthen market oversight and rein in prescription drug costs. In closing, I want to reinforce CHIA's commitment to providing relevant, reliable, and timely data to meet the evolving needs and priorities of the legislature, policymakers, and the healthcare system more broadly. I want to thank you again for the opportunity to present today and for your consideration of CHIA's FY 26 budget request. I'm happy to respond to any questions.
SPEAKER1 - Thank you, Director Peters. Appreciate you hanging in there for the day and for your testimony and for the work that you do. I will say, speak parochially for a minute. The work that we've asked you to do on the Financial Services Committee to, you know, constantly be doing Chia reports and analysis as we dig in and and delve in, to the legislation before us has been very, very helpful. You've always met, you've always met the demand, and I really appreciate your work on that. Open it up to questions to members of the Committee. Representative Beal?
SPEAKER5 - Thank you, Chair. Director Peters, just 1 question for clarification. Talking about the H-one, recommendations versus, the proposal from CHIA. Does H-one as it stands current adequately fund your department for the projects and initiatives that you plan on undertaking for the next fiscal year?
SPEAKER18 - So we are requesting, a slightly modest increase from what was filed in House 1, and that's primarily reflective of the new legislation that was that was passed and enacted, really just after, I think, House 1 was finalized. So, House 1 in the development did not reflect all of the new responsibilities that CHIA was was assigned in that in those 2 health care list bills.
SPEAKER5 - Thank you for the clarification.
SPEAKER1 - And just to clarify, House 1 came in, it was at 33.7. Was that the, in the draft? 3364. 30 3 6 4. And the request is? 35. 30 5. Perfect. Okay. Makes sense. Any other questions from members of the committee? Going once, twice? Excellent job. Thank you. Seeing that. Appreciate it. Thank you. Great next would like to invite up Massachusetts commission on youth.
I believe we'll be hearing from executive director Brooks.
Once again, for committee members, this is the Massachusetts Commission on LGBTQ Youth, and we're hearing from Executive Director, Shapley Brooks. Director Brooks, welcome.
SPEAKER2 - Thank you.
SPEAKER17 - Good afternoon, everyone. It's been a long day, but thank you for hearing from us. Thank you to the chair, and, and the members of the joint committee for the opportunity to advocate on behalf of the commission's LGBTQ youth budget, and to share more about the Commission's work and anticipated budget needs for FY '26. We appreciate the ongoing support from many of you, over the years to make sure that the state of Massachusetts is a place where all youth can thrive. To set the stage, we first want to share just a bit more information about what we've been up to, and our positioning in Massachusetts. The Commission on LGBTQ Youth is an independent state agency of the Commonwealth and is the first and is still the only agency of its kind in the entire United States. Our agency was first established as a governor's commission in 1992 to respond to the high suicide rates, and risks, excuse me, and the ongoing HIVAIDS crisis, as well as the rising bullying rates in schools. These risks are much more critical now more than ever, as we all know, with the targeted attacks on LGBTQ communities, and communities of color. In 02/2006, the Legislature made a unanimous unanimous and bipartisan vote to codify our commission as an independent state agency and has tasked us with investigating the use of resources from the public and private sectors to enhance and improve the ability of the state's agencies to provide services for LGBTQ youth. This work is reflected every year in our comprehensive and intersectional annual recommendations report, with our next report slated to be released at the May. You will see a summary of more than 80 plus policy and programming recommendations, and we've had comments about how many recommendations we have had, and programming and recommendations that the Commission has made to the Governor, the Legislature, and to our 20 plus state agency partners.
Per our establishing legislation, the Commission also is tasked with working with DESE to create7938 a school based and community based programs to address discrimination against LGBTQ7942 youth across the state. Much of this work is done through our collaborative relationship with DESE as we oversee, fund, and manage the Safe Schools program fully on our own. We have a long history in Massachusetts, state policy, communities, and schools, and are dedicated to developing and advocating for equitable policies, programs, and resources for LGBTQ youth, especially our youth who live in multiple with multiple intersecting identities, those who are black, indigenous, disabled, immigrant, trans, and non binary, in a wide range of areas that include health care, education, the child welfare system, the juvenile carceral system, and housing access. You can see the range of topics that the Commission works on reflected in our recommendations.
And these recommendations reflect the numerous conversations we have with community partners, constituents, youth, educators, providers, and more, and reflects the the serious concerns about equitable policy and programs, particularly in our child serving agencies, including DCF, DYS, and the OCA, just to name a few. To do this work, we partner closely with more than 200 Massachusetts public schools, more than 20 state agencies, and countless families, youth, and organizations. All of this work with our partners is done consistently throughout the year, and, in fact, we have the opportunity to collaboratively meet monthly and bi monthly with our agency partners to actively work on our recommendations throughout the entire year. In the past few years, we have also advised national and international partners on how to create similar agencies and advance to and advance LGBTQ equity around the world. We have been advising in states lately. We have been advising in states like Florida, Michigan, Illinois, Mississippi, Alabama, and Georgia, just to name a few. We have also started conversations with South Africa. Our recommendations have made it all the way across the ocean, and have been a blueprint for their activism.
The Commission is absolutely thrilled to see that the governor, that Governor Healy's FY 26 budget recommendations include a baseline budget of $1,600,000 for the upcoming fiscal year. This recommendation restores and cements funding the Commission was previously granted through supplemental funding but did not receive, in the last fiscal year to maintain, strengthen, and strengthen the critical services it provides to support LGBTQ youth in Massachusetts. Given the increasingly hostile federal administration towards the rights of LGBTQ youth, specifically transgender youth, and the programming that supports the diversity of the youth we serve, state protections and support are more important now than ever. The work of that Commission, the work that the Commission does is essential to the commonwealth and its youth. Some of the things that we are are aiming to do is to increase our consultant capacity to advance research development, student and community supports and trainings. We have a limited staff. We have we are a staff of 6, and, that more than 300 page report that you see is done
SPEAKER18 - by us.
SPEAKER17 - And so, we have a strong cadre of consultants to advance the research development, student and community support, and trainings. And this funding will allow the Commission to meet the increasing demand for new research and additional trainings. It would also support the implementation of highly requested training on caretaker engagement currently being piloted through education agencies since 2024, with the projected expansion to DCF, DYS, DMH, and DDS in late 20 25. Strong relationships with youth and their caregivers are critical to the safety, permanency, and well-being of LGBTQ youth in Massachusetts. The Commission's new curriculum is designed to build awareness within state agencies on how they can support youth and caregivers utilizing their services. But more importantly, the caregiver engagement will assist in restoring LGBTQ youth to their families and decrease the likelihood of familial disruption, ultimately initiating a decline in many of the disparities that plague LGBTQ youth. Another, initiative is to bolster the Commission's GSA Student Leadership Council to expand programming, support student empowerment, and leadership development. Over the last couple of years, students have increasingly, been seeking ways to get involved with LGBTQ advocacy, and that that has an impact on their communities. And with this funding, the commission intends to expand this programming and increase the diversity of the council and create new opportunities for learning. Finally, these funds will be used to8231 increase our data collection and research8233 for the Safe Schools program and our recommendations reports. Just a snapshot of what what's been happening in the last 10 weeks since this administration has taken office. In response to recent executive orders and heightened anti LGBTQ rhetoric, the Safe Schools program has experienced a significant uptick in technical assistance requests from school districts across Massachusetts. There are 2 people answering those requests. Compared to this time last year, we have had a 25% increase in our technical assistance request just in the last 10 weeks alone, and we still have 3 months in the current school year. Many8271 of these students are driven by fear and8273 uncertainty amongst their families,8275 school leaders, and educators, particularly concerning the safe the safety and well-being of LGBTQ students8281 and those holding multiple marginalized identities. School leaders are increasingly reaching out for assurance, guidance, and concrete strategies to navigate complex community pushback, including organized resistance to inclusive curricula and educational materials that reflect diverse identities and family structures. The nature of this technical assistance request has become more intensive, often requiring sustained engagement with schools' teams through multiple points of contact, coordination, and district leadership, and development of new and or expanded, tools and resources. Families are also8317 turning to the Safe Schools program for direct support and ensuring safe and affirming learning environments for8323 their children, further increasing the program's demand and reach. In response to schools challenges and scheduling comprehensive8330 all staff all staff professional development, we are increasing professional development opportunities that are tailored to specific roles such as student support teams, school based leadership, and district administrators. These role specific professional development opportunities are essential in building localized capacity to respond effectively and proactively to the evolving threats facing LGBTQ students and school communities.
Lastly, 1 project that we are looking forward to sharing with the legislature is a special report that, excuse me, investigating the experiences of transition age youth. We spoke about this last year, and, we've had to stretch out our, our release date, specifically around what's happening right now in our country. Our transition age youth are young people who are aging out of the youth serving agencies such as DYS, DCF, and far too often they are transitioning out of care without tools they need and the skills they need to survive.
As we approach, FY8397 '26, we are also in the process of finishing new research project. Again, for the first time ever in our state, we will uplift8403 the voices of LGBTQ immigrant youth and families to provide clear recommendations8407 and programs, policies, and resources for agencies and providers for many of the same reasons that I've already covered. As the Commission continues to push forward in the work that we're charged to do by the state, we ask the committee to consider adding the funds we need to continue this work. This very modest addition of $500,000 to this year's, budget will allow us to continue to maintain the bare minimum of our the bare minimum of our services and programs, and anything less than these funds will stretch our capacity, beyond its limits. We're obviously in a crisis. We are in a mental health crisis, especially amongst our youth, a migrant crisis, a housing crisis,8445 all while our community, our youth are watching their peers in other states,8449 as well as this state, suffer from assaults on their rights. And, in fact, many of these youth in our great state are suffering themselves, often driven to suicide, bullying, and killed because of their gender identity and expression. Many of them are in your districts and your schools and your libraries, and they are your constituents. And we are here to help them and here to help you. The Commission is here to illuminate the gaps in service provisions for LGBTQ youth in a way that centers intersectionality and positions Massachusetts as the light health state in our country. We have witnessed time and time again how the8485 system fails to support marginalized groups8487 and how often marginalized groups, especially youth, are not considered in the development process of funding, programming, and crisis management. We see that it is always the marginalized groups. We've heard it from multiple agencies, the most vulnerable yet resilient among us who suffer disproportionately in our state and have significantly worse outcomes because no 1 counted them or considered their needs. And far8510 too often, we all know, responses from the state to address disparities and crises, often comes too late and fails to consider multiple intersecting identities and needs. The work of the Commission provides opportunities for the state to do something different. That is why we are here, the only agency of our kind in the entire country. I am very proud of that. We shine a light on the problems, that our youth are experiencing, and8536 we also create and uplift real solutions and8538 frameworks to address them every year8540 and then actively work on these solutions8542 in a multitude of areas every day. We can work, excuse me, we can work8548 we can work to better a system that was set up to create these problems and to be proactive in our efforts to create better future for for our youth. Thank you for your continued advocacy through your vote to approve our modest budget from 1.1 to 1.6, and I am happy to take any questions.
SPEAKER1 - -Thank you so much, Director Brooks, not only8568 for your testimony, for hanging in here, all day, but for the incredibly meaningful and important work you do8574 and for lifting up the voices of people in the Commonwealth that need you to, especially, during these times. So thank you. Thank you. I'm going to open it up to questions from members of the committee if there are any. Representative Moran.
SPEAKER19 - Thank you very much, Director Brooks. I just wanna I know it's getting late in the day. I just wanna thank you for all the work that you do. I just had 1 specific question, and it relates to suicide. And I know that according to the Trevor Trevor Project in 2023, '18 percent of LGBTQ plus youth have attempted suicide. And that rate is 2 times higher than the teenage general population. And I know from my work as an LGBTQ plus legislator, that this has unfortunately been a trend for the last 10 years and it's getting worse. What specific programs do you have, or I know you only have 6 people, but what specific programs can you point to that are, especially in light of the, war and d and d and I? Sorry, guys. This is what it is.
What specific programs do you have to protect our youth in the Commonwealth against suicide?
SPEAKER17 - Thank you for your question, and thank you for naming that it is a war. Right now, we have our Safe Schools program. We partner with many community agencies to be able to8658 deliver some of those program, some of that programming. We've been on several panels together where we're at Bagley, or we have many other programs like BLUE, which is the8670 Boston Lesbian Gay Urban Foundation, who does so much program, not only in schools, but also in the community. And so a lot of the programming that we do has has to be community involved because of the how we're set up as a state agency. The other thing that we do as a as a state agency, especially during our summit, is that we have mental health providers there, the entire time we are there, that help youth while we are teaching them how to testify, how to write testimony, all of the things, right? And we're teaching them about the, the legislative process, and how to advocate for themselves, we have mental health there to provide those services to them as well. So, again, we're partners partnering with schools and community organizations to get that done. Absolutely.
SPEAKER1 - Great question, representative. Thank you again, director Brooks. I am wearing my my 9 8 8, bracelet, which I think is important for people to know, that they are not alone, that there is somebody there always for, you know, if they need to reach out, they can do that. Just a real quick question, 30 seconds if you can. What do we do as legislators? Right? As a legislative body, we know, you know, you articulated today, and I'm sure you're seeing, a rise of of fear and trepidation and just unknown, you know, especially what we're hearing coming out of different levels of government. What can we do as a legislative body to respond to that? Is this something that we should be doing? You know, policy, programs, obviously, making sure that we're devoting resources to, you know, to to you and others8767 that are doing the work. But is there anything that we should be doing as a legislative body now to be able to to best protect8773 our residents in the common law?
SPEAKER17 - -Yeah. I mean, I would say thank you for your question I would say here, while we're asking questions to always consider that most marginalized person in the room. So all of the state agencies that have come up, there have been some that have mentioned LGBTQ people. And I would say,8789 as a body, making sure that they are, when you're asking those questions about how that's showing up in their work and what they're doing specifically on their behalf, yes,8797 we're here as a commission to provide recommendations. But it it helps us so much when they're hearing it from you, and you're really putting their their feet to the fire, about what8808 they're doing. Obviously, you've named all the other ways that, that you can assist as well. But I think8813 being loud and proud and visible to young8815 people and letting them know that you're on8817 their side is is definitely needed right now.
SPEAKER1 - Very, very interesting. Thank you, Director Brooks. I really appreciate your perspective. No No other questions from the members of the committee? Thank you. Appreciate it.
SPEAKER18 - Thank you.
SPEAKER1 - Okay. Next, panel, we have 2 left. We want to hear from, from both of them. We will bring up Massachusetts Asian American and Pacific Islanders Commission. I'd like to invite8852 up chairperson Sadfik Aluwalia.
Did I get that right? Close? Okay. Got it.
Chairperson, thank you for being here. Once again, Massachusetts Asian American and8866 Pacific Islanders Commission.
SPEAKER20 - Welcome. Good evening, Chair Senator Feeney and Representative Beal and esteemed members of the Committee Joint Committee on Ways and Means. My name is Saathbuk Ala Walea.8882 I was born and raised in Massachusetts and8884 it's such an honor and kind of,8886 a little scary to sitting in front of all of you today. I'm here as the Chair of the Asian American Recipping Islander Commission, which I'll talk about as the AAPI Commission going forward. I'm joined by our Executive Director, Yasmin Patna Shee Forbes. Thank you for this opportunity to offer testimony on behalf of the AAPI Commission in support of our fiscal 26 budget request of $586,188 which aligns with the Governor's proposed budget. The AAPI Commission is the Commonwealth's only permanent state agency solely dedicated to advocating, for the nearly 505,000 Asian Americans and Pacific Islander residents who live in Massachusetts. That's 8% of the State's population. We're comprised of 21 commissioners appointed by constitutional officers, dedicated staff and interns, and a dynamic youth council of high schoolers from across the state. The AAPI Commission8940 addresses the unique needs of our community8942 in Massachusetts by engaging in advocacy,8944 informing policy, and fostering8946 unity among our communities and organizations.8948 Findings from the Asian American Foundation's 208952 24 status index reveal that Asian Americans of any racial group feel the least included in society. This is consistent with a Massachusetts statewide survey conducted by the Department of Public Health that found that over 40% of AAPIs in the state who responded, faced some 1 or more experience of discrimination. In this context, the AAPI Commission's role as a statewide voice and advocate is more essential now than ever. We respond to these disparities in a number of ways through targeted programming and prioritize access to rights and resources to elevate, anti AAPI hate prevention, language access, mental health awareness, and youth empowerment. From July first of 20 24 onwards, we've held 10 culturally responsive events, including 2 mental health forums in Worcester and online in partnership with the US Department of Health and Human Services. We've held listening sessions with the with the Bhutanese community and in Western Massachusetts, connecting to legislators and city officials. We've enhanced outreach to9012 the Pacific Islander community. We have reenvisioned9014 our youth council on its programming by implementing youth led civic, community projects. Currently, we're leading the first ever statewide AAPI survey in collaboration with UMass Boston, the Asian Community Fund at the Boston Foundation, and, the Asian9028 Pacific Islander Civic Action Network. This initiative gathers disaggregated data to better understand our community's needs and inform the evidence based policy decisions across the Commonwealth. We've given financial support to9040 23 community organizations to hold community events and gatherings, helping build a dynamic and expanding network of AAPI leaders, across the State. And finally, we've supported organizations dedicated to serving refugees in Massachusetts, reaffirming the Commission's, commitment to fostering impactful work within refugee communities across the State. We've received 42 applicants and 9 organizations were funded. As part of our strategic plan, the AAPI Commission is committed to advancing systemic change, policy driven advocacy across the state.
Over the next fiscal year, our funding will support the following initiatives. 1, we will advise executive and legislative bodies about the potential effects of proposed legislation and partner with advocacy organizations to cohost 1 to 2 public hearings annually on priority bills, using them to elevate AAPI voices and increase policy transparency. 2, we'll be expanding our AAPI youth council from 10 members to 14, including other regions in the state we're9097 not currently in, and to continue and engage in youth led community projects to promote civic engagement and community impact. Third, we'll deepen regional connections to underrepresented areas and support language access for populations in with limited English proficiency. And finally, we will continue building strategic relationships and hold joint events with our other affinity commissions to amplify cross cultural solidarity and statewide equity efforts. The recent revocation of9122 the White House initiative on Asian Americans, Native Hawaiians, and Pacific Islanders underscores the urgent need, for state level action. As federal support diminishes, Massachusetts must step up and the AAPI Commission is ready to lead, but we can't do it without sustained investment from all of you. The AAPI Commission is uniquely positioned to serve 1 of Massachusetts' fastest growing and most diverse populated populations. The 586,000 a 88 in FY '26 funding will allow us to ensure equitable access and opportunity to all AAPI residents. Before I finish, I also want to talk about myself as a constituent. I was in middle school during nineeleven. And while many of us remember the day after nineeleven as a moment of unity, that wasn't my experience. I was the outsider, I was the bad guy. And for well over a decade, I lived with that self hate and I wished that there were people who looked like me, people who looked like you, who said, you are worthwhile, you are loved. In 2020, when we saw the rise in AGPI Hate, I had a chance to stand up for my community and say to those kids that you are okay. When I moved back here, now I have a 4 year old, I'm gonna have a a baby in May as well. We need to be there for those kids who are experiencing fear right now as immigrant populations, people of color being terrorized by the current administration. We had 1 of our community members picked up in Somerville earlier this month or last month. We have an opportunity to stand up and say that you are loved, you belong here, and that's really why we're here today to talking to you.
Thank you. I appreciate it. We ask this Committee to approve our budget in full and recognize the AAPI Commission as a key partner in advancing racial equity, representation, and access across the Commonwealth. On behalf of our commissioners, staff, and the communities we serve, we extend our heartfelt thanks to the Asian Caucus and leaders across the legislative and executive branches for your continued partnership, leadership, and unwavering support. We're happy to answer any questions you might have. Thank you so much.
SPEAKER1 - Alright. Chair9234 Preston, thank you as well for all your important, very meaningful, critical work, especially these days, and for sharing your own9242 story, your own frame of reference, and for turning that pain that you9246 felt then into purpose and giving power, to others now, that's what this thing is all about. So we're, very, very grateful to you, and, appreciate you being here today. I'll turn it over to representative Beal for any questions from the house.
SPEAKER5 - Chair, just thank you for your testimony, your advocacy, and also sharing your personal story. It's 1 of the most impactful things we hear9267 as legislators and policymakers. So thank you for all that you've done, continue to do.9271 Congratulations to you and your family, in the upcoming edition. We do have9275 a question from Rep Howard.
SPEAKER13 - Thank you Mr. Chairman it's actually more of a comment than a question I just want to say thank you for your patience waiting here all day, to to to be here to testify and so and thank you for being here to testify on behalf of the API Commission as a as a former proud Commissioner of the API. So yes, thank you for amplifying the API community and currently, Mr. Chairman, we have 3 former API commissioners myself, Rob Donald Wong and Rep Taki Chen. And so 3 of us are now serving on the, Massachusetts House Asian Caucus. So thank you so much for your testimony today.
SPEAKER20 - Of course. Thank you for your support. Thank you
SPEAKER13 - so much.
SPEAKER1 - 3 for 3. Wow. It seems like there's some pressure on you now, maybe somewhat down the road.
SPEAKER20 - I'll have to ask my kids.
SPEAKER1 - Yeah. Right. Take care of the young ones first before you do that. Seeing no other questions from members of the Committee, again, thank you so much for spending all day here and for your testimony.
SPEAKER20 - It really helps. Thank you. Thank you so much.
SPEAKER13 - So much.
SPEAKER1 - Thank you. All right. Next is our last and certainly, certainly, certainly not least, panel up here is Betsy Lehman Center for Patient Safety. I hope everybody on this Committee is familiar with the Betsy Lehman Center. If not, you're about to learn how important and critical their work is. We want to invite up Executive Director Barbara Fain, who will testify. Director Fain, thank you for being here.
SPEAKER4 - Thank you very much for having me. Thank you for for sticking it out till the end, and thank you for my CHIA colleagues over there for for also staying around. And, so just, just very quickly, good, wanna just, good afternoon, good evening, Chair Feeney, Chair Beal, members of the committee. My name is Barbara Fain. I am the executive director of the Betsy Lehman Center for Patient Safety. We are, just very briefly, for those who aren't familiar with us, we were, established, under chapter 29404 24 along with CHIA. We are affiliated with CHIA. They provide our, operations support, and we are funded through, the same assessment, industry assessment that funds, CHIA. I also will, submit written testimony that will provide more, detail about, about our work. But9425 I'm just, really grateful for the chance to testify about how our center is carrying out a unique mandate conceived, by this legislature to reduce preventable patient harm in the Commonwealth. I'm also acutely aware of the time, so I'm going to try to be brief and really 0 in on our top priority, funding priority for the year. So first I want to focus, a bit on how unsafe care not only causes great human suffering, but is a significant driver of the cost and capacity issues that others have spoken to today. I'll then turn to a key step we can take right now, not only to reduce patient harm, but to alleviate these broader challenges facing the healthcare system. I'll also explain that key investment that we're seeking through the budget, to carry out this work. Anything with just a snapshot of the current state of patient safety in Massachusetts. So our research, and research of9485 others, shows that 1 in 4 Massachusetts patients are going to experience at least9491 1 harm event during a hospital admission. That's almost 180,000 harm events each year in hospitals alone. And because almost, dollars 10,000 in excess costs are gonna be incurred for each of these events on average, That amounts to almost $1,800,000,000 in claims to payers that, could be avoided each year. And around a quarter of those excess claims are paid by MassHealth. So this is a real, impact on, on the state. These figures don't include other costs like out of pocket expenses and lost wages to patients and families, and they pertain only to hospitals. Harm events also happen in long term care facilities, outpatient care, even home care, but we don't have as much data on those. It would be perfectly reasonable for you to wonder if there's a mistake in our math. How could it be that, so many patients are being harmed in a place like Massachusetts, which we all know is home to some of the best health care institutions in the world? I can explain. Only a fraction of these events are the dramatic cases that tend to come to mind when people think about medical error, like surgery on the wrong patient or surgery on the wrong body part or the massive overdose of chemotherapy that killed, Betsy Lehman, the Boston Globe health columnist, which that was 30 years ago, just this past December. What's behind most of those, these big numbers are mistakes during routine care. So like a failure to communicate a critical test result, or a delay in administering a medication. So while these events, individually may seem unremarkable, they often cause significant setbacks in patient care and can lead to to serious injury or death. Their effects hit patients and families first, obviously, but then they spread across the entire healthcare system, raising costs and straining capacity. So these big numbers of harm events, cause big impacts at the system level. Our research shows that on average, a hospital harm event will increase a patient, a patient's length of stay by almost a week. So at a time when Massachusetts hospitals are operating at capacity, this causes patients to be stacked up in emergency departments as they wait for patient beds to open up, where they are more prone, to, to a preventable, error. And some of these beds, may be occupied by patients who instead of being able to go straight home as planned, now need post acute care. So that further, strains, that end of the system. So I've just given you a lot of bad news. The good news is that, there is, a way forward. So for decades, we've, we've known, that the leading barrier to safety improvement has been the lack of timely, reliable information about patient harm events. As explained in our recent annual report to the legislature, hospitals' current internal reporting systems detect less than 15% of the harm happening to their own patients. So improving patient care safety improving patient safety starts with improving the information landscape. You cannot fix it if you don't even see it. So seeing it recently has become possible through, what's called automated adverse event monitoring. These systems continuously scan every patient's electronic health record and can reliably detect, well over 100 types of common harm events in near real time. The way it works is of, of the, the, the, these, the data gets fed to remote teams of clinicians who are able to validate the events before, feeding information back to hospitals every day. And they also work with the hospitals to identify root causes and offer advice on interventions to prevent future harm. This approach has been a game changer for several hundred early adopter hospitals outside of Massachusetts,9734 which are uncovering, 10 times more harm events than they were aware of before. And this information, shines a light on9742 what they are doing well and what they need to fix. And it also allows them to move quickly.9746 The result has been unprecedented reductions in harm events, at least 25% overall and in some cases much more. In addition to preventing human suffering, improving throughput, reducing excess claims to payers, these early adopters are also improving, their own bottom lines. They're avoiding unreimbursed care under their payer contracts and their liability claims and payouts have declined. And these hospitals, start seeing these gains within9775 months, which is a strong indicator that some improvement is, really quite possible without major operational changes. So the Betsy Lehman Center's highest budget priority for FY 26 is funding for a pilot of automated adverse event monitoring in 06/2008 Massachusetts hospitals. So in preparation for, what will be an 18 month pilot, we've already procured, the leading provider of these systems, and are well into the hospital recruitment and selection process. Moving forward, however, is gonna depend on additional investment, because our maintenance budget, which is currently just over $3,000,000 doesn't support projects on the scale. Our budget request for FY '26, is just over $6,000,000 While this looks like a doubling of our current budget, the lion's share of this increase is 2,300,000 in non permanent funding, for the first year of the hospital pilot. Every dollar, will be a pass through. It, it, it will cover the cost of the vendors, contracted services. And as illustrated in, that handout, we fully expect the state to more than recover this investment through harm reduction to mass health members alone. The rationale for, for a state pilot and and for covering, participating hospitals costs during the pilot period is that, they will agree to share relevant data with us and the independent research team we're partnering with to conduct the evaluation. They will also consent to our publication of the findings. This is really important. So none of those out of state early adopter hospitals I mentioned earlier are willing to acknowledge publicly that they're using these tools, let alone disclose their data. Though we have a high level of confidence that this investment will prove to be a rare win win for patients, providers, and payers, including the state, a rigorous pilot conducted with transparency will help inform future state policy. We really see this pilot as the linchpin of our efforts and those of hundreds of stakeholders and experts who have, participated on the advisory committees and consortia we've, convened, to strategize on how we can finally break through and move the needle. Nothing else has worked so far, over the past few decades to stem, the human and financial, costs of patient harm. So especially now, with with all of the pressures facing the system, it's really time to try something different. So I just want to thank you again for your, interest, for your support9932 of our work, and I would be happy to answer any questions.
SPEAKER1 - Great. Thank you so much, Director Finn. I really appreciate, you being here and for the work that you do. Certainly critical in in in your saving lives. And, it's just I I can't overstate how important it is. I when when we met recently, first of all, I was surprised to even learn that you were a state agency. I think a lot of us, you know, think of you as a foundation. Right? And we joked a little bit about it. I think it's I9961 joked.
SPEAKER4 - I said including my husband.
SPEAKER1 - Including your9963 husband. Right. But to know that you are funded, through our, GA every year is important and to understand the work that you do. I'd like to open up to, to any questions from members of the committee. I'll turn it over to Representative Beal.
SPEAKER5 - Yes. Thank you for your testimony. We do have a question from Representative Holmes.
SPEAKER8 - Rep. Bill has been asking this question all day, so I'm a ask it. Does the governor's budget have the money you're needing to do this pilot?
SPEAKER4 - No, it it does not.
SPEAKER8 - Alright. So how much do you need to do the pilot? So we need, dollars 2,300,000.0. Oh, it's real money. So it's not done short. Alright. So $2,300,000 in addition to what the Governor has asked for.
SPEAKER4 - Correct.
SPEAKER8 - And that is to address 1 in 4 hospital visits in this commonwealth. There is an error.
SPEAKER4 - Correct.
SPEAKER8 - At least 1 error.
SPEAKER4 - At least 1.
SPEAKER8 - Okay. Yeah. Thank you.
SPEAKER1 - Okay. Any other questions from members? Yes. Representative.
SPEAKER18 - A quick follow-up on that. I see here on your presentation, you list 6 to 8 pilot hospitals. Have you identified? Do you have an idea of where those pilot hospitals will be located?
SPEAKER4 - So we're in, the middle of the recruitment and, interviewing process. The, the goal is 6 to 8 diverse hospitals. So everything ranging from, academic medical centers down to, safety net hospitals and everything in between. So we're looking for geographic diversity. We're looking for diversity in the patient population served.
SPEAKER1 - Any other questions from members of the committee? I just have 1, Director Fain. You'd mentioned, and I agree with you. I mean, it just makes sense that ultimately this is the more efficient way to10084 do things. We save money and we're avoiding these adverse, these adverse actions in hospitals and through healthcare, we're going to save money. Is there10092 any way to calculate that? Is it something that that, you know, you could get to us? Yeah. I think it's a worthy investment personally, but, you know, that's something we're going to have to weigh. But if there's a way that we can kind of look, you know,10104 long term down the road at what those efficiencies are, then, you I think it would help us in that argument.
SPEAKER4 - So, I've included some of that information, some projections in this handout.
And the purpose of a pilot, with a really, just a rigorous evaluation, independent evaluation is to get actual, projections, long10128 term projections. But10130 I think, you know, just based on the, the conversations we've been able to have with some of these early adopter hospitals elsewhere, which are, I can't name names, they've been willing to share information with me confidentially,
they are very consistently some of them are, are really driving down. They're they're achieving a 7 to 1 return on their investment. They're, they're driving down firm. I mentioned it's 20 over just over 25% on average. And it's interesting. That's consistent from system to system that we, we've spoken to. Some of the, some hospitals are, are doing much better than that. The 66, they're reducing harm by 60%. So you just keep sort of multiplying out. I mean, we do have the information based on just the number of admissions we have and, and the cost of each of these events. You just it's it's otherwise, it's just pretty simple, math. But it's you know, it won't solve all of the problems you've heard about today, but it will make a significant dent. I mean, this is, we project, you know, if we were to scale this statewide, just to mass savings to MassHealth alone, if this were operating, and sort of at steady state in every Massachusetts hospital, we were looking at a sort of a minimum $93,000,000 savings each year. So that's, again, it doesn't solve, you know, they're talking about much bigger numbers, but that's that's not nothing. That's, that's that's. And I can
SPEAKER1 - sleep at night if we're saving that much, you know, that much money. Yeah. And with a10225 relatively modest investment, we can get that data to actually show that. So. I appreciate it. Any other questions for Director Fane, from members of the Committee? Seeing10234 none, thank you so much for being here10236 for your testimony and for the work that you do. I do want to, before we lose everybody, and gavel out of this committee hearing, we have some thank yous. First of all, thank you to Attleboro Mayor Kathleen DeSimone, who spoke to us earlier, who's doing a great job leading the City of Attleboro. To Attleboro High School, to the team here at the high school, incredible work. Thank you so much for your hospitality, and for the work that you do every day. Superintendent Sawyer, Principal Kate Campbell, to the folks that worked with us in facilities and technology that have this hearing here today, Jonathan Plourde, our technology administrator Doug Heel, Edward Student Services, Jason Parenteau, the facilities director, Angela Lassen, the events manager, to Attleboro Police and Attleboro Police Chief Kyle Hegney, who sent some of his officers today to make sure that everybody was safe and comfortable here. Thank you as well. To Jeremy, the CTE Director, for10290 the work that he does for students here, a big big big big thank you. This would not have happened without Attleboro Area Cable System. We know them lovingly as double ACS. They are the ones that you see here running, the tech and the cameras. They're all good friends. Jim Jones, the Operations Manager, who is the, wizard behind the curtain over there, switching everything. To James10313 Friedman, who is over here on camera as well, and Austin Ricketts on camera, as well for spending all day with us. Benjamin Feiner, Network Support Specialist. To the team back at the State House at LIS, to our clerks and our court officers that made the trip down here today, Anthony, our House Court Officer, Mike, our Senate Court Officer, thank you for what you do to cochair Representative David Beal and his staff, Shane Perkins. To my incredible staff that always makes me look good even though I probably don't deserve it, my chief of staff, Keith Drucker, who put all the work in to make this happen today, Shane Corrially, our Legislative Director, Myra Bynovitz, our Communications Director, and Bill Titus, our District Director. And, also to Ali's Cookies, for keeping us, keeping us awake all day. Thank you to Ally's Cookies up in Foxborough, a small woman owned business who does incredible work. To the students who came here today from the civics classes and those that shared their school with us, thank you so much. To To the members of the committee from driving all across the Commonwealth to be here with us in Attleboro today, really, really appreciative of this process. Once again, for anybody in the public that wants to testify, tomorrow is the last joint committee on ways and means, hearing where the public is invited to testify at 11AM in the State House. So I encourage you all to do so. To the members of the public that were here today with their signs, respectfully, advocating for their voice and their frame of reference. Thank you for being here10403 as well. I want to turn it over to Representative Beal for a quick thank you, and then we will adjourn.
SPEAKER5 - Well, I think you covered most10409 of it, Senator. But a quick, thank you to you as well for, running a very efficient hearing.10413 We appreciate it. Thank you for opening, your district, to the members of the committee. It's been, it's been a memorable experience. It's my first time, chairing a hearing. So, thank you for showing me the way. You and your team have been great. And, to all of, my colleagues in the House and Senate who made the trip down, to Attleboro, thank you so much for being part of the process.
SPEAKER1 - Thank you, representative. You do good10436 work, my friend. And now a motion to adjourn is in order. Moved and seconded. All in favor say aye. Opposed, no. The ayes have it. We are adjourned. Thank you.
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