Representative Gail Mooney
The Human Services and Health Services Committees have had opportunities to meet a
couple times now since last November. Each committee deals with slightly different facets of issues that overlap, so as a concerted effort, the committee chairs have elected to run these meetings back-to-back as a means to maintain some continuity in discussions and testimonies.
Because of the exorbitant amount of information we receive, breaking the reports out by topic, rather than committee, seems to make the most sense. Here are some highlights….
Behavioral Health. The study of the Behavioral Health systems within our state is expansive, with far-reaching implications. Begun in 2013 with a broad overview, this 2015 study has focused primarily on Substance Abuse Disorder (SAD). To say this study is intense would be an understatement! Substance Abuse impacts our schools, hospitals, emergency rooms, jails, and prisons. It disrupts and negatively affects families and communities through loss of income, fractured home life, the ability to learn, domestic violence – and is an economic drain to the state as a whole.
Department of Corrections Director, LeAnn Bertsch (Hillsboro native), has provided the committee with some truly alarming statistics: 75% of people incarcerated in North Dakota have some level of SAD with the vast majority of these individuals receiving treatment while incarcerated; since 2010, DOCR has tripled the number of people receiving treatment for substance abuse; while the number of incarcerated or paroled individuals has risen by 200% since 1992, the state’s population has only increased by 16%; the DOCR’s budget has increased by 163% since 2003. These numbers only reflect the state Dept. of Corrections – and do not represent the impacts to our county jail systems.
The data indicates a direct correlation to mental health and substance abuse as it relates to our penal system. And, given that beginning with the federal Olmstead Act of 1999, which moved to de-institutionalize our mental health system, it becomes equally clear the penitentiary system has become our new institution for behavioral health – statistically the most costly and least effective to the state, communities and families.
Caregiver Supports & Services. In the 2015 session, AARP brought forward a national initiative that would require hospitals to incorporate optional caregiver designation and training within their discharge processes. As someone who has twice been a caregiver, the idea of bringing greater supports to patients and their caregiver(s) is something I could truly, and wholeheartedly, support.
But, as with most things, the devil is always in the details. And, in the case of HB 1279, the details proved logistically and legally troublesome for our North Dakota hospitals, and less effective than intended to patients and caregivers. After lengthy discussions, the bill was changed to a study – which is the focus of this study.
As a means to cut to the chase and arrive at comprehensive initiatives, the chairman has appointed a sub-committee to work on strategizing effectived processes, procedures, and supporting systems that might be considered for meaningful improvements to the continuum of healthcare as patients transition from a hospital setting to their home environment. As a member of this sub-committee, I can report that our efforts for positive outcomes continue.
In committee we have heard from AARP, the hospitals, caregivers and patients on the subject. All can agree that there are inconsistencies and potential gaps as people transition to at-home care. Arriving at solutions is complicated by existing federal and state regulations, reimbursement factors, and disconnects between federal requirements affecting Medicaid patients versus private-pay (insurance and out-of pocket) patients. In a perfect world, there would be no differences – but there are.
We will continue to wade through this, and will press on for solutions that help to bridge gaps to provide the continuum of services, supports and care management for patients and their caregivers. I have faith we’ll arrive at positive conclusions since everyone feels a true sense of investment in this.
In January we focused almost exclusively on the affects of Substance Abuse Disorder as it relates to our youth. I’ll report on that next week.
Till then…. lets hope for some warmth and sunshine in the coming days!
Representative Gail Mooney
Access full hearing testimony: http://www.legis.nd.gov/assembly/64-2015/committees/interim