A bill in the House Early Learning and Human Services Committee that would move children’s behavioral health to a stronger care coordination model had a hearing today.  HB 2264 attempts to add accountability to the system by aligning incentives with the quality of care provided to kids and families in the child welfare system.

In spirit, Rep. Ruth Kagi’s bill aligns closely with what is happening in health reform broadly:  moving behavioral health towards an integrative model of care that can coordinate more closely with primary medical care providers.  However, there are some significant gulfs between the bill and what is occurring in the rest of the health care system, namely that while the liability for care is proposed to be privatized, the decisions for utilization management will stay with the state.

This bill would be a transformational bill for children’s behavioral health, and the ambition of the legislation brought out a diversity of opinion today.

Greg Deveraux of the Washington Federation of State Employees testified strongly against it saying that his members do enough care coordination as it is, and that there doesn’t need to be any more.  Rather, he stated this appeared to be nothing more than “fulfilling a promise, though I don’t know to who” to privatize state jobs.  A recent posting at the union’s legislative “Action Center” made the point as well.

The bill “concerning performance-based contracting related to child welfare services” purports to be about “reform” to create a “flexible, accountable community-based system of care that utilizes performance-based contracting.”

This is really code for costly contracting out that follows models that have failed in other states.

Erik Fenner, from Casey Family Programs and who had previously run a child welfare agency in Ohio, provided testimony at Rep. Kagi’s request.  He spoke glowingly about performance based contracting saying that “Our workers saw this as a support, not a replacement.”  He continued saying it “provided a team approach to the practice of child welfare.”

Rep. Kagi responded “I do appreciate the emphasis on team.  That is the key.”

Brian Carroll, President and CEO of Secret Harbor in Anacortes, testifyied on behalf of the Washington State Coalition of Children in Care, the association of child welfare providers in the state.  He said that the association was “not expressing support or opposition at this time.  The membership has a number of specific concerns.”  He continued “The Coalition does fully support the notion of performance-based contracting, but has 4 specific concerns.”  To paraphrase Carroll’s points, the concerns from providers were:

—  The timeline of implementation by Dec 1, 2012 is far too ambitious.

—  There are not the funds for a transition to a new system, or additional overhead costs in the bill.

—  Consideration should be given for the demonstration sites envisioned in the previously adopted HB 2016.

—  Case management must be tied to the liability of risk.  Currently, the bill keeps case management with the state, while putting financial risk with the providers.

Noteworthy was that the handful of parents speaking today, some from the Washington State Parent Advocacy Committee, all spoke strongly in support of the bill.

Darlene Zacherle, an elected official of Colville Federated Tribes, said “We have a particular interest in eliminating the disparity of enrollment of native children in the child welfare system.”

Laurie Lippold of the Children’s Home Society, spoke in support of the bill.  “We don’t believe its about privatization… This bill is about providers and the state coming together to improve outcomes for Washington State’s children and families.   I really hope this bill continues to move forward.”