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Meyers: Audits Ongoing for All Drug Treatment Centers in N.H. to Ensure Proper Services

Jessica Hunt / NHPR

Jeffrey Meyers, Commissioner of the N.H. Department of Health and Human Services, says his agency is beefing up oversight of substance use disorder treatment centers that have been struggling to stay afloat or that have closed altogether after financial struggles – a situation the state can ill afford in the midst of the opioid crisis.  

Speaking on The Exchange, Meyers said the state is auditing these organizations regularly.

“These are not gotcha audits. We want to take a look at how they're operating to ensure that they have the resources the staff their credentialing that they're operating in the best possible way and that they will utilize public funds appropriately. And our expectation is when so utilized that they're going to help improve outcomes. I mean they're going to deliver services that will help address the crisis out there.”

Interview Highlights

In addition to audits, what else is the state doing to supervise these organizations?

We are working with the Charitable Trusts Division at the Attorney General's Office and other state resources so that we can keep track of these organizations. We're asking for financials. You may recall that a few months ago I announced that we were going to be doing financial audits of all of our treatment providers to ensure that we are tracking how they're doing. 

We are doing audits of all the 20 or so treatment organizations. Those audits are being released. Hope for New Hampshire Recovery audit was released. There's a second audit that's about to be released very shortly of another organization, and we're going to continue releasing those audits as they're completed.  

Has that additional oversight required hiring more staff?

I appointed a new director of the Office of Program Integrity, and we have added some staff, and I'm obviously looking at that in terms of our next budget.

How about prevention efforts?

Prevention is really where it is, and we've got to reach the younger generation. And I've been working with the Governor for quite some time now to help direct some of the funding that comes with the Governor's commission… and the expectation that we're going to get more federal funding soon. We are funding prevention programs. We funded a prevention program just a few months ago at Timberland High School that is putting professionals in the school, really reaching out to kids, really trying to educate the kids. We need to be doing more of that.

Are federal funds on the way?

So we believe that we're hopefully on the cusp of getting an injection of federal funds that will make a difference, not only for treatment but also for prevention and recovery services.  

We recently had a suicide attempt in our family by an adult suffering from major depression. The family member will receive 3 to 5 days hospitalization at an inpatient psychiatric unit at a nearby hospital, then will be discharged to their home where they live alone; and nearby family, who work full-time, fear another attempt will be made. Because this individual is not schizophrenic or bipolar, they would not qualify for a group home. Why don’t we have supportive housing and/or home visit services for individuals suffering from major depression in NH? What can we do to change this? -- An Exchange listener who wished to remain anonymous.

The number of people stuck in emergency rooms awaiting inpatient mental health care is still high; should hospitals play more of a role in providing that care?

Yes. I do feel that way. I want to say that any day that any one person is waiting is too much. And the fact that we have 30 and 40 people, adults predominantly, waiting is not something that's acceptable.  It’s something I've been working on from the beginning of my tenure. There are hospitals that have closed wings. There are other hospitals however that have added designated-receiving facility beds -- they've set aside beds and have taken on the responsibility of running a number of beds for the involuntary admission of people who are waiting at hospitals, and so they've expanded some capacity.

The reason that so many people are waiting is a combination of a number of factors and to the extent that there was some closure of some voluntary beds, that may be a contributing factor. But there were other community resources that were there as well earlier. There were transitional beds that went away because the funding wasn't there. And that's something that the Governor and the legislature and the department have worked together on over the last year or so.

"The expectation," Meyers says, is "that we're going to get more federal funding soon."

We added 20 new transitional beds in fiscal year 2017; there's an RFP that's already gone out for 20 new beds for this year. We re-purposed some money that we had in one of the bills passed last year to bring on some more transitional beds.

The need for foster parents has grown due to the opioid crisis. Exchange listener Michael, a foster parent, said the system for foster parents is overly bureaucratic and discouraging. 

Well we don't want it to be discouraging.  We want to be able to empower families to come forward and be foster families. It's obviously an important part of our child welfare system in New Hampshire. It's one of the reasons why the Governor and the Senate came forward with a Senate Bill that has $1.1 million dollars for additional foster care rates and other foster care support services.

We don't want to perpetuate bureaucracy; on the other hand we need to make sure that you know we have safety in our system. And so there are certain things that we know that we have to do to ensure that the kids we place are placed in appropriate homes and that we know that they're going to be safe there.

How confident are you in the Medicaid expansion plan? There have been some major questions about the financial underpinnings of this.

This program is playing just an incredible role in addressing people's health conditions that were not being addressed before there are over. I think now about 13,000 unique individuals who have gotten substance use disorder benefits. There are tens of thousands of individuals who are getting mental health benefits. About 98 percent or 99 percent of the people enrolled have a primary care doctor -- some of them for the first time in their lives. So their chronic conditions, their medications are being addressed. This is making such a huge impact to the health outcomes and to the population health of this state that it's imperative that the bill work its way through the House Finance Committee and back onto the House floor and hopefully to final passage.

So I think we have really we've come up with a sustainable program that will pass CMS muster. I've had a number of discussions; the Governor and I have been to Washington a couple of times together meeting with CMS about this. We are not relying on hospital donations in a way that raised issues before.  What we're doing is accessing money that's derived from gross liquor profits in the state, that gets put into the alcohol prevention and treatment fund; that's going to be raised for the first time to 5 percent. That's quite an achievement for everybody.

And it's going to be fully funded. And so that 5 percent will pay the non-federal share so the cost of services is a particular amount of money. The Feds starting in 2020 will pay 90 percent of that. So this alcohol fund will pay for that 10 percent. And we have found a way through the hospitals to ensure the continuation of our substance use disorder programs through the Governor's commission.

What kind of progress has the child protection services department made after an independent review found serious problems and made many recommendations for reform.

I think we've made real progress and surely there's more to be done.  With respect to staffing, we've added about 40 assessment workers for child protection. There are 13 additional assessment workers funded in one of the Senate bills that is now sitting in the House. And we're certainly going to look at additional resources as well.

But we've increased the number of assessment positions to 125 now statewide, which was I think a bit more than what was targeted by the independent review; 115 of those are filled. And so I think that's a positive development. We've added family service workers. We have 92 now of those family-service workers who basically help manage a case once it is open. The assessment workers get referrals and take the complaints, the allegations that are made, to investigate the allegations. So if a case is opened, then the family service workers take over. There are 92 authorized positions right now; 87 of those are filled. The number of assessments coming in is coming down a little bit. The overdue assessments rate is coming down.

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