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Commissioner's Budget Message

TO: Community Services Board, Behavioral Health Authority, and Local Government
        Department Executive Directors
        State Hospital and Training Center Directors
        State Mental Health, Mental Retardation and Substance Abuse Services Board
        Mental Health, Mental Retardation, and Substance Abuse Services Advocates
FROM: James S. Reinhard, M.D.
SUBJECT: Governor Warnerís 2006 - 2008 Biennium Budget
DATE: December 16, 2005

Today, Governor Warner presented his 2006 - 2008 biennium budget and provided more details about his System Transformation Initiative, which he announced at a press conference on December 6, 2005. I am writing now to share this initial information with you. As additional information becomes available, I will share it with you.

Governor Warnerís System Transformation Initiative will be an unprecedented infusion of critically needed financial resources into the public mental health, mental retardation, and substance abuse services system. This initiative signals a multi-year commitment to transforming our services system, achieving the vision articulated in State Board Policy 1036 of a consumer-driven system of services and supports that promotes self-determination, empowerment, recovery, resilience, health, and the highest possible level of consumer participation in all aspects of community life, including work, school, family, and other meaningful relationships. This vision also includes the principles of inclusion, participation, and partnership.

This initiative reflects proposals in the Departmentís Comprehensive State Plan for 2006 - 2012, the Departmentís Integrated Strategic Plan, and the Olmstead Implementation Plan. The initiative contains funds for a significant expansion of community services capacity while replacing the outdated and inefficient physical plants of four state facilities, Eastern State Hospital, Central Virginia Training Center, Western State Hospital, and Southeastern Virginia Training Center.

The tables on the next pages list the major components of the Governorís System Transformation Initiative and several other proposed investments. Appropriation Act item numbers are shown in parentheses, for example (312 BB), for reference purposes and additional details.

System Transformation Community Initiatives FY 2007 FY 2008 Biennium
Medicaid MR Waiver Rate Increases: 10% for congregate living services, 5% for other services1 (312 BB) $34,710,014 $34,710,014 $69,420,028

Community Medicaid MR Waiver Slots: 80 slots in

FY 2007 and an additional 69 slots in FY 20081 (312 AA)

$4,972,250 $9,260,816 $14,233,066
Community Medicaid MR Waiver Slot Start Up: $4,000 per slot for one-time start up costs (312 CC) $320,000 $276,000 $596,000
MR Guardianship Services for individuals residing in or at risk of placement in state training centers (312 Y) $720,000 $1,341,000 $2,061,000
Part C Early Intervention Services for Children: Funds to serve additional infants and toddlers (312 K.1) $4,078,366 $4,078,366 $8,156,732
Community MH Discharge Assistance: Fund plans for civil and NGRI state hospital consumers (312 T) $2,880,000 $2,880,000 $5,760,000
MH Services for Children and Adolescents: $1 M for two system of care projects, $1 M for expanded services in juvenile detention centers (312 R and X) $2,000,000 $2,000,000 $4,000,000
MH Community-Based Recovery: Increase availability of targeted community-based services statewide2 (312 W) $3,750,000 $3,750,000 $7,500,000
SA Crisis Stabilization Services: Expand existing sites and establish additional crisis stabilization units (312 S) $4,678,568 $4,678,568 $9,357,136
Eastern State Hospital: Community-based services for individuals otherwise served by the hospital3 (312 V) $4,796,640 $6,928,480 $11,725,120
Western State Hospital: Community-based services for individuals served in HPR I and II3 (312 U) $6,575,000 $6,575,000 $13,150,000
Southeastern Virginia Training Center: MR waiver slots for 28 discharges in FY 2007, an additional 24 in FY 20081 with $4,000/slot for start up costs (312 Z and CC) $2,678,928 $4,863,152 $7,542,080
Central Virginia Training Center: MR waiver slots for 52 discharges in FY 2007, an additional 45 in FY 20081 with $4,000/slot for start up costs (312 Z and CC) $4,975,152 $9,072,572 $14,047,724
Central Office Licensing Positions (3) $248,128 $248,128 $496,256
Central Office Architecture & Engineering Positions (3) $285,541 $285,541 $571,082
Total Community General Funds $54,126,191 $62,098,136 $116,224,327
Total Community Non-general (federal Medicaid) Funds $23,542,396 $28,849,501 $52,391,897
Total Community Funds $77,668,587 $90,947,637


1 Includes 50% federal financial participation and 50% state matching funds.
2 Services include discharge assistance planning, inpatient MH treatment, in-home residential support, jail-based hospital diversion projects, psychiatric evaluation and crisis counseling, and expanded case management services.
3 Services: discharge assistance planning, inpatient MH treatment, in-home residential support, crisis stabilization and other related MH services to delay or deter state hospital admission.

Other Investments
Community Resource Pharmacy $2,031,325 $3,782,139 $5,813,464
State Facility Pharmacy $4,240,088 $4,950,771 $9,190,859
Medicare Part D Implementation $759,000 $759,000 $1,518,000
State Facility Direct Care Aide Career Ladder $148,658 $811,861 $960,519
Total Other Investments $7,179,071 $10,303,771 $17,482,842

In addition to the funds included in the 2006 - 2008 biennium budget, the Governor is proposing adding $1.69 million for the Community Resource Pharmacy, $3.57 million for State Facility Pharmacy, and $410,000 for Medicare Part D implementation in the FY 2006 caboose budget. This is very welcome news and reflects the efforts of Department and CSB staff to manage the use of pharmacy resources more effectively.

The Governorís 2006 - 2008 biennium budget also estimates the following amounts for the projected replacement costs for the four state facilities. The Governor will introduce a separate bill that will propose Virginia Public Building Authority (VPBA) bond financing for the replacement of Eastern State Hospital, Southeastern Virginia Training Center, and Central Virginia Training Center. The Governor is proposing language in the FY 2006 caboose budget bill to allow Public-Private Partnership Educational Facilities and Infrastructure Act of 2002 (PPEA) proposals or VBPA bond financing for the replacement of Western State Hospital.

Projected State Facility Replacement Cost
State Facility Replacement Cost
Eastern State Hospital $59,715,369
Western State Hospital $80,471,415
Southeastern VA Training Center $55,375,312
Central VA Training Center $94,371,777

Total Estimated Replacement Costs


I urge you to support Governor Warnerís historic System Transformation Initiative at the regional budget hearings conducted by the House Appropriations and Senate Finance Committees at noon on January 5, at the budget hearing on January 18 at 1:00 p.m. in House Room D of the General Assembly Building in Richmond, and throughout the legislative process, so that it will remain intact in the final budget that Governor Tim Kaine will consider next April.

In anticipation of its passage by the General Assembly, the Department will convene the System Transformation Implementation Advisory Committee. This broadly inclusive group of system stakeholders will include significant numbers of consumers, family members, and advocates and representatives from CSBs, state facility directors and staff, and the Departmentís Central Office. Beginning in mid- to late January, the Committee will advise the Department, state facilities, and CSBs on planning and implementing this initiative. Clearly, it will be very important to solicit and incorporate the views and suggestions of consumers and their family members to ensure the ultimate success of the System Transformation Initiative.

The Governorís Initiative is an exciting opportunity to address the unmet needs of consumers; it also will be a tremendous challenge for all of us to implement this sweeping change successfully in a very short period of time. We will need to work collaboratively, decisively, and expeditiously to realize the promise of this initiative and, through its timely and thorough implementation, to generate the support necessary to sustain and expand this transformation over succeeding biennia.

Please join me in thanking Governor Warner for proposing this unprecedented infusion of needed resources for our services system. This far-sighted initiative will enable the public mental health, mental retardation, and substance abuse services system to move much closer to full realization of our vision. 

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