D B H D S Virginia Department of Behavioral Health and Developmental Services Community Services Boards (CSBs) Funding Process Flow

D B H D S Virginia Department of Behavioral Health and Developmental Services FY 2013 CSB Funding Sources  Total Fiscal Year 2013 operating budget was $1.03 Billion  State Revenue includes all state General Funds sent directly to the CSB’s by DBHDS  50% of Medicaid funds are from the state match - $199 million  Total FY 2013 state General Funds (State General Funds and Medicaid match) were $447.6 million  Breakdown of all DBHDS funding to CSB’s (Medicaid match not included) – 81.5% General Funds, 18.5% Federal Funds  Local Revenue is assumed to be local general funds that are derived from tax revenue *All amounts shown in this presentation are in millions of dollars. **Unless otherwise noted, State Revenue does not include Medicaid match or Federal funds passed through DBHDS to the CSBs.

D B H D S Virginia Department of Behavioral Health and Developmental Services Historical CSB Funding by Service  Funding for MH Services has increased 109.1% over the 11 year period  Funding for IDD Services has increased 39.2% over the period  Funding for SA Services has only increased by 14.8% over the same period

D B H D S Virginia Department of Behavioral Health and Developmental Services  Total Fiscal Year 2013 MH funding was $570.1 million  Medicaid Revenue shown above includes both the State match and Federal portions  50% of Medicaid funds are from the state match - $104.2 million FY 2013 Mental Health Funding, by Source

D B H D S Virginia Department of Behavioral Health and Developmental Services FY 2013 Developmental Services by Funding Source  Total Fiscal Year 2013 DV funding was $308.3 million  50% of Medicaid funds are from the state match - $93.3 million

D B H D S Virginia Department of Behavioral Health and Developmental Services FY 2013 Substance Abuse Funding by Source  Total Fiscal Year 2013 SA funding was $146.8 million  50% of Medicaid funds are from the state match - $1.6 million

D B H D S Virginia Department of Behavioral Health and Developmental Services Relationship Between State & Other Funding Sources  Other Funding sources includes Federal Grants, miscellaneous fee revenue and other sales  State General Fund dollars increased 65.5% over this 11 year period  All other combined fund sources (Local, Medicaid and Other) increased 64.6% over the same period

D B H D S Virginia Department of Behavioral Health and Developmental Services Funding Flow Chart, initial allocation of new funds DBHDS Program Staff develop plan for the funding and send CSBs Request for Proposal DBHDS Receives funding from the General Assembly DBHDS Management reviews the CSBs proposal Not Approved Approved CSB is notified that their proposal has not been approved CSB is notified that proposal has been approved. Fiscal office is copied on notification. CSBs interested in providing the services put together a proposal package and submit to DBHDS Funding is added to CSBs Performance Contract with DBHDS Fiscal office adds funding to bi-monthly payments to the CSB CSB does not receive funding for the program CSB receives funding and begins providing services CSB provides reports to program and fiscal staff Unsatisfactory Satisfactory DBHDS continues to provide on-going funding New funds are often restricted for a specific program based on wording in the appropriation act. After time, they no longer have the same emphasis put on them, and are then earmarked, by DBHDS, for the purpose they were originally given. Eventually, the funds will be classified as “base funding” and will be combined with other funds. At this point, the funds are being provided to the same CSB as ongoing, and DBHDS is comfortable with the services being provided.

D B H D S Virginia Department of Behavioral Health and Developmental Services Restricted Funds Pros & Cons Ensures the funds are spent according to the defined program and identified purpose Provides an incentive to prioritize resources to establish processes and plan the funds payouts to support services in a timely and consistent manner Restricted fund balances are reclassified as unrestricted fund in the subsequent year Restricts the use of funds to a specific program although local need priorities may have changed Requires critical attention and monitoring to ensure conformity to the performance agreement at the risk of losing the grant for non-compliance Administratively documentation intensive for both the local and central offices

D B H D S Virginia Department of Behavioral Health and Developmental Services Local Match Rates  Per Code of VA, localities are required to match 10% of the combined state and local funding, unless granted a waiver by DBHDS  Boards contributing Greater than 50% are receiving more local funds than state funds  9 Boards received 88% of all the local funds provided in FY 2013  Fairfax-Falls Church CSB is an outlier, receiving $100.3 million in local funds, the next highest received $23.0 million (FY 2013)  The 8 boards with the largest funding component(excluding Fairfax) received an average of $14.4 million local funds and an average of $7.7 million in state funds (FY 2013)  The 12 boards with the least funding component received an average of $571,861 local funds and an average of $6.5 million in state funds (FY 2013)  Boards with waivers: Alleghany, Blue Ridge, Cumberland Mountain, Danville, Mount Rogers, New River, Piedmont, Planning District 1, Planning District 19, Richmond Behavioral Health Authority, Southside and Valley  Waivers are granted by the Community Contracting Office at DBHDS and are given based on the CSB meeting certain criteria

D B H D S Virginia Department of Behavioral Health and Developmental Services Rate Variances *CSB 1 is in an urban setting and CSB 2 is in a rural location  CSB data provided by 2 random boards, based off of their Fee Schedule  Medicaid rates based off of Psychiatric Outpatient codes and Rehab codes  DBHDS does not have the authority to establish a fee schedule at the CSBs  Rates vary by CSB for services  For example the rate for MH Support Services at CSB 1 is $91/unit but $83/unit at CSB 2  Fees charged by the CSB are not required to be in-line with Medicaid rates