PROVIDENCE – In the traffic jam that is the General Assembly during budget season, it can be difficult to be heard during the steady stream of testimony being presented on budget items before the finance committees in both the House and the Senate.

It is not just the process of being “heard” – but also the importance of being listened to – by elected officials.

Indicative of the difficulties in being heard – and being listened to – were several items: One was a letter from several members of the General Assembly who reside in the East Bay, requesting that R.I. Director of Transportation Peter Alviti provide them with regular updates on the expected timeline for when the bridge will be fully operational.

What the elected officials were looking for, apparently, is more detail. The lack of clarity that has surrounded the “malfunction junction” known as the northern span of the Washington Bridge was underscored by the March 3 letter sent out by Sen. Sam Zurier to his constituents attempting to cut through the “miasma” – literally the bad air – of several consultant reports. The bottom line: Sen. Zurier expects that the state will need to rebuild the span.

One of the more important budget hearings took place on Wednesday evening, Feb. 28, before the House Finance Committee under the leadership of Chair Marvin Abney, focused on what to do about the need for increases in Medicaid provider rates.

As readers of ConvergenceRI may certainly know, last September, OHIC recommended that the General Assembly increase the Medicaid reimbursement rates for fee-for-service providers by $45 million in the FY 2025 budget. The Governor’s proposed budget, however, seeks to spread the increases over three years, despite the fact that those rates have not seem any meaningful increases in nearly 15 years.

Here is the written testimony presented by Linda Hurley, CEO of CODAC, Inc., and by John J. Tassoni, Jr., President/CEO of the Substance Use and Mental Health Leadership Council of RI.

Hopefully, their powerful voices will be heard – and listened to – by state legislators.

JOHN TASSONI Jr.: I wish to attack this from a different angle. We currently have a behavioral health workforce shortage. Due to low reimbursement rates, providers are not able to offer competitive pay to potential employees who can make more money working in fast food places.

Because many of these potential employees are coming out of college, they are seeking jobs that provide enough money for them to pay their student loans and also be able to live, they will take the higher-paying jobs in retail and food services.

Speaking bluntly, we cannot get people to work in the human service industry because of the low pay.

When I talk to people about this issue, my agency's providers have not had rate increases in some 10-20 years on services rendered.

Some of these providers have told me that they have to sell buildings in order to make payroll. Another provider told me they asked employees who received paychecks on a Friday to hold off cashing them until the following Tuesday.

This request led to employees leaving the agency for other jobs because of concerns about being paid.

A crisis point in health care in RI.  
We are at a crisis point with healthcare in Rhode Island. [We have] a shortage of doctors in primary care. [We have a shortage] of specialty doctors. [We have a shortage of] dentists.

Why? Because we don’t pay competitive wages and rates for services.

The other issue is uncompensated care: the hospitals get a chunk of money; we don’t. We also serve anyone who comes through our doors.

I sat on the rate review commission and we did a lot of work on this issue. This can’t be spread over three years. You need to bite the bullet and do it now before we fall further behind the eight ball.

Question: Can you operate your business on what you were making in 2000? My providers can’t wait; they are struggling.

When I started [serving] in the General Assembly in 2001, we were fourth in the nation on substance use and mental health programs. The last I [looked it up], we were Number 48. The state took their eye off the ball, so “batter up!” Let’s do it!

LINDA HURLEY: [Written Testimony on Behavioral Health Medicaid Rates: Opioid Treatment Programs. Committee Hearing 02-28-2024]

Request:

1. Maintain the increase as recommended by the Office of the Health Care Commissioner [OHIC] for behavioral healthcare Medicaid rates. [Page 222 of the Governor’s proposed budget.]
2. Allow for Opioid Treatment Program (OTP) rates to be implemented in 1 year vs. the suggested 3 years, as has been suggested for other entities, i.e., Early Intervention. [Pages 222 and 223 of the Governor’s proposed budget.]
3. If cuts are indicated in this budget, do not cut the OHIC recommended rate increase for Opioid Treatment Programs. This request is based on the length of time it has been since any significant increase has been allocated. Opioid Treatment Programs have not received an increase or any significant increase in Medicaid rates in 14 to 17.5 years.

Rationale:

•  No significant decrease in opioid overdose deaths in Rhode Island. The Rhode Island death rate has essentially plateaued. It has been postulated that a 7 percent decrease can be expected. This is unacceptable.
•  Rhode Island has the 11th highest death rate per capita for opioid overdose of all U.S. states [CDC 2023] and the 4th lowest Medicaid rate of those states providing Medicaid assistance.
•  Outpatient Treatment utilizing medication is the ONLY longitudinally, evidence-based intervention.
•  The chronically substandard reimbursement rates have resulted in an exacerbated workforce crisis in the provision of Opioid Use Disorder Treatment. The most commonly utilized service in an OTP is compensated in Rhode Island at $88 per week. The exact same service is compensated in Massachusetts at over $200. We lose all levels of staff to our neighboring state daily. This increases onboarding, training, supervision and human services costs while decreasing competence and enhancement of offerings.

Confounding and Compounding Issue:

•  Of utmost importance concurrent to the rate discussions is the facilitation and distribution of Rhode Island Opioid Settlement Funds. The Rhode Island Opioid Settlement Advisory Committee [OSAC] has provided NO opportunity for facility expansion for the evidence-based, out-patient treatment for those who continue to use drugs. Though early intervention and residential treatment are a vital part of the treatment continuum, OTP is again the only evidence-based modality. BUT no adequate funding has been allocated by OSAC for this modality.
•  Residential treatment is NOT an effective, evidence-based care for opioid treatment.  Shelter and housing are a critical piece for healing and recovery for all diseases. Stabilization “beds” are important to engage in care. None of those shelter options, however, replace treatment.
• As of three months ago, well over $30 million had been disseminated, allocated or otherwise dedicated by R.I. EOHHS staff: $1.5 million dollars was all that was given for treatment and that was for residential treatment. Massachusetts, Connecticut, and New York States have allocated the majority of their settlement funds to the expansion of treatment and recovery including outpatient and recovery services.
• In Rhode Island, no settlement dollars were allowed for physical plant expansion for OTPs to expand and or enhance capacity for the only intervention [and] treatment that has been proven to decrease overdose deaths and enhance recovery.

I am happy to provide 50 years of research references. These references are from the CDC, NIH, NIDA, SAMHSA as well as hundreds of journal articles. I will provide some of these at your request. Two months ago, during the Opioid Settlement Advisory Committee [OSAC] meeting, it was agreed upon by all members that brick-and-mortar expansion would be funded for outpatient opioid treatment.

The next three categories issued for funding did not include this agreed upon critical need. It is often reiterated that OSAC committee members are advising not defining. Exactly who or what positions at EOHHS make these decisions is not publicly available. Many have asked. PLEASE! Oversight of the EOHHS administration of the opioid settlement dollars is desperately needed and absolutely requires a legislative fix.

Respectfully submitted:  
Linda Hurley, CEO, Codac Inc.

Will the General Assembly act?  
The ongoing health care crisis in Rhode Island – the financial instability of hospitals, nursing homes, and medical facilities – is being driven in large part by the failure by the General Assembly to raise the Medicaid provider rates.

Much like with the current crisis in housing and homelessness, the past failures by the General Assembly and state government to act in support of higher reimbursements for Medicaid providers has made it difficult to attract providers all across the delivery of care system in Rhode Island. The stark testimony by both John Tassoni Jr. and Linda Hurley offers a compelling rationale for legislative leaders to take action through investments in higher rates for Medicaid providers in the FY 2025 budget.

Simply put, the “infrastructure” of the health care delivery system in Rhode Island is on the verge of collapse. Members of the General Assembly have been warned. The question is: Did they listen? Did they hear what was said?