COMMONWEALTH OF PENNSYLVANIA HOUSE OF REPRESENTATIVES

JOINT HEALTH, HUMAN SERVICES, AND OLDER ADULT SERVICES COMMITTEE HEARING

STATE CAPITOL MAIN BUILDING ROOM 140 HARRISBURG, PENNSYLVANIA

MONDAY, APRIL 17, 2017

IN RE: CONSOLIDATION OF THE DEPARTMENT OF AGING, DRUG AND ALCOHOL PROGRAMS, HEALTH & HUMAN SERVICES

BEFORE:

HONORABLE MATTHEW BAKER, MAJORITY CHAIRMAN, HEALTH COMMITTEE HONORABLE VANESSA LOWERY BROWN HONORABLE ALEXANDER CHARLTON HONORABLE BECKY CORBIN HONORABLE JIM COX HONORABLE MARY JO DALEY HONORABLE PAMELA DeLISSIO HONORABLE KRISTIN PHILLIPS-HILL HONORABLE AARON KAUFER HONORABLE STEPHEN KINSEY HONORABLE HARRY LEWIS, JR. HONORABLE MICHAEL SCHLOSSBERG HONORABLE JUDITH WARD HONORABLE MARTINA WHITE HONORABLE DAVID ZIMMERMAN

————————— JEAN DAVIS REPORTING POST OFFICE BOX 125 • HERSHEY, PA 17033 Phone (717)503-6568 1 BEFORE (cont.'d):

2 HONORABLE TIM HENNESSEY, MAJORITY CHAIRMAN, AGING & OLDER ADULT SERVICES COMMITTEE 3 HONORABLE CAROLYN COMITTA HONORABLE MARY JO DALEY 4 HONORABLE PAMELA DeLISSIO HONORABLE MICHAEL DRISCOLL 5 HONORABLE CRIS DUSH HONORABLE JONATHAN FRITZ 6 HONORABLE STEVE McCARTER HONORABLE ERIC ROE 7 HONORABLE FRANCIS RYAN HONORABLE WILL TALLMAN 8 HONORABLE PARKE WENTLING HONORABLE GENE DiGIROLAMO, MAJORITY CHAIRMAN, 9 HUMAN SERVICES HONORABLE BUD COOK 10 HONORABLE MICHAEL CORR HONORABLE CRIS DUSH 11 HONORABLE JONATHAN FRITZ HONORABLE RICH IRVIN 12 HONORABLE AARON KAUFER HONORABLE HARRY LEWIS, JR. 13 HONORABLE THOMAS MURT HONORABLE ERIC ROE 14 HONORABLE JUDITH WARD HONORABLE PERRY WARREN 15

16 ALSO IN ATTENDANCE:

17 WHITNEY KROSSE, REPUBLICAN EXECUTIVE DIRECTOR, HEALTH COMMITTEE 18 BECCA SAMMON, DEMOCRATIC EXECUTIVE DIRECTOR, HEALTH COMMITTEE 19 NICOLE SIDLE, REPUBLICAN RESEARCH ANALYST, HEALTH COMMITTEE 20 CAMILA POLASKI, DEMOCRATIC RESEARCH ANALYST, HEALTH COMMITTEE 21 PATIENCE HILL, REPUBLICAN ADMINISTRATIVE ASSISTANT, HEALTH COMMITTEE 22 DINA WHITE, DEMOCRATIC EXECUTIVE ASSISTANT, HEALTH COMMITTEE 23

24 JEAN M. DAVIS, REPORTER 25 NOTARY PUBLIC

2 1 I N D E X

2 TESTIFIERS

3

4 NAME PAGE

5 REBECCA MAY-COLE, EXECUTIVE DIRECTOR, 12 P4A, (PA ASSOCIATION OF AREA AGENCIES ON AGING) 6 DIANE A. MENIO, EXECUTIVE DIRECTOR, 18 7 CARIE, (CENTER FOR THE ADVOCACY FOR THE RIGHTS AND INTERESTS OF THE ELDERLY) 8 LINDA DOMAN, PRESIDENT, BOARD OF DIRECTORS, 24 9 SWPPA, (SOUTHWESTERN PA PARTNERSHIP FOR AGING)

10 HANNAH WESNESKI 58

11 RICHARD EDLEY, PRESIDENT & CEO, 67 REHABILITATION & COMMUNITY PROVIDERS ASSOCIATION 12 GEORGE HARTWICK, DAUPHIN COUNTY COMMISSIONER, 73 13 COUNTY COMMISSIONERS ASSOCIATION OF PA

14 DEB BECK, PRESIDENT, 119 DRUG & ALCOHOL SERVICE PROVIDERS ORGANIZATION 15 OF PENNSYLVANIA

16 GARY TENNIS, FORMER SECRETARY, 132 DEPARTMENT OF DRUG & ALCOHOL PROGRAMS 17

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3 1 P R O C E E D I N G S

2 * * *

3 MAJORITY HEALTH CHAIRMAN BAKER: The hearing will

4 now come to order. We have a lot of wonderful committee

5 members here.

6 I've been asked by the committee transcriber --

7 you won't see them here but they are listening. This is

8 being televised. It's being taped. And we'll very quickly

9 -- if members would come to the mike. They are going to be

10 putting your name in the transcript. And we found out last

11 time we did this that we didn't always go to the mike and so

12 some members were not properly recorded in the transcript.

13 And they're still trying to figure that out.

14 Why don't we start with Chairman DiGirolamo.

15 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

16 Gene DiGirolamo, 18th District in Bucks County. Welcome to

17 everyone.

18 MAJORITY HEALTH CHAIRMAN BAKER: Representative

19 Matt Baker, Chairman of the Health Committee, 68th District,

20 Tioga, Bradford, and Potter Counties.

21 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

22 HENNESSEY: Tim Hennessey, Republican Chair of the House

23 Aging & Older Adult Services Committee from Chester and

24 Montgomery Counties in the southeastern part of

25 Pennsylvania.

4 1 REPRESENTATIVE LOWERY BROWN: Representative

2 Vanessa Lowery Brown, Acting Chairman, Democratic Chairman

3 for the Health Committee, Philadelphia County.

4 REPRESENTATIVE McCARTER: Steve McCarter, House

5 District 154, Montgomery County.

6 REPRESENTATIVE COMITTA: Carolyn Comitta,

7 District 156, Chester County.

8 REPRESENTATIVE TALLMAN: Will Tallman, parts of

9 Adams and Cumberland Counties.

10 REPRESENTATIVE WARREN: Hi. Perry Warren from

11 District 31 in Bucks County.

12 REPRESENTATIVE DRISCOLL: Good afternoon. Mike

13 Driscoll, Northeast Philadelphia.

14 REPRESENTATIVE DALEY: Mary Jo Daley, Montgomery

15 County, serving today as Acting Chair for the Aging

16 Committee, the Minority Aging Committee.

17 REPRESENTATIVE SCHLOSSBERG: Good morning or good

18 afternoon or whenever. Mike Schlossberg, 132nd District,

19 Lehigh County, also serving as Acting Chair of Human

20 Services.

21 REPRESENTATIVE COOK: District 49, Bud Cook,

22 Washington and Fayette Counties.

23 REPRESENTATIVE KAUFER: Aaron Kaufer, 120th

24 District, Luzerne County.

25 REPRESENTATIVE MURT: Tom Murt, Montgomery

5 1 County, Philadelphia County.

2 REPRESENTATIVE WARD: Judy Ward, 80th District,

3 Blair County.

4 REPRESENTATIVE PHILLIPS-HILL: Kristin

5 Phillips-Hill, 93rd District, Southern York County.

6 REPRESENTATIVE DeLISSIO: Pam DeLissio,

7 representing Montgomery and Philadelphia Counties, the

8 194th.

9 REPRESENTATIVE IRVIN: Rich Irvin, 81st District,

10 representing Centre, Huntingdon, and Mifflin Counties.

11 REPRESENTATIVE CORBIN: Becky Corbin, 155th

12 District in Chester County.

13 REPRESENTATIVE RYAN: Frank Ryan, 101st District,

14 Lebanon County.

15 REPRESENTATIVE CORR: Michael Corr, 150th

16 Legislative District, Montgomery County.

17 REPRESENTATIVE DUSH: Cris Dush, 66th District,

18 Jefferson and the northern half of Indiana County.

19 REPRESENTATIVE CHARLTON: Alex Charlton, 165th

20 Legislative District, Delaware County.

21 REPRESENTATIVE FRITZ: Jonathan Fritz, 111th

22 District, Wayne and Susquehanna Counties.

23 REPRESENTATIVE ROE: Eric Roe, Human Services and

24 Aging Committees, 158th District, Chester County.

25 REPRESENTATIVE LEWIS: Harry Lewis, 74th

6 1 District, Chester County.

2 REPRESENTATIVE KINSEY: Good afternoon. Stephen

3 Kinsey, 201st Legislative District, Philadelphia County,

4 Human Services and Health Committees.

5 REPRESENTATIVE ZIMMERMAN: Dave Zimmerman, 99th

6 District, Lancaster County.

7 REPRESENTATIVE WENTLING: Parke Wentling, 7th

8 District, portions of Erie, Crawford, Mercer, and Lawrence

9 Counties.

10 MAJORITY HEALTH CHAIRMAN BAKER: I believe we

11 have all the members. We also have our professional staff

12 from the three Committees present as well.

13 We welcome our first panel. We always afford the

14 Chairman the first opportunity to make opening comments

15 before we go into our stakeholder testimony. It's a very,

16 very important issue, the proposal to consolidate the State

17 Departments.

18 Since the first panel is with regard to the Aging

19 Department, we'll defer to Chairman Hennessey.

20 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

21 HENNESSEY: Thank you, Mr. Chairman.

22 Ever since Governor Wolf announced publicly his

23 intention to have a merger between Aging, the Departments of

24 Aging, Health, Human Services, and the Department of Drug

25 and Alcohol Prevention, I've tried to listen to see if I

7 1 thought that it was necessary in all of its facets.

2 As I looked at the Department of Aging over the

3 course of years now, it seems to me to be a smoothly run

4 operation, not something that needed to be lumped into

5 another department, a much larger department, in order to

6 make it function any better.

7 I suppose you'd say I've been skeptical all

8 along. Aging has 102 employees. The Department of Human

9 Services, as it's being proposed, would have over 17,000

10 employees. That's about 170 Human Services employees for

11 every employee of the Department of Aging.

12 I don't know how we don't get outnumbered in that

13 kind of situation. It's an $800 million department, which

14 is run totally from Lottery and Older Americans Act funding

15 from the Federal Government, while Human Services would be a

16 $40 billion operation department and have an operating

17 budget of $40 billion. That's more than probably five or

18 six -- only five or six states have a budget more than the

19 department that we're proposing would be.

20 When you speak of saving $45 million from the

21 dispensing fees, frankly, that would save the Lottery money,

22 but it wouldn't save the General Fund any money. So as you

23 try to put this under a microscope, it looks to me like some

24 of the savings really are sort of ephemeral. They just

25 won't, you know, be realized. And any savings that would be

8 1 realized would be savings to the Lottery, not to the General

2 Fund.

3 I just don't know that it's a good idea. Some

4 mergers are planned. And when they're proposed and they're

5 thought out, their good ideas, you know, when you put them

6 under a microscope, turn out to be not such a good idea.

7 This is one where I think that's not such a good

8 idea. I'm waiting for someone to tell me why it should

9 happen and convince me that I'm wrong. So maybe your

10 testimony today will help us with that.

11 Thank you.

12 MAJORITY HEALTH CHAIRMAN BAKER: Thank you,

13 Chairman Hennessey.

14 Chairman DiGirolamo for opening remarks.

15 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

16 Thank you.

17 Just very quickly. Nothing I have seen in the

18 last week to two weeks has changed my mind. I think this is

19 a terrible, terrible idea.

20 For those that are concerned about the Department

21 of Aging and our senior citizens across the State of

22 Pennsylvania, just take a look at that chart in front of the

23 podium and you'll find out where your Deputy Secretary for

24 Aging and Adult Community Living is, buried all the way down

25 at the bottom of that chart.

9 1 So you're going to go from a department to a

2 Deputy Secretary buried in a bureaucracy you're never going

3 to be able to find your way out of, as well as the

4 Department of Drug and Alcohol program.

5 So with that, I'm looking forward to hearing your

6 testimony.

7 Thank you.

8 MAJORITY HEALTH CHAIRMAN BAKER: Thank you,

9 Chairman DiGirolamo.

10 I would just like to acknowledge, before we

11 introduce our first panel on opening remarks, a letter that

12 was proffered by the Pennsylvania Association of Elder Law

13 Attorneys who have serious and grave concerns about this

14 consolidation -- I will provide that for the record -- as

15 well as a letter from the Bradford, Sullivan, Susquehanna,

16 and Tioga Area Agency on Aging also expressing serious

17 concerns about the consolidation. And, of course, we

18 acknowledge the document that has been provided to us as the

19 standing committees for consideration of this hearing.

20 At this time, I understand Mary Jo Daley, who is

21 serving as the surrogate for Chairman Steve Samuelson of the

22 -- he's the Minority Chair of the Aging Committee, would

23 also like to offer some opening remarks -- or did you have

24 questions, Mary Jo?

25 REPRESENTATIVE DALEY: You know, I just found out

10 1 I was going to be opening Chairman about two minutes ago.

2 I'm more than happy to be recognized to ask questions after

3 we hear the testimony.

4 MAJORITY HEALTH CHAIRMAN BAKER: Very good.

5 REPRESENTATIVE DALEY: Thank you.

6 MAJORITY HEALTH CHAIRMAN BAKER: We're on a tight

7 schedule to be able to get everyone in in time.

8 Mike says no. How about Vanessa? Where is

9 Vanessa?

10 HONORABLE LOWERY BROWN: Here.

11 MAJORITY HEALTH CHAIRMAN BAKER: There she is.

12 Opening remarks, Vanessa?

13 REPRESENTATIVE LOWERY BROWN: Briefly.

14 MAJORITY HEALTH CHAIRMAN BAKER: Okay.

15 REPRESENTATIVE LOWERY BROWN: Thank you, Mr.

16 Chairman.

17 I just wanted to acknowledge that our Chairman

18 Flo Fabrizio just asked everyone to keep him in your hearts.

19 This is a very serious issue. We are talking

20 about dealing with very -- extremely vulnerable populations.

21 And when you think about these populations, you usually

22 think about more, not less. So I hope that as we continue

23 these conversations that we figure out how we can do the

24 best that we can for the people that we serve.

25 Thank you, Mr. Chairman.

11 1 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

2 I, too, would like to give my best regards to

3 Chairman Fabrizio, who has a rather serious health concern.

4 We offer up our support and prayers to him going forward.

5 So our first testifiers today in the panel, we

6 have with us Rebecca May-Cole, Executive Director, P4A,

7 Pennsylvania Association of Area Agencies on Aging; Diane

8 Menio, Executive Director at CARIE, Center for Advocacy for

9 the Rights and Interests of the Elderly; and Linda Doman,

10 President of the Board of Directors of the Southwestern

11 Pennsylvania Partnership for Aging.

12 I'm not sure who got the short straw to go first

13 but whomever.

14 P4A EXECUTIVE DIRECTOR MAY-COLE: I will go

15 first.

16 MAJORITY HEALTH CHAIRMAN BAKER: All right.

17 P4A EXECUTIVE DIRECTOR MAY-COLE: Can you hear me

18 okay?

19 MAJORITY HEALTH CHAIRMAN BAKER: Yes.

20 P4A EXECUTIVE DIRECTOR MAY-COLE: Okay.

21 Good afternoon. My name is Rebecca May-Cole,

22 Executive Director of the Association of Area Agencies on

23 Aging. I appreciate the opportunity to be here, Chairman

24 Hennessey, Chairman Samuelson, Chairman Baker, Chairman

25 Fabrizio, Chairman DiGirolamo, and Chairman Cruz. I think

12 1 the fact that we have that long list of Chairs here today

2 shows the importance. And I appreciate all of your time and

3 attention to this very important issue.

4 The Association of Area Agencies on Aging is

5 deeply committed to improving services and coordination for

6 seniors. The AAA network -- and we are all the Area

7 Agencies on Aging, AAA. The AAA network is consistently

8 thinking through ways to meet the needs of seniors in a

9 rapidly changing service delivery environment.

10 The P4A membership has 40 years of experience and

11 expertise in facilitating the delivery of services to

12 seniors, and we appreciate the opportunity to share what

13 we've learned over the decades.

14 On February 2nd, as you know, Governor Wolf

15 announced his proposal to combine the services provided

16 through the Departments of Health, Aging, Drug and Alcohol

17 Programs, and Human Services into one agency.

18 P4A, therefore, formed an Ad-Hoc Committee of its

19 members to examine the proposal and consulted colleagues in

20 other states that have experienced similar consolidation s.

21 The AAA network appreciates the Legislature's

22 commitment to our seniors. The typical senior served by

23 AAAs -- and I think this is important to note. The typical

24 kind of person that we're talking about here is a

25 79-year-old widowed female living just above the poverty

13 1 level. She's not eligible for Medicaid, but also has a very

2 limited income.

3 If Pennsylvania's senior service delivery system

4 fails her, the consequences could be very dire or even

5 fatal. The unique needs of seniors must be deeply

6 understood, valued, and prioritized. With this as our

7 focus, P4A would like to provide the following thoughts

8 regarding the consolidation proposal:

9 We support the following concepts when looking

10 for better ways to serve Pennsylvania older adults: More

11 effective collaboration between offices and departments;

12 enhanced program effectiveness; the reduction of unnecessary

13 bureaucracy; the efficient use of land, buildings, leases,

14 and space; and the merging of human resource departments

15 across agencies.

16 In addition, we support the merging of

17 information technology across agencies, which could lead to

18 improved data collection and facilitate sharing across

19 different offices serving the same consumer, which could

20 also improve their health outcomes.

21 In fact, the Centers for Disease Control has long

22 focused on this effort through its program Collaboration and

23 Service Integration Program. We support any efforts in

24 streamlining and improving data systems to ultimately

25 improve service delivery.

14 1 P4A strongly believes the following principles

2 must be followed in order to ensure that Pennsylvania is

3 addressing the needs of its older population, a population

4 that is slated to grow to an amazing 28 percent of our

5 Commonwealth by 2024. And I'll repeat that again, 28

6 percent by 2024.

7 So the first principle is a voice to advocate on

8 behalf of the unique needs of seniors must be maintained.

9 The current Pennsylvania Department of Aging is a State

10 agency with a cabinet-level Secretary. Through the Federal

11 Older Americans Act, the Aging Secretary has the

12 jurisdiction, power, and duty to advance the well-being of

13 Pennsylvania's older citizens.

14 P4A is concerned that losing a cabinet-level

15 advocate for Pennsylvania's aging adults means a

16 diminishment of senior voice. The most obvious way to

17 maintain that voice is to not combine PDA with other

18 agencies. However, if consolidation were to move forward,

19 we respectfully urge the consideration of the following:

20 First, keep a cabinet-level advocate for seniors;

21 second, create a separate Office of Aging within the

22 proposed new agency; and redistribute staff roles so that

23 all aging-related services and funding fall within the

24 Office of Aging regardless of funding source.

25 The second principle, the community-based No

15 1 Wrong Door Infrastructure for seniors must be maintained.

2 The value of No Wrong Door for a senior cannot be

3 understated. Having a consistent place in every planning

4 and service area where older adults and their families can

5 physically go across the Commonwealth is incredibly

6 important. This consistency and availability is available

7 through our AAA network.

8 A great deal has changed in service delivery in

9 just a couple of years. For example, there have been

10 changes to service coordination, changes to enrollment,

11 which has led to some definite confusion and differences in

12 the experience of seniors who are going through our system.

13 AAAs are assisting numerous seniors who become

14 confused after being mailed a packet or receiving an

15 automated phone call with a recording on the other end of

16 the line instead of being enrolled in services through their

17 local AAAs through personal interactions.

18 Our network is aligned with the Governor's

19 one-stop-shop philosophy as AAAs are truly the stop for

20 Pennsylvania's seniors. We respectfully request that the

21 current one-stop shop for seniors be maintained through

22 Pennsylvania's local AAA network by legislation that assures

23 that any changes to the number of AAAs in the future be done

24 with some sort of legislative oversight.

25 The third principle is ensuring that the Lottery

16 1 Fund continues to be used to support seniors living in their

2 homes and communities. Established in 1971, the

3 Pennsylvania Lottery continues to be the only State Lottery

4 in which all of the net revenue goes to programs that

5 benefit older residents.

6 Initially targeted to provide property tax relief

7 for Pennsylvania seniors, Lottery-funded programs have since

8 grown to include home- and community-based services

9 facilitated by AAAs, rent rebates, free and reduced fare

10 transportation, funding for PACE and PACENET, and funding

11 for senior centers as examples.

12 The ongoing use of these dollars in this fashion

13 is a clear demonstration of the Commonwealth's commitment to

14 help seniors live in their homes and communities. The

15 Lottery Fund provides services to seniors who are not

16 financially eligible for Medicaid, people who have worked

17 hard their whole lives but are not quite eligible for

18 Medicaid and need a helping hand to continue to live in

19 their communities.

20 AAAs have been able to maximize the ways these

21 dollars are used by leveraging local resources and in-kind

22 donations to further this. The State's Lottery Fund must

23 continue to be utilized for these services.

24 Therefore, we respectfully request that the

25 Legislature ensure that the Lottery Fund continues to be

17 1 used for these purposes.

2 Thank you for inviting me to provide our input as

3 a stakeholder on behalf of Pennsylvania's older adults. P4A

4 will continue to evaluate the proposal as more information

5 is shared, always keeping the needs of seniors at the center

6 of what we do.

7 Thank you.

8 MAJORITY HEALTH CHAIRMAN BAKER: Thank you very

9 much.

10 Diane.

11 CARIE EXECUTIVE DIRECTOR MENIO: Good afternoon.

12 My name again is Diane Menio. And I'm the

13 Executive Director of the Center for Advocacy for the Rights

14 and Interests of the Elderly. We like to call ourselves

15 CARIE because it's a little easier.

16 And thank you, all, all the chairpersons. I'm

17 not as bold and as sure of myself as Rebecca is to get

18 everyone's name right. But I really do appreciate all of

19 the Chairpersons, the Acting Chairpersons, and the Committee

20 members for inviting me here and having this hearing.

21 CARIE has been providing advocacy services to

22 older Pennsylvanians for 40 years. We can testify that

23 older Pennsylvanians have benefited by having a

24 cabinet-level Department of Aging focused on their needs.

25 While we have concerns about the consolidation

18 1 overall, we are strongly opposed to including the Department

2 of Aging in this proposed consolidation. The Secretary of

3 Aging has served a critical role as the Commonwealth's

4 leading advocate for older Pennsylvanians.

5 In the 1970s, Pennsylvania took bold steps to

6 show its commitment to senior citizens, first in 1971 by

7 establishing funding for aging programs through the

8 Pennsylvania Lottery and then in 1978 by enacting Act 70,

9 elevating the Department to its current cabinet level.

10 No other state has shown this commitment. This

11 has had a dramatic impact in helping to amplify and address

12 the needs of older Pennsylvanians. Including the Department

13 of Aging in the new Department of Health and Human Services

14 will bury the needs of older adults within a behemoth of a

15 bureaucratic agency while saving little in the budget, as

16 funding for the Department of Aging, as we've heard, is

17 solely derived from Lottery and Federal dollars and not from

18 the General Fund.

19 In addition, we are concerned that the proposed

20 consolidation will threaten the viability of many Lottery

21 programs that older Pennsylvanians have come to rely upon,

22 many of which help to avoid unnecessary

23 institutionalization. We are worried that under the

24 consolidation, Lottery Funds could more easily be diverted

25 to pay for Medicaid coverage fund obligations.

19 1 A Department of Health and Human Services

2 Secretary may be more inclined to rely upon Lottery dollars

3 to fill gaps in the Medicaid budget.

4 It's also interesting to note that while the

5 proposal to eliminate the Department of Aging is being

6 considered, Pennsylvania has among the highest numbers of

7 aging adults in the nation. And by 2020, the population of

8 those age 60 and older is expected to grow and reach as much

9 as 25 percent of Pennsylvania's population.

10 Much is at stake with this proposed transition.

11 We hope you will consider the following points as you

12 discuss the merits of any consolidation proposal:

13 Demoting the Secretary of Aging diminishes

14 effective advocacy for older Pennsylvanians. How effective

15 could a Deputy Secretary be when policy recommendations

16 conflict with their superior's positions?

17 It may be fine to consolidate certain

18 administrative functions to save costs and improve

19 efficiencies. But as evidenced by the current shared IT

20 services, consolidation is not the only answer to doing

21 that.

22 Stakeholder efforts to address policy and to

23 advocate with the Secretary must not be diluted. Older

24 Pennsylvanians need and deserve an effective and independent

25 advocate that reports directly to the Governor.

20 1 We are not against reinventing or reimagining

2 government, nor are we defending the status quo. What seems

3 clear is that there is a proposed immense system change set

4 to begin July 1 that evolved without meaningful external

5 stakeholder input.

6 Many would argue that DHS is already too big and

7 certainly bigger does not mean better. An overloaded

8 bureaucracy may have the opposite impact on the stated goals

9 for less confusion and easier access to services for an

10 improved experience.

11 Will calling a mega agency like this ensure that

12 consumers will get the information or resources they need?

13 When DHS has worked to streamline programs, it has left

14 older adults behind and their needs unmet.

15 We know you are well aware of the major problems

16 that have been occurring for over a year with the Aging

17 Waiver enrollment process. Is it wiser to give a bigger new

18 Department of Health and Human Services more responsibility

19 for aging programs?

20 Community HealthChoices is the most significant

21 long-term care system change to ever be implement ed in

22 Pennsylvania. And it's scheduled to begin in June 2017, a

23 few short months away, eventually moving 420,000 nursing

24 home residents, waiver participants, and other individuals

25 who are covered by both Medicaid and Medicare into managed

21 1 care for the first time.

2 It seems the timing could not be worse than to

3 implement a massive reorganization at the same time as an

4 immense system change that impacts the most vulnerable

5 people in Pennsylvania.

6 The proposed department may jeopardize many

7 Lottery-funded programs. How will Lottery dollars be

8 tracked and accounted for? Lottery programs must be

9 protected and funding levels must keep pace with the need.

10 What are the risks involved with moving the PACE

11 program and unifying it with other State pharmaceutical

12 programs? This change would be permanent, lasting well

13 beyond this current Administration. We've seen past

14 promises by Administrations not realized after a transition

15 of power.

16 How can this be avoided? There are numerous

17 conflicts of interest that need to be identified and

18 addressed. One example is the Long-Term Care Ombudsman

19 Program where there are clear Federal requirements that must

20 be met to avoid conflicts of interest.

21 The proposed consolidation is based in part on

22 misinformation. The Department already acts as a focal

23 point and provides older Pennsylvanians a single point of

24 contact through which they can address their concerns and

25 needs with State Government.

22 1 The proposed change is happening too fast. It is

2 important to have a public vetting of all issues, costs, and

3 potential conflicts, as well as identifying a transition

4 process that will minimize disruption for consumers.

5 We believe consolidation can be done without

6 eliminating the Department of Aging and its mission for

7 services for older adults. Previous testimony from the

8 Administration indicates that they will be sharing enabling

9 legislations for consolidation with the Legislature soon.

10 We request that as this bill is debated it

11 include more than a shared vision. It should include

12 language that ensures needed legislative oversight and

13 approval by the Legislature for policy changes.

14 The expedited rule making authority under Act 22

15 of 2011 did not allow for important oversight of the

16 Legislature or the engagement of stakeholders to offer

17 meaningful input, troubleshoot, or plan for proper

18 implementation that could have avoided disruption in

19 services and barriers in accessing care.

20 We are a member of the Disability Budget

21 Coalition, which is compromised of more than 80 groups

22 working together. The Coalition agrees that any

23 consolidation must adhere to the following principles that

24 we hope the Legislature will consider as the debate

25 continues. And I have those in writing for you.

23 1 In conclusion, we urge that the Pennsylvania

2 Department of Aging be maintained as a cabinet-level agency

3 and excluded in any future consolidation of Pennsylvania's

4 Health and Human Services Agencies.

5 Older Pennsylvanians need a strong and

6 independent advocate. Lottery-funded programs must be

7 protected and funding levels must keep pace with the need.

8 We hope that older Pennsylvanians can count on your support

9 to preserve the Pennsylvania Department of Aging to help

10 ensure their dignity and well-being.

11 Thank you again for the opportunity to comment

12 and for sponsoring today's hearing.

13 MAJORITY HEALTH CHAIRMAN BAKER: Thank you very

14 much, Diane, for giving us a synopsis of that eight-page

15 document. Well done.

16 CARIE EXECUTIVE DIRECTOR MENIO: Thank you.

17 MAJORITY HEALTH CHAIRMAN BAKER: Well done.

18 We also have Linda Doman.

19 SWPPA PRESIDENT DOMAN: Hello. Good afternoon.

20 Thanks, everyone, for having me here. In my

21 professional life, I'm the Executive Director of a

22 non-profit agency that provides in-home services, protective

23 services, investigations, senior centers, Meals on Wheels .

24 I've worked in the system for 40 years.

25 Today I'm here representing the members of the

24 1 Southwestern Pennsylvania Partnership for Aging. We all

2 call it SWPPA, so I'll do that moving forward.

3 We write out of grave concern over Governor

4 Wolf's proposal to consolidate the Department of Aging with

5 three other State Departments. SWPPA is an independent,

6 non-profit organization dedicated to improving the quality

7 of life for older adults in ten counties in Southwestern

8 Pennsylvania: Allegheny, Armstrong, Beaver, Butler,

9 Fayette, Greene, Indiana, Lawrence, Washington, and

10 Westmoreland.

11 We formed in 1990. We have over 300 members who

12 serve over a million older adults. SWPPA members include

13 older adults, providers of services, for-profit and

14 non-profit businesses, government entities, universities,

15 and community members.

16 SWPPA acts as a neutral forum for education,

17 collaboration, and the formulation of policy recommendations

18 for older adults and those with disabilities. This

19 testimony reflects our thoughtful discussion and

20 deliberation about the proposed change.

21 As we learn more about the proposal, our concern

22 is increasing and is twofold. Number 1, our greatest

23 concern is that this merger could constitute a dismantling

24 of the Department of Aging along with its powers and duties

25 to represent our aging population.

25 1 Number 2, equally troubling is the lack of any

2 specific and clear information within the proposal that

3 addresses how these powers and duties would, in fact, be

4 preserved if the Department of Aging is absorbed within this

5 new super department, including the preservation of Lottery

6 funds specifically for aging services.

7 One of the principal powers and duties of the

8 Department of Aging as stated in its founding act is to

9 serve as an advocate for the aging at all levels of

10 government. This chart is gray and shows that a Cabinet

11 Secretary would best meet the goal of serving as an advocate

12 for aging.

13 Please understand we certainly see the value and

14 need for routine consolidation of Harrisburg-based

15 administrative functions if they're cost effective and will

16 not cause disruption to aging services.

17 We believe, however, this consolidation can be

18 done as it has in the past without dismantling the entire

19 Department of Aging and diminishing its primary mission of

20 advocacy for seniors and on the ground service delivery to

21 seniors in our Commonwealth.

22 While we fully understood the need to make

23 changes in response to Federal regulation, DHS's recent

24 management of the transition of Medicaid waiver enrollment

25 from the AAA to Maximus heightens our concern and was

26 1 incredibly harmful to countless older adults trying to

2 remain in their communities.

3 Without a Secretary of Aging to advocate, we fear

4 that this leaves the aging network weakened without an equal

5 seat at the table. Furthermore, we're seriously concerned

6 about the idea of placing the Lottery fund into the hands of

7 the new Department.

8 As recently as three years ago, the Department of

9 Human Services with legislative approval was withdrawing

10 $500 million from the Lottery Fund to subsidize the General

11 Fund for Medicaid payments. This withdrawal caused

12 increased waiting lists and short-funding for aging programs

13 which are funded only by the Lottery. Across the State,

14 Meals on Wheels, protective services, home care services,

15 the waiting list existed.

16 To the Governor's credit, he decreased the

17 withdrawal from the Lottery Fund for the past two years.

18 But this decision appears to show a reverse course by

19 suggesting that dismantling the Department of Aging will

20 provide savings to help address the General Fund deficit

21 when, in fact, it will not.

22 Not a single dollar of General Fund money

23 supports the Department of Aging or the programs it

24 administers. The cost of the Department, including

25 administrative costs, are paid for with Lottery funds or

27 1 Federal funds.

2 Therefore, the only way dismantling the

3 Department of Aging could help to reduce the General Fund

4 deficit would be to shift more Lottery funds into General

5 Fund programs.

6 Finally, we're very disappointed with the process

7 by which this consolidation proposal was created. To the

8 best of our knowledge, no stakeholder input was solicited by

9 the Administration from within the aging network. To assume

10 that the State can begin to undertake such a massive

11 consolidation effort in less than four months seems unwise.

12 We believe that any plan to dismantle several

13 cabinet-level departments, which has such deep and broad

14 consumer implications, deserves more careful consideration,

15 planning, and community input than appears to have been done

16 in this case.

17 We've already talked about the growth of our

18 population over age 60. The duties of the Pennsylvania

19 Department of Aging extend beyond serving those with

20 physical and mental health needs. It extends to promoting

21 engagement, wellness, and health for all older

22 Pennsylvanians regardless of income.

23 This reality clearly underscores the need for a

24 cabinet-level department representing our aging population

25 responsible for advocating for their needs and administering

28 1 the delivery of their services at the community level.

2 The needs and potential contributions of

3 Pennsylvania seniors are unique and specific.

4 Lottery-funded services are used by all seniors in the

5 Commonwealth. Think about transportation, insurance

6 counseling, prescription assistance, property tax rebates.

7 All seniors and their families likely take advantage of

8 these Lottery-funded programs. Seniors use Lottery-funded

9 programs to help others.

10 We have a volunteer at the agency where I work

11 at. She's 75 years old. She uses the reduced-fare

12 transportation. She pays her part, uses the reduced-fare

13 transportation to get to our senior center three days a week

14 to pack meals for about 200 homebound seniors that we then

15 deliver.

16 Vulnerable people who are unsure where to go for

17 help or how to access the help they need to age well also

18 use Lottery-funded services. Families need these services,

19 too.

20 Past experiences show us that seniors attach a

21 stigma to receiving help through a Public Welfare Office.

22 This department consolidation will likely further alienate

23 our aging constituents as their services are linked to

24 Public Welfare Programs. It will reduce the likelihood they

25 will seek help.

29 1 To support such a consolidation, we would need to

2 see clearly how absorbing the Pennsylvania Department of

3 Aging into a new super department will provide real cost

4 savings while maintaining or improving representation of and

5 services for our seniors. Short of this, we cannot support

6 the Department of Aging being dismantled.

7 Our members would be happy to discuss this

8 further. And I want to thank you again for having me today.

9 MAJORITY HEALTH CHAIRMAN BAKER: Thank you very

10 much. We appreciate your leadership on behalf of our senior

11 citizens and their rights and interests of the elderly. We

12 appreciate that.

13 We're going to move now to members' questions.

14 And we'll start with the Chair of the Aging Committee, Older

15 Adult Services, Chairman Hennessey.

16 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

17 HENNESSEY: Thank you, Mr. Chairman.

18 Rebecca, you had mentioned that you already have

19 in place a No Wrong Door Policy for the aging in

20 Pennsylvania. But I think it's important for you to talk

21 about that in a little more depth so that our members

22 understand that it's already in place in the aging segment

23 of our population in terms of delivering services to them.

24 How do you feel this would be somehow jeopardized

25 should a merger take place as proposed?

30 1 P4A EXECUTIVE DIRECTOR MAY-COLE: Thank you,

2 Chairman Hennessey.

3 To talk about the way that we feel, AAAs really

4 are a No Wrong Door. When you look at the local access, the

5 local person, the, you know, Mrs. Smith who is sitting in

6 her home right now, she is going to call her Area Agency on

7 Aging for help.

8 The Area Agency on Aging is going to help

9 facilitate, you know, whatever it is that she needs, helping

10 her figure out does she need to -- you know, what kind of

11 services does she need? Does she need a ramp? Does she

12 need home-delivered meals? Does she need home- and

13 community-based services in her home?

14 She is calling a single place, the Area Agencies

15 on Aging. There are 52 AAAs that cover all of our counties

16 because we have planning and service areas, some of which

17 cover more than one county. There are physical locations

18 local to these folks, local phone calls that they make.

19 It's in their zip code. They are calling the AAAs. The

20 AAAs are facilitating the discussions, the behind-the-scenes

21 work.

22 They're not calling necessarily the Department of

23 Human Services for questions about Medicaid. They're

24 calling the local AAA. And that's where we feel the No

25 Wrong Door, the one-stop shop, sort of happens locally. And

31 1 so that's where we feel -- that's what we have right now.

2 Folks aren't calling the State. They're calling

3 the local areas. That's where they are getting the

4 assistance that they need.

5 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

6 HENNESSEY: With regard to the -- some of you have alluded

7 to the changeover for the over-60 waiver, the Aging Waiver

8 in Pennsylvania, from AAAs to a new enrollment broker,

9 Maximus. That basically was for a population of 50,000

10 elderly who partake in that program.

11 The Community HealthChoices Program has about

12 420,000 seniors. Given how badly the Maximus takeover of

13 that function occurred, what do you see as far as the

14 420,000 population? What awaits them in terms of this kind

15 of a changeover?

16 Diane.

17 CARIE EXECUTIVE DIRECTOR MENIO: Yeah. I just

18 want to add to the No Wrong Door question as well because

19 this ties into this question.

20 People who are going through this new enrollment

21 system are still calling their local AAA when they need help

22 because it's the place that they know in the community. And

23 it's the people. A lot of people that are there, that's

24 where they go for help. They might go to a senior center.

25 They get to -- you know, the community-based agency is where

32 1 they go. And so they are still calling.

2 We're really dealing -- you know, we have very

3 grave concerns about a system that went online very quickly

4 last April. It's almost a year now. And it's still having

5 problems. We get calls from people who are waiting six

6 months just to get services.

7 So we have grave concerns that they're stuck at

8 home. They're ending up in nursing homes. They're ending

9 up in hospitals because their health is declining. Families

10 are getting stressed. We don't know what's happening in

11 people's homes all the time. So we try in our organization,

12 if they get to us, we try to help them get services. AAAs

13 are doing similar work.

14 So I think that we're very, very concerned about

15 the large numbers that will be taken on as a result of

16 Community HealthChoices. As I mentioned in my testimony,

17 doing this consolidation at the same time we're making this

18 massive change in the way long-term care is delivered in

19 Pennsylvania is very concerning.

20 I just have to say this because I say it -- we

21 say it every time we get a chance to say it. The way that

22 -- another issue that we're very concerned about is with the

23 new Community HealthChoices Program. There's no plan to

24 have an Ombudsman for people to call when they have a

25 complaint.

33 1 And so obviously the Maximus issue has given us

2 that real look on that need for someone for them to call to

3 kind of troubleshoot, you know, what happened to my

4 application? You know, sometimes there's a time limit. You

5 know, they're supposed to be processed within 60 days. But

6 then we learn that there's a lot of times when the

7 application stops and starts over again. So that's how we

8 end up with people waiting those long, long times to get

9 services.

10 So we are very concerned about the fact that

11 people will not have a place to call to make a complaint, an

12 advocate to be able to help them. And whenever you have

13 this kind of change, no matter how well-meaning it is -- and

14 I'm sure it is well-meaning -- you're going to have

15 problems. People have problems. We are very concerned

16 about it.

17 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

18 HENNESSEY: With regard to the Department of Aging, the

19 adage that comes to mind more than anything else is if it

20 ain't broke, don't fix it. I said earlier in my opening

21 comments, I think the Department of Aging functions

22 extremely well and extremely smoothly and efficiently.

23 So I don't know that there's any need to include

24 that in the merger if the merger goes through at all. And

25 what we've heard as a recurring theme from four or five

34 1 hearings that we've had and the Senate hearing that was held

2 last Wednesday or Thursday, people were saying, it's coming

3 at us way too fast. Even if it was a good idea, there's no

4 way that we can do this in the time frame that it's being

5 proposed. I think I've heard that in your testimonies as

6 well.

7 Thank you for standing up and making that point

8 of view heard.

9 Thank you, Mr. Chairman.

10 MAJORITY HEALTH CHAIRMAN BAKER: Thank you,

11 Chairman Hennessey.

12 Representative Mary Jo Daley.

13 REPRESENTATIVE DALEY: Thank you, Mr. Chairman.

14 Thank you, all, for your testimony today. I

15 think in listening to you, it's very clear that you have big

16 concerns and valid issues that should be brought forward in

17 this discussion. It seems like the process is moving

18 forward.

19 What I'm wondering is, if you could each just

20 talk about -- I think, Rebecca, you did this in your

21 testimony. You talked about you had formed a task force and

22 you would look at how this would affect you and you came up

23 with your list of what you would like to see. But I think

24 that it's really important to find a way that maybe even if

25 you could lead something with these other organizations --

35 1 well, I guess what I'm trying to say is, I think it's

2 important to be able to find a way that if this does happen,

3 these are your main concerns, which you all did a good job.

4 I mean, it's very clear. I think everybody sitting in this

5 room is worried about the Lottery funds, also worried about

6 being a very small voice in a very big room and clearly

7 having an important constituency to represent.

8 So I thank you for that. But I think if you

9 could also think about if this does move forward, how does

10 everyone work together to ensure that it works so that

11 seniors continue to be represented so that they can continue

12 to get their questions answered and not feel lost in the

13 fray?

14 Certainly with 25 to 28 percent of the

15 population, which I think a couple people talked about those

16 numbers, they have a big voice. And there a lot of

17 advocates for the seniors, including a lot of us here as

18 Legislators. But considering the budget pressures that this

19 State has been under, I think that is what is leading to

20 this idea of consolidation despite whether or not a lot of

21 it is coming from -- you know, State funds going to the

22 departments.

23 But that's what I would ask you. And I'm not

24 asking -- I don't want to put you on the spot right here

25 today to even provide an answer. But I think that clearly

36 1 there's going to be stakeholder input. And clearly you

2 three all have a really good view on this. But I would also

3 look at it in a way that how do we actually work to make

4 this work if, in fact, it continues to move forward in the

5 way that it looks like.

6 So thank you so much for being here and for your

7 testimony today.

8 And if you do want to comment, that's okay.

9 P4A EXECUTIVE DIRECTOR MAY-COLE: I did mention

10 it briefly in our testimony. You know, if the consolidation

11 were to occur, there's several levels of, you know,

12 priorities. It would be having a cabinet-level Secretary,

13 having a separate office.

14 Right now it's been proposed, at least the last

15 that we've heard, as an Office of Aging and Adult Community

16 Living. And we still very strongly feel that there are

17 unique needs of seniors that need to be addressed and

18 recognized.

19 And so having a separate Office of Aging perhaps

20 could be one way of dealing with it. And then the third

21 item that I had mentioned in the testimony was that

22 consolidating the functions so aging-related services and

23 funding would fall within that Office of Aging so that there

24 is that kind of unified look at what it is that seniors

25 need.

37 1 Those are the three things that I had mentioned,

2 of course, in my testimony.

3 REPRESENTATIVE DALEY: Okay. Thank you.

4 Thank you, Mr. Chairman.

5 MAJORITY HEALTH CHAIRMAN BAKER: Representative

6 Hill.

7 REPRESENTATIVE PHILLIPS-HILL: Thank you, Mr.

8 Chairman.

9 Ms. May-Cole, you spoke with regard to some

10 concerns about these Independent Enrollment Brokers. And

11 I've heard similar concerns from our Area on Aging in York

12 County. I guess what I wanted to say or see if you know is

13 that when they made the decision, the Department of Human

14 Services made the decision, to transfer the enrollment

15 function to that Independent Enrollment Broker, what has

16 been asserted to me is that there are a lot of efficiencies

17 lost that our older York Countians were perhaps forced into

18 facilities as opposed to being able to stay home and receive

19 these services that are in a way maybe less costly. Let's

20 face it. We all want to stay in our own homes as long as we

21 possibly can.

22 Have you made any attempt to quantify, you know,

23 what has transpired there? Do we have data that shows us

24 it's actually costing us more? Are we just basing this on,

25 you know, sort of -- I don't want to say hearsay, but just

38 1 anecdotal evidence? Have there been any attempts to

2 quantify the cost to Pennsylvania for making this transition

3 to these independent brokers?

4 P4A EXECUTIVE DIRECTOR MAY-COLE: To quantify the

5 cost, we have not been involved with anything to

6 specifically find, you know, what the cost implications have

7 been. We have been involved with tracking across the State

8 numbers of people who originally were, you know, put in

9 under the new Independent Enrollment Broker and the length

10 of time it's been taking. A lot of our AAAs have actually

11 really bent over backwards to keep assisting people, whether

12 it's, you know, helping them with finding the forms, filling

13 out the forms, helping to coach them along the way, you

14 know, phone calls they need to make, just explaining what

15 the process will be.

16 So we certainly -- and I don't have anything here

17 right in front of me today. But we have worked to get an

18 idea in each county. Really there's specific information

19 about how long it has taken folks and folks who have fallen

20 through the cracks who we've gone back to try to address and

21 find what happened with them and can we restart the process

22 or get them back in line and going.

23 REPRESENTATIVE PHILLIPS-HILL: I mean, I

24 certainly think that, you know, regardless of what decision

25 is made going forward, whether these agencies stay as they

39 1 are or whether they're consolidated, that's probably

2 something that we need to address because we need to find

3 every efficiency that we possibly can.

4 And so anything that's costing money and

5 decreasing quality of care for people is something that we

6 do need to address. So any information that you could

7 possibly share with our Chairmen, our Aging Committee, our

8 Health Committee would be greatly appreciated.

9 Thank you.

10 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

11 Representative DeLissio.

12 REPRESENTATIVE DeLISSIO: Thank you, Mr.

13 Chairman.

14 It's interesting that 1978 was the year that the

15 Department was founded. That was the same year I graduated

16 Penn State, a Health Policy and Administration major,

17 because they had no such major as long-term care. So to get

18 any of those courses, I had to go outside of my college in

19 order to have that concentration.

20 And there was two reasons I had chosen long-term

21 care. It, in fact, was if you looked at the demographics of

22 Pennsylvania, it was going to be a field that you'd be able

23 to be employed in as long as you wanted to because there

24 were a lot of older adults 40 years ago. And there

25 certainly are as many, if not more, now and, as you ladies

40 1 have projected, will continue to be.

2 And I dare say a good majority of the people in

3 the room fall into the category you were representing, 60

4 and up, a few that are younguns, but most of us are near 60

5 or on the other side of it.

6 And I think if indeed -- and this is not a dis in

7 any way, shape, or form, for this Secretary sitting here

8 today or any Secretary before that for the Department of

9 Aging. If this Department had been as stellar as I think we

10 had all hoped, Pennsylvania would indeed be on the cutting

11 edge of policy for aging citizens in Pennsylvania. And we

12 are not.

13 In fact, I have seen things happen in those 40

14 years that the Department hasn't been able to stop or impact

15 because it happens in departments outside their purview. So

16 I remain highly interested in this idea and concept of

17 reimagining government within this larger agency.

18 Like Acting Chairman Daley had said, I hear all

19 the concerns. And I think that the timeline, too -- I can't

20 quite get my head around how this timeline is going to trip

21 magically July 1 and be smooth, etc., etc. But the concept

22 I think still has tremendous merit.

23 When we talk about things, you know, regulation

24 and reimbursement fall primarily under Health and Human

25 Services now. I don't know if the everyday consumer knows

41 1 that or the everyday citizen.

2 Those are issues that are not impacted by the

3 Department of Aging. The Lottery, the discussion about the

4 Lottery, kind of makes me chuckle in a way. I've been here

5 six years under two gubernatorial administrations. The

6 Legislature, the folks in this room, are the ones voting on

7 that budget that saw the transfer of those dollars to things

8 other than what the Lottery Fund is designated for.

9 So, in essence, when you testify, I want to be

10 clear to my colleagues, what I'm hearing is -- and perhaps

11 rightfully so, they don't trust the Legislature to do their

12 job and keep true to what the Lottery Funds' intent is for.

13 You know, I don't know whether that will be

14 exacerbated under a consolidated agency. Personally, I

15 think not, because the Legislature's role is not going to

16 change as it pertains to the Lottery Fund. We're here at

17 the other end of the day as well as we are here today.

18 Maximus is an interesting area. I sat through a

19 hearing in October of the Senate and Aging Committees in the

20 House and Senate. And I picked up a good piece of the

21 hearing. I had some other commitments that morning. But

22 I'm wondering if the consolidation had been in place that

23 the Deputy Secretary of Aging wouldn't have been

24 well-situated and well-suited to intervene in that before it

25 became the bit of a cluck fester it is today and has been.

42 1 So the idea of a Deputy Secretary as well having

2 conflicts with perhaps their Secretary is interesting

3 because as I understand it, most of the agencies are set up

4 with Dep Secretaries. They all oversee different functions

5 within the Agency. And I think they represent these

6 functions well to the Secretary.

7 So in listening, I'm taking down all of the

8 concerns at this point to ensure that those concerns are

9 factored into the larger discussion as well. And again,

10 this detail is still coming out. As of this time, I also

11 see this as a potential serious benefit for our older

12 citizens in Pennsylvania.

13 Mr. Chairman, I have no questions.

14 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

15 Representative Dush.

16 REPRESENTATIVE DUSH: Thank you, Mr. Chairman.

17 For the second time in a row, I end up following

18 Representative DeLissio. And again, I'm going to mirror

19 some of her comments. I do have a feeling that we do need

20 to take a look at consolidating some of these services. We

21 do have a lot of duplication of effort.

22 But I'm going to reiterate, because I still

23 haven't received any responses since the hearing we had two

24 weeks ago with the Secretaries, I have a lot of concerns

25 about how fast we're pushing this stuff through. I'd like

43 1 to get some information from the Department, as I said two

2 weeks ago, on who your staff are who are the key players and

3 if any of them have had any experience in mergers of any

4 type.

5 We're looking at a $40 billion process that's, as

6 Chairman Hennessey pointed out, bigger than all but five

7 states' entire budgets. It also puts us into a Fortune 100

8 Company level. And yet, I don't know of any staff who have

9 had that kind of merger experience under their belt.

10 That is a grave concern especially given the

11 timeline that we're looking at in putting all this stuff

12 together. What happened with Maximus is a prime example of

13 exactly why these concerns have to be addressed. We had

14 people dying waiting for those services. My constituents,

15 they're not numbers. They're people.

16 Rebecca, you threw some excellent questions out

17 there. A lot of the concerns, I'm not going to reiterate

18 them. What I would appreciate is if you would provide your

19 written testimony to the Secretaries as well as to the

20 Chairmen, I would like to have responses back from the

21 Departments on how those concerns are going to be addressed,

22 something in writing that I can actually take a look at.

23 We are fast approaching this deadline. Ladies

24 and gentlemen, I voted for the Budget hoping that we were

25 going to have something solid to work with. We're just over

44 1 70 days away from that thing right now. And I don't have

2 anything that I can place any confidence in. That is my big

3 concern.

4 I don't have a mission statement from you guys,

5 either for the Department as a whole or as to what the

6 different sub bureaus or offices are going to be. I don't

7 have any identified outcomes as to what the services are

8 going to be under those new mergers. I don't have anything

9 that tells me what the conflicts of interests are with the

10 mergers. I don't have anything that identifies the duties

11 of the Deputy Secretaries or the senior management.

12 I don't have any real numbers as to what the

13 specific savings are going to be. If we're going to be

14 pushing this through and expect to be starting to operate

15 around the 1st of July, I don't want people dying as a

16 result of people just haphazardly putting this stuff

17 together without solid information.

18 How do we do this with people's lives on the

19 line? I want the savings. I want the consolidations where

20 it makes sense. But you haven't shown me what you're going

21 to do that makes sense. I haven't got a scrap of paper.

22 We're 70-some days away from this. We need something out of

23 these Departments.

24 Thank you.

25 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

45 1 Representative Ryan. Full bird colonel.

2 REPRESENTATIVE RYAN: No, I have not been

3 promoted to General, but thank you.

4 I'm Representative Frank Ryan. Just a very quick

5 question. I've been to (inaudible) organizations for 40

6 years of my life. And in doing that, I would typically see

7 an operating plan in extreme detail before we would approve

8 it. I've not seen anything like that.

9 We've heard testimony from three prior reps

10 speaking about that. So it's generally speaking pretty

11 imprudent for it. But the same token, we're $3 billion

12 short on the budget. And that is without addressing the

13 fact that we've got a $74 billion -- in my mind $110 billion

14 unfunded pension liability.

15 Have you come back with any type of ideas where

16 we could change the delivery model to, as Representative

17 DeLissio said, come up with a more modern, more effective

18 delivery model, that puts us state of the art rather than

19 behind the eight ball?

20 Have you considered something so we have

21 alternatives to look at? Because again, without looking at

22 a very specific detailed operating plan, I'd be very, very

23 concerned about implementing something. But by the same

24 token, I do recognize that we have a fiduciary

25 responsibility of 3 billion and to take care of the

46 1 pensioners of the Commonwealth as well as property tax

2 owners and taxpayers.

3 Any thoughts?

4 CARIE EXECUTIVE DIRECTOR MENIO: Well, I just

5 have to say you have a lot more experience than I do in

6 these things.

7 REPRESENTATIVE RYAN: I'm also a senior citizen.

8 CARIE EXECUTIVE DIRECTOR MENIO: I'm there

9 myself.

10 But I wanted to respond to your question by

11 saying it would be kind of a shame to go ahead with this

12 without the good planning. I have been involved in enough

13 business planning and those kinds of things to understand

14 that you need to come up with a good plan. You need to

15 understand where the roadblocks might be and where the

16 savings is going to come from.

17 I think it would be a shame to make this big

18 consolidation without actually realizing what it's intended

19 to do, which is save money in the State Budget.

20 And I apologize to you because we don't have any

21 answers for you because we got this information so recently.

22 We haven't really had that opportunity. We're kind of in

23 defense mode at the current time. At the same time, we've

24 also been doing a lot of advocacy around Community

25 HealthChoices and other things and the Independent

47 1 Enrollment Broker and many of the other things that are

2 happening right now that impact older adults.

3 So we haven't had the time as, you know, the rest

4 of you haven't had the time to come up a good plan for this.

5 So that's part of the reason we say, step back and make a

6 plan.

7 You know, we talked to one large state that made

8 this change and didn't have quite the structure we have in

9 terms of having a cabinet-level position. But it took over

10 three years to do this. And that's what a good plan takes.

11 It doesn't take six months. It takes years.

12 REPRESENTATIVE RYAN: Just one final comment.

13 Representative DeLissio, in the time I've gotten

14 to know her, has got some tremendous experience. I can't

15 speak for her. But I'm sure she'd be willing to help.

16 We've got to come up with some solutions rather

17 than just saying, this wouldn't work, let's not do anything

18 because the money is not there.

19 Thank you.

20 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

21 Chairman DiGirolamo.

22 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

23 Thank you, Matt.

24 First, the three of you did a terrific job,

25 really a terrific job. I absolutely share concerns. And

48 1 just a quick question for the three of you. Have any of the

2 three of you had meetings with anybody from the

3 Administration or any of the Secretaries?

4 P4A EXECUTIVE DIRECTOR MAY-COLE: There was a

5 stakeholder meeting about a month ago, I believe it was,

6 with the Governor's Policy Office that we had. It was more

7 of an opportunity for us to share our thoughts and concerns.

8 I understand that there's another stakeholder

9 meeting that's coming up. There's, I believe, several of

10 them. I know ours is going to be happening on -- I think

11 it's Wednesday to get more information.

12 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

13 Did you get any details on how this is going to

14 work? No details?

15 P4A EXECUTIVE DIRECTOR MAY-COLE: No, not yet.

16 CARIE EXECUTIVE DIRECTOR MENIO: And I will say

17 that there was a stakeholder call right before the official

18 announcement of this and we were not invited.

19 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO: Oh,

20 you were not invited?

21 CARIE EXECUTIVE DIRECTOR MENIO: No. I know that

22 Rebecca was on that.

23 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO: So

24 no details on how this is going to work as far as the

25 Department of Aging is going?

49 1 CARIE EXECUTIVE DIRECTOR MENIO: No.

2 SWPPA PRESIDENT DOMAN: No.

3 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

4 Don't feel too bad. I don't have any details

5 either on how this is going to work.

6 We actually have our very first meeting I think

7 on Wednesday with the Chairman. So here we are 70 days out

8 and I don't have any details either.

9 But guess what we have? We have a cosponsorship

10 memo in the House that was sent out last week. Nice

11 document. Sounds really, really good. No details in the

12 cosponsorship memo either. It just talks very nicely about

13 how this is going to work and what a big improvement this is

14 going to be, 70 days out.

15 And I'm going to end it with this. I have a

16 cosponsorship memo out also with Representative Seth Grove,

17 which says that this will not be implemented, this

18 consolidation plan, until the Legislative Budget and Finance

19 Committee and Joint State Government Committee, the two of

20 them combined, do a study, one on the financial aspects of

21 doing this, the other on the programs and how it's going to

22 affect the programs. And it gives them a year to do the

23 study and then come back and report back to the General

24 Assembly whether this is feasible, a good idea, a bad idea,

25 or not.

50 1 It makes a whole hell of a lot of sense to me.

2 You talk about -- somebody said in your testimony, rush

3 forward. This to me -- this to me is really moving and

4 rushing forward without having any details of how this is

5 going to work and how it's going to affect our most

6 vulnerable citizens in the State of Pennsylvania.

7 I thank the three of you for your testimony.

8 Thank you, Mr. Chairman.

9 MAJORITY HEALTH CHAIRMAN BAKER: You're welcome.

10 Representative Kaufer.

11 REPRESENTATIVE KAUFER: Thank you, Mr. Chairman.

12 I'll be very brief. I just have one question.

13 Besides not using Lottery funds for other

14 departments or the vice versa that this might be absorbed by

15 other departments, we also hear about Maximus and no input

16 from Aging Services stakeholders, which is a major concern

17 of mine.

18 Can you give me an example from this

19 Administration that should give me faith that older

20 Pennsylvanians will be prioritized?

21 P4A EXECUTIVE DIRECTOR MAY-COLE: I would suggest

22 that having a department-level, a cabinet-level Secretary is

23 currently providing that prioritization.

24 CARIE EXECUTIVE DIRECTOR MENIO: And, you know, I

25 would just add that while we do this advocacy, I do believe

51 1 that we need a strong voice at that level. We need a voice

2 that is the advocate that was envisioned back in 1978.

3 Again, you mentioned Maximus. We need a strong

4 advocate to make sure that -- and this is part of what needs

5 to happen when you have these different departments. They

6 need to be advocating for the population they're concerned

7 about. The people who are aging in Pennsylvania need an

8 advocate.

9 And if you put everyone in one big department,

10 you lose that advocate. I mean, yes, we can advocate from

11 within. And you see that in many cases. But the power

12 structure is missing. And so, you know, I often say that

13 once we get done, if the Department of Aging does survive,

14 we need to keep advocating to make that a stronger

15 department than it already is.

16 REPRESENTATIVE KAUFER: And I appreciate that

17 because it sounds like that's at least the one thing that

18 we'd be losing in the consolidation. Your silence is

19 deafening on this issue that we can't name one thing that

20 gives us faith that this will move forward in a proper and

21 good way of showing a good sign of faith already.

22 Thank you for that. I appreciate your testimony.

23 CARIE EXECUTIVE DIRECTOR MENIO: Sure.

24 MAJORITY HEALTH CHAIRMAN BAKER: And the last

25 question in order to try and stay on schedule for the next

52 1 panel, Representative Tallman.

2 REPRESENTATIVE TALLMAN: Thank you, Chairman

3 Baker, for the opportunity.

4 I'm going to ask questions. I'm going to say

5 something that I did say to our Agency heads. Maybe our

6 Chairmen should bring our Agency heads back for a second

7 go-around. Just a suggestion.

8 In the private sector, I've been involved with

9 three consolidations. One actually went according to plan,

10 achieved the goals that it was desired. Two did not. One

11 was just a horrendous disaster on the part of the company.

12 So consolidations need to be done very carefully.

13 And I liked what Representative Ryan said. All

14 the consolidations I've been involved with had a very

15 detailed -- I'm going to refer to it as a perk chart, which

16 is an old-time way we did projects. There's newer

17 methodologies today. But the time frame with those

18 consolidations typically were a half -- you know, a

19 full-year-type operation. And we're doing this much, much

20 more quickly, nor do we have numbers.

21 So my question to you is, the Governor is

22 proposing this as a methodology of cost savings. We haven't

23 identified any cost savings. And typically cost savings in

24 the private sector when we did consolidations, people lost

25 their jobs. Yet the Governor said, we're not going to loss

53 1 jobs. That's how you get cost savings. That's the easiest

2 way to get cost savings.

3 So where do you folks see in this consolidation

4 -- by the way, I'm 70. So I fit right in. So where do you

5 guys see -- where's the cost savings? I know you're not an

6 agency head. But where do you see outside agencies that

7 have to deal with this, where would you see efficiencies or

8 cost savings?

9 SWPPA PRESIDENT DOMAN: Well, with respect to the

10 Department of Aging, we don't see any cost savings since the

11 General Fund monies are not used for the Department of

12 Aging. The only thing that we could see would be that the

13 Lottery Fund would be used in a different way than they have

14 been.

15 REPRESENTATIVE TALLMAN: Well, a very significant

16 portion of Human Services is Aging programs.

17 SWPPA PRESIDENT DOMAN: Pardon me?

18 REPRESENTATIVE TALLMAN: A significant portion of

19 Human Services is Aging programs.

20 CARIE EXECUTIVE DIRECTOR MENIO: Yeah, you're

21 absolutely correct there. And, you know, certainly it is

22 true that, you know, when we talk about what is

23 traditionally handled by the Department of Aging, it is not

24 General Fund money. But certainly there are many programs

25 in the Department of Health and the Department of Human

54 1 Services that are programs for the elderly and mainly

2 Medicaid programs.

3 And so, you know, it's very -- that's a very

4 tough question to answer. You know, we're not really sure.

5 I think that, you know, we've been told that the Community

6 HealthChoices was not a cost-saving measure either. I don't

7 know how that's going to work out.

8 One of the things we did see -- someone asked a

9 question about the Independent Enrollment Broker earlier and

10 the costs. I think you were referring to the costs of, you

11 know, how many more people go into nursing homes and so on.

12 But I think it's also important to look at the

13 cost of that contract. We do have a copy of the contract

14 and did some of the math. It's a little challenging because

15 part of it is for just Aging Waiver and part of this was the

16 emergency procurement contract, part of it is for -- the

17 ongoing contract is for both under 60 and over 60. So it's

18 hard to discriminate what's aging, except we know that

19 almost half of the waivers are -- Aging is almost half of

20 the waivers.

21 And so what we figured out, and it's kind of a

22 vague number, but it's at least five to six times as much as

23 being spent on that contract than was actually provided to

24 the Area Agencies on Aging in 2015 because they were getting

25 $95 per enrollment. And now I think the number -- and this

55 1 is including all of the waivers -- is somewhere around

2 $650,000 a month, plus $45 per enrollment.

3 So we're talking about -- and in 2015 when we

4 figured out what the AAAs were paid, it was about $660,000

5 for the year for enrollments. So we're talking about

6 something that actually ended up costing a lot more.

7 And so that's one of the things I worry about as

8 well. As we make these changes, we still don't really know

9 what the managed care plans -- you know, how that's going to

10 work with the system and, you know, in terms of the

11 Community HealthChoices. We don't have enough information

12 to even begin to talk about this.

13 REPRESENTATIVE TALLMAN: Thank you.

14 And just to the Chairmen, if we can get the

15 Agency heads back because, as you can see, many of our

16 questions are not being answered with any type of details or

17 specificity.

18 Thank you.

19 MAJORITY HEALTH CHAIRMAN BAKER: Thank you,

20 Representative Tallman.

21 Before we let you go, we just want to thank you

22 for your testimony, for answering all the questions, and for

23 your gracious time. Very probative, salient issues that you

24 have proffered in your testimony. Many questions need to be

25 answered.

56 1 I continue to have a concern about the cost

2 savings, allegedly $90 million for the consolidation, half

3 of which would come from the dispensing fee, as I understand

4 it, through the PACE/PACENET Program and worked within that,

5 embedded within that, is the presumption that CNS is going

6 to approve the lowering of that dispensing fee. And we do

7 not know that because, as I understand it, they have not

8 approved such a low dispensing fee.

9 So I'm not sure the numbers work. I believe that

10 we need a lot more answers. And I also believe that perhaps

11 we're moving a little bit too quickly here on this. And

12 particularly, I've made it known to the Cabinet Secretaries

13 as well that one of the big ifs is, what's Congress going to

14 do? Are they going to repeal and replace Obamacare? And

15 how is that going to impact all of these agencies?

16 I'm just not sure about the timing right now. I

17 think we need to be open-minded about some other

18 alternatives and options.

19 But thank you very much for your testimony. We

20 really appreciate it.

21 P4A EXECUTIVE DIRECTOR MAY-COLE: Thank you.

22 CARIE EXECUTIVE DIRECTOR MENIO: Thank you.

23 SWPPA PRESIDENT DOMAN: Thank you.

24 MAJORITY HEALTH CHAIRMAN BAKER: Our next panel

25 will be from the health sector. We have Hannah Wesneski;

57 1 Richard Edley, President and CEO, Rehabilitation & Community

2 Providers Association; and George Hartwick, Dauphin County

3 Commissioner, on behalf of CCAP, County Commissioners

4 Association of Pennsylvania.

5 I note the presence of Commissioner Ed Bustin

6 from Bradford County. I'm not sure if there are other

7 county commissioners here as well, but welcome. Glad to

8 have you with us.

9 We'll begin with Hannah. If you would kindly

10 introduce yourself and begin with your testimony.

11 MS. HANNAH WESNESKI: Yes. Thank you.

12 My name is Hannah Wesneski. I'm a former LIHEAP

13 worker, income maintenance caseworker, and income

14 maintenance caseworker supervisor. I also worked in

15 long-term care in waiver services.

16 Even though I do not currently work for the

17 Commonwealth, I still care very deeply for the citizens of

18 PA. And I wanted to bring to your attention the importance

19 of keeping our County Assistance Offices local.

20 There are currently 96 County Assistance Offices,

21 or CAOs, as we call them.

22 MAJORITY HEALTH CHAIRMAN BAKER: If I could

23 interrupt.

24 MS. HANNAH WESNESKI: Sure.

25 MAJORITY HEALTH CHAIRMAN BAKER: She does have a

58 1 PowerPoint presentation. If the members want to move or get

2 a better view, feel free to do that.

3 And if you could bring your microphone a little

4 closer, that would be great.

5 MS. HANNAH WESNESKI: Okay.

6 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

7 MS. HANNAH WESNESKI: You're welcome.

8 So again, there are currently 96 County

9 Assistance Offices, or CAOs, operating in PA. Each county

10 has at least one CAO, with more populated counties have

11 multiple offices.

12 So here's just a quick look at Governor Wolf's

13 proposal. His proposal is to reduce the local County

14 Assistance Offices and construct five mega processing

15 centers. The first two anticipated locations are Erie and

16 Pottstown. Each center will house about 500 workers. Right

17 now there's approximately 4,000 workers or IMCWs with 500 in

18 each center. That's a significant job loss.

19 This map right here shows where proposed

20 locations could be. Darker counties are more likely

21 locations with prime areas outlined in red. As you can see,

22 a large part of the State is left out, especially the rural

23 areas, which already face difficulties with phone services,

24 transportation, and Internet access. The proposed locations

25 will make it even more difficult for our rural residents.

59 1 These proposed locations also have high turnover

2 rates, which will lead to less skilled workers, longer

3 processing times, and increased errors.

4 Having worked in both the County Assistance

5 Office and Processing Center, I can point out a few

6 differences between the two offices. Local assistance

7 offices are very client focused. They work with a client

8 closely to accurately complete the application in a timely

9 and efficient manner. They schedule phone interviews and

10 also conduct face-to-face meetings when talking over the

11 phone is too difficult.

12 The Processing Center is more project focused.

13 They excel in helping larger counties with overdue work and

14 application backlog and are great for special projects.

15 However, this was also a challenge as clients had

16 a really hard time understanding why, when they applied in

17 one county, they had to speak to another worker in a

18 different county that doesn't know their situation. They

19 often had to meet with their caseworker in their home county

20 to access other benefits that they may need or submit other

21 verifications.

22 Scanning was also an issue as sometimes the

23 images were not legible or a narrative was incomplete,

24 making the Processing Center jobs very difficult.

25 Here are some of the negative impacts it will

60 1 have on our clients. Clients will lose direct contact with

2 their local caseworker. It is much easier for a client to

3 explain their situation to one local caseworker rather than

4 having to explain repeatedly to multiple workers in

5 different locations.

6 Workers will get to know their clients and can

7 understand their situation, making it more likely that they

8 will be able to offer services that make sense for their

9 family. They're also telling their story once rather than

10 having to explain their oftentimes painful situation

11 multiple times.

12 If the proposal goes through, clients would

13 likely be talking to someone in one location, sending in

14 documents to another, the work may be processed by another

15 worker, and then clients may meet another worker

16 face-to-face for assistance. How is this making processing

17 more accurate? How is this more efficient?

18 One resolution was to push for more on-line

19 applications and submitting of documents, including a new

20 app for Smartphones. I think we've all struggled with

21 technology at some point. But our elderly and disabled

22 clients are more likely to struggle with applying and

23 submitting verifications online.

24 Lower income households are also less likely to

25 have access to technology required to complete applications

61 1 online and submit verifications electronically. How is this

2 helping our most vulnerable citizens?

3 If you're not familiar with Compass, the online

4 application, I encourage you to go on and attempt to fill

5 out an application, but not submit, to see how difficult it

6 is to navigate.

7 Current PA Compass usage is less than one-third

8 of submitted applications. Compass has been around since I

9 started as a worker in 2010 and yet one-third of the apps

10 are on Compass. That should speak volumes.

11 Our local caseworkers know how to help their

12 clients. It's not likely that a caseworker hours away will

13 be familiar with the services that are available in the

14 local communities or be able to explain how to access those

15 services.

16 For example, in Tioga County, the Food Banks are

17 only open on certain days, certain churches are willing to

18 assist clients in their communities, CCIS childcare is

19 located in a neighboring county that operates on certain

20 days in a housing complex, local workers are also more

21 likely to know what employers are hiring, when and where job

22 fairs are being held, what daycares have vacancies and what

23 ages they will accept. The local service providers and the

24 Assistance Office work together to provide the best services

25 for the clients.

62 1 While not the norm, welfare fraud and abuse do

2 happen. And local workers are more likely to be able to

3 prevent and detect abuse and fraud. Local workers are more

4 likely to find out things about people in their own

5 community than a worker hours away.

6 With the expected high turnover rate, the

7 referrals to the Office of Inspector General would be very

8 far and few between. Many workers have the mindset to close

9 their eyes and authorize to get their numbers up and their

10 work done.

11 Long-term care. Governor Wolf has proposed an

12 increase in home- and community-based service programs. Yet

13 Ted Dallas wants to reduce all CAOs to storefronts. How is

14 your 80-year-old mother and father going to navigate this

15 complicated process? Nursing homes or community partners do

16 not determine eligibility; skilled caseworkers do.

17 Statistics from the CDC and the Pennsylvania

18 Healthcare Association, two-thirds of people that reach age

19 65 will need long-term care during their lifetime. And they

20 will receive care for an average of three years.

21 The number of American s over age 65 is expected

22 to double from 40.2 million in 2010 to 88.5 million in 2050.

23 PA is the fourth in the nation for their percentage of

24 people 65 and over. The median annual cost for a

25 semiprivate room in a PA nursing home is $108,847.

63 1 The need for long-term care will likely be

2 increasing over the next few decades. Long-term care

3 workers receive additional training and experience. Skilled

4 long-term care workers that have developed relationships

5 with their local providers will be key at managing the costs

6 associated with this care while still providing the care

7 that our older generation deserves.

8 It has been suggested that all long-term cases

9 may be handled out of one processing center. By

10 consolidating long-term care to one office, you're forcing

11 poor families to have to hire an attorney, which can cost

12 thousands of dollars, just to submit an application when

13 they would have been able to meet with their worker

14 face-to-face to figure out difficult situations.

15 Governor Wolf and Secretary Dallas are using

16 clever wordplay to minimize and hide the negative impact on

17 consolidating the Assistance Offices into regional

18 processing centers.

19 I'd like to address some of the phrases and

20 statements that have been put out. Back office and front

21 office. Governor Wolf and Secretary Dallas have both talked

22 about moving the back office functions to processing centers

23 to reduce the physical footprint of CAOs. There truly is no

24 such thing as front office or back office.

25 This proposal will not affect service delivery

64 1 and will improve the way that we do business. As I

2 mentioned before, the proposal splinters the services,

3 forcing the client to call one location, mail documents to

4 another, and meet another worker face-to-face.

5 Clients will not have one caseworker that they

6 can call. Caseworkers will have to reconstruct the case

7 each time they work on something, leading to delays,

8 possible errors, and frustration for clients who have to

9 repeat their situation every time they talk to someone new.

10 It was also said CAOs will maintain a presence in

11 each county. CAOs' clients will not be impacted, as

12 storefronts will remain. Storefronts with minimal staff

13 will not be able to meet the needs of the local communities.

14 Ted Dallas stated that all clients will still have access to

15 all services at their CAO.

16 This may simply mean a computer to apply for

17 services with a clerical staff to assist them on the

18 computer. Storefronts may be able to hand out applications

19 and accept paperwork but will not have sufficient staff to

20 answer questions, handle emergency situations, refer clients

21 to community resources, etc.

22 Community partners. It has been suggested that

23 community partners can help meet the needs for the clients

24 in the counties. The McKinsey Report even suggests kiosks

25 located in other locations in the community. Income

65 1 maintenance caseworkers have an initial eight weeks of

2 training with frequent training throughout. Policy is

3 complicated and updated and clarified all of the time.

4 When I was personally in training, my mentor told

5 me that it takes a minimum of two years before you're even

6 comfortable being a caseworker due to all of the changes

7 that take place.

8 Community partners are more likely to get clients

9 outdated or inaccurate information that will lead to

10 additional frustrations.

11 In closing, just a statistic from the Tioga

12 County Assistance Office. They see about 800 clients per

13 month. This does not include those that are just picking up

14 applications or dropping off verifications. This is

15 face-to-face contact. They are not just numbers on a

16 dashboard. They are fathers, mothers, sisters, brothers,

17 grandparents, aunts, uncles, and children. They are PA

18 residents that deserve to have a local caseworker.

19 If you do not have a local office to go to, I

20 fear they are going to be in your office.

21 Thank you for your time.

22 MAJORITY HEALTH CHAIRMAN BAKER: Thank you very

23 much, Hannah. We appreciate the presentation.

24 MS. HANNAH WESNESKI: Thank you.

25 MAJORITY HEALTH CHAIRMAN BAKER: Richard Edley,

66 1 welcome.

2 RCPA PRESIDENT & CEO EDLEY: Thank you.

3 And I'll echo the comments from earlier in the

4 first panel in thanking all of you for taking this much time

5 on this important issue.

6 My name is Richard Edley. I'm President and CEO

7 of RCPA, the Rehabilitation & Community Providers

8 Association. We're a statewide association representing

9 over 330 providers and other members of health and human

10 services across the Commonwealth, serving well over a

11 million Pennsylvanians annually.

12 RCPA is one of the largest and most diverse

13 health and human services agencies of its kind in the

14 country. And I want to come back to that point a little bit

15 later in my testimony.

16 What I'm going to be doing here is just providing

17 a summary and talking on a few of the key points. I gave

18 you, obviously, the written testimony for time and just to

19 answer any questions.

20 First and foremost, I did want to make it clear

21 that RCPA is supportive of this proposed consolidation and

22 the development of a new and unified Department of Health

23 and Human Services. Our association views the consolidation

24 as an opportunity to modernize and streamline an outdated

25 system and to find efficiencies, all of which should lead to

67 1 better service and potentially freeing up dollars for better

2 use in the community.

3 Simply put, as providers who are often pushed to

4 be as efficient and streamlined as possible, when we hear

5 the Governor and the Administration saying they would like

6 to be efficient and streamlined and potentially save money,

7 it's hard for us not to support that at the highest level.

8 I understand the concerns and I'll come back to that as

9 well.

10 The second reason why we feel comfortable in

11 supporting this is I wanted to remind people that RCPA is

12 actually the merger of two historical associations that

13 occurred about four years ago.

14 We brought together these two large associations

15 under one umbrella association because we really felt that

16 it was the best way to coordinate, to collaborate, to share

17 information, to develop best practices, so today our

18 providers serve mental health, drug and alcohol,

19 intellectual and developmental disabilities, medical

20 rehabilitation, brain injury services, long-term living,

21 aging, and physical disabilities and other related health

22 and human services.

23 We really felt that that was the right thing for

24 the provider community to do. So again as we sit here, if

25 we really believe that that's the best way to share best

68 1 practices and collaborate and to find efficiencies, how can

2 we then turn to the Governor and say, it's good for the

3 provider community but you shouldn't do it? We've seen it

4 work. We get it.

5 Now having said that, we're not naive. I share

6 the concerns that have been laid out. And there are some

7 good concerns. I've spoken with several of you. And,

8 Representative DiGirolamo, we spoke. And we have a lot of

9 respect for all of you and have done a great deal of work on

10 health and human services with many of you.

11 So when we hear these concerns, we don't take

12 that lightly. We're not blindly supporting this. I guess

13 if I would sum up our view though, we're saying these are

14 great concerns and the Administration should answer them but

15 aren't necessarily a rationale to derail the plan.

16 So let me go through a couple of these. We've

17 talked about the time frame. And that gave me some concern

18 initially as well. I immediately said, July 1st, you'll

19 have this done? And what has clearly been said in the

20 recent meetings and testimonies is, July 1st is a starting

21 time . Of course, it's going to take time into a merger.

22 And quite frankly, that's what we saw with the providers

23 associations coming together. I'm not saying that our

24 merger was as difficult as bringing these departments

25 together, but I've also gone through mergers and

69 1 acquisitions in my past professional career. And I can't

2 think of one that was completed on Day 1. That was always

3 the starting point.

4 And, of course, the things you do in Year 2, 3,

5 and 4 probably are different even from what your vision was

6 when you created the merger. And that's more of what I've

7 been hearing the department heads saying about the merger.

8 The second one, which, you know, we represent

9 drug and alcohol members, is, you know, what's shown in the

10 chart and what was raised earlier and I'm sure later in the

11 testimony. And what happens, what are drug and alcohol

12 services going to be focused on? And that's a very

13 reasonable question and one that needs an answer.

14 We've heard different things about creation of --

15 these are my words, not the Governor's -- a drug czar and

16 how it will continue to be focused on and so forth. We just

17 need more of the detail. But certainly I haven't heard

18 anyone say it would be lost. And I think the same could be

19 said about aging. Very valid concerns. So we have to make

20 sure that whatever plan is rolled out, it's addressed and

21 addressed well.

22 And then the issue about the savings. I hear

23 that. Savings are obviously very important. I will admit

24 that in some of the merger acquisitions I've been involved

25 in, that was not one of the rationale, because we really do

70 1 things because we want to do business better. So quite

2 frankly, in all these proposals, that's more of what I've

3 been focusing on, can this achieve a better outcome? But

4 certainly if that's part of the proposal, then those

5 questions need to be answered as well.

6 I do want to talk a little bit about

7 transparency. Because earlier on when this happened, that

8 was also a question to me by some legislators. Has the

9 Administration met with you? Have you been involved? I

10 think you asked the first panel that. I will say that they

11 have.

12 Within the first couple of days after the

13 proposal, Secretary Dallas offered to meet with my Board of

14 Directors and came and answered questions. It was a good

15 discussion. And actually next month he's agreed to come

16 back at our annual meeting to address any other additional

17 concerns.

18 Just last week DDAP Acting Secretary Jen Smith

19 met with our Drug and Alcohol Committee and providers.

20 Again, just a very open forum. What are people hearing?

21 What can we be doing differently? and so forth.

22 I also was invited to -- I think Rebecca May-Cole

23 alluded to the Governor's Office had a meeting. I did

24 attend that first meeting. And our next one is this

25 Thursday. I understand exactly your point made earlier.

71 1 I'm hopeful that in this meeting maybe more detail will

2 come. The first was more of a general overview. Well, we

3 have another shot at it this week.

4 And I would continue to ask that the Governor's

5 Office and the Administration continue these kinds of

6 stakeholder meetings and other forums. Because I really

7 believe that meeting with stakeholders is the way that some

8 of the best ideas will be generated, best management

9 practices, streamlining reporting requirements, revamping,

10 repealing some burdensome and costly regulations, and

11 recommending other efficiencies for systemwide changes.

12 Finally, our Association has also been asked by a

13 few legislators sort of at the level of, couldn't this all

14 be done, all of this efficiency and streamlining, without

15 the departmental consolidation? Couldn't it just be done?

16 And the answer, of course, is yes. I mean, you know, you

17 could always find efficiencies. You could always do

18 business better. You could always collaborate better. So

19 there's no doubting that.

20 What I do think, though, is maybe the better

21 question to ask is, if you had a clean sheet of paper,

22 what's the best way to go about the efficiencies and

23 collaborations and so forth? Under that scenario, I'd say,

24 well, consolidation, bringing all the people together under

25 one roof. So I'm not saying we couldn't do better today.

72 1 We absolutely can. But I think that this is a serious

2 proposal that should be looked at seriously in terms of what

3 could be a positive outcome.

4 In conclusion, obviously I said I'm supportive.

5 I'm not naive to the concerns. But I do think that there's

6 a lot of positive that could come out of it. And I would

7 hate that the concerns or that every possible detail hasn't

8 been worked out by July 1 means that it would be pushed off

9 a year, two years, or perhaps indefinitely, when maybe we

10 could be operating at a very different level under this new

11 consolidation.

12 MAJORITY HEALTH CHAIRMAN BAKER: Thank you very

13 much, Mr. Edley.

14 And, County Commissioner George Hartwick, I've

15 heard you speak before. We appreciate your leadership with

16 CCAP. You have a very fine group and organization that you

17 represent there.

18 Your turn, sir.

19 CCAP COMMISSIONER HARTWICK: Thank you, Mr.

20 Chairman.

21 To all the Chairmen and Chairladies of the

22 Committee, both Majority and Minority, and members of the

23 Committee, thank you for allowing us an opportunity to

24 present testimony today.

25 My name is George Hartwick. I happen to be the

73 1 Oversight Commissioner in Dauphin County of Human Services.

2 I also serve as the Policy Chair for the County

3 Commissioners Association, Health and Human Services Policy

4 Committee. I was elected by my colleagues across the

5 Commonwealth to represent us on the Executive Board at the

6 national level. And I serve both as Chair and this year's

7 Vice Chair of our Health and Education Steering Committee at

8 the National Association of Counties.

9 I'm going to handle my testimony this way. I'm

10 going to provide a couple of editorial comments. I'll try

11 to be concise with presenting the testimony. I'm really

12 anxious to get to the point of trying to bring forward

13 proposals we had just heard about, the idea of, do you need

14 consolidation or do you not need consolidation to form these

15 efficiencies?

16 The County Commissioners Association is not

17 taking a position on whether we support or we do not support

18 consolidation. However, we've taken a strong position on

19 being able to support the efficiencies. We've come up and

20 we've charged our affiliates with coming up, if you had a

21 brass ring for a day and you could address regulatory

22 concerns, licensure concerns -- you know, ultimately the

23 consumer at the end of the day does not care where the

24 dollars are coming from. They want it to be a

25 patient-centered form of delivery that's allowing us to do

74 1 it as efficiently as possible in a way that we can deliver

2 to where folks are at at the time that they need the

3 services.

4 So anything that allows us to move in that

5 direction, we want to be supportive of and is part of the

6 solution. So the politics of whether this happens or not,

7 we're going to stay out of, but being a part of a solution

8 related to how we can more efficiently govern and how we can

9 obviously come together in a partnership to be able to

10 create efficiencies.

11 And we heard from some of the members of the

12 Committee at our spring conference saying that, you know, we

13 may not need consolidation to do that. Well, we want to

14 roll up our sleeves and get to work on some of these

15 recommendations regardless of the outcome of this

16 consolidation.

17 I think we've gotten a good starting point of a

18 level of recommendation that I think could really provide a

19 level of efficiencies. I don't think we need a salient

20 topic of consolidation to begin active work on doing that.

21 I also would be remiss if we didn't talk about,

22 you know, the budget cuts that have recently been proposed,

23 $800 million. The idea that we will be, in fact, in a

24 position to have eliminated Adult Juvenile Probation,

25 Intermediate Punishment, the very things that stop us from

75 1 further engaging individuals into system involvement is

2 going to be extraordinarily difficult. You cut out and

3 continue to reduce the ability for us to do things at the

4 front end of the system.

5 I mean, you know, we've all been successful in

6 reducing the number of juveniles in our system. You

7 eliminate those opportunities to be able to, you know, find

8 community-based alternatives. We've reduced our numbers in

9 our county from over 300 individuals in placement down to

10 about 55 individuals. Instead of $515 a day at a Youth

11 Detention Center, I'd rather have them in the community

12 engaging families and figuring out ways for us to spend less

13 money on individuals because we're trying to find

14 alternative ways to give them access to community-based

15 services, whether it's drug and alcohol, mental health

16 services.

17 All of those cuts really don't present a stricter

18 budget. It presents a cost shift to counties that I think

19 are going to spend and cost a significantly larger amount of

20 money for all of us as taxpayers, just a different place to

21 be able to pay it from instead of the State revenue s, local

22 property tax dollars.

23 So I will move off my soapbox and move into the

24 presentation. I want to thank you for the opportunity to

25 speak today on the proposed unification of the Departments

76 1 of Aging, Drug and Alcohol Programs, Health and Human

2 Services, into a single Department of Health and Human

3 Services.

4 Counties are uniquely positioned as key partners

5 with the State in the delivery of a broad set of human

6 services to all of the Commonwealth's citizens, including

7 mental health, intellectual disabilities, Children and Youth

8 Services, drug and alcohol programs, nursing homes and

9 long-term care, housing, and juvenile justice services.

10 While CCAP has not taken a position on the

11 proposed unification, our members, working together with our

12 six human services affiliates, have given great thought to

13 what the role of counties would be in the event these four

14 agencies were unified or not.

15 We have also developed what we believe are the

16 basic and necessary components that must be in place and

17 adopted systemwide prior to implementation of a unified

18 model. And we have identified opportunities to enhance our

19 partnership to assure improved services and access for

20 service recipients of the various human services systems.

21 You have before you the complete outline of those

22 components and opportunities. But in the interest of time,

23 I would like to highlight for you the county's top ten list

24 -- and, no, this is not Late Night.

25 First and foremost, CCAP -- I'd like to go

77 1 through these. We've actually got 38 proposals in here,

2 some of which I think have significant merit related to

3 those aforementioned ideas that we had discussed.

4 First and foremost, CCAP believes that the goals

5 of any change made to the structure of government must be

6 service-recipient centered and not driven by just advocacy

7 groups. The goal must be to assure ongoing service

8 provisions of the many programs impacted and not be a means

9 of shifting costs to counties.

10 CCAP urges the Commonwealth to utilize the

11 opportunity of unification to develop and implement human

12 service career goals that improve the ability of State,

13 County, and contracted service providers to recruit and

14 retain staff who are dedicated to the delivery of services

15 to our residents. We know the challenges that exist in all

16 of our systems related to staff turnover and what that means

17 in outcomes to our consumers.

18 CCAP strongly urges an understanding and

19 agreement that involvement of counties in decisions for

20 addressing concerns or requests of Federal regulating and

21 funding entities must include counties at the earliest

22 possible time.

23 We would have liked to have been involved when

24 CMS talked to the Department about withholding dollars

25 before Maximus and the implementation strategy. We know at

78 1 the local level trying to partner and see and provide that

2 vision, you know, it's not just about planning horizontally.

3 It's also about planning vertically where the rubber meets

4 the road and where we know we have that relationship with

5 our consumers at the local level.

6 CCAP believes that the unified agency must

7 develop efficiencies between programs internally as well as

8 with local service delivery agencies at the local level.

9 Through improved methods for information sharing and the

10 elimination of silos further, the opportunity to develop

11 data systems that create more focused and efficient service

12 delivery should be a primary goal of the unification effort.

13 We're always looking for, how are we able to

14 define success? And how are we able to track it? Are

15 counties investing in a unified data system for the ability

16 to hopefully target the high-end utilizers, focus on

17 multi-disciplinary teams as well as the ability for us to

18 look at forensic teams to reduce the formal engagement from

19 folks in our system?

20 Not all counties can come up with the idea to

21 gain those resources and figure out ways for us to have the

22 appropriate level of data to help drive our decision-making.

23 With resources so limited, without having that data, I don't

24 know if we're making the best possible, most efficient

25 decisions for the consumers and the taxpayers that we serve.

79 1 Counties must remain on the forefront of service

2 delivery models that may result from this transition. And

3 CCAP and their human services affiliates must be at the

4 table as those plans are developed because counties are the

5 closest to the people who rely on our critical services.

6 Further, counties must retain the option of

7 selecting the structure of local human service delivery. A

8 one-size-fits-all approach mandated upon counties would be

9 opposed.

10 CCAP believes that counties should retain

11 responsibility for all planning and quality assurance.

12 Counties should be responsible for complex care management

13 to assure communication and collaboration among disciplines

14 for the most vulnerable of our residents.

15 Counties in the State should partner rather than

16 duplicate efforts for licensing and quality oversight,

17 sharing in the process as opposed to duplicating thereby

18 saving costs and undue burden to our many providers.

19 CCAP believes that licensed entities should have

20 the option to request technical assistance inspection to

21 assist with policy, training, and staff compliance efforts.

22 This can be best accomplished by separating licensing from

23 technical assistance.

24 CCAP believes that opportunities to use county

25 service structures and sites to deliver State services is

80 1 another area we encourage the State to consider.

2 CCAP believes that the unification should include

3 the encouragement for counties to develop and implement

4 innovations that enhance service. The unification should

5 encourage the development of prevention models and define

6 opportunities to direct services to high utilizers and

7 service recipients with complex problems.

8 Further, if prevention strategies or enhancements

9 result in cost savings, counties must be given the option to

10 reimburse services, processes, and structures that will

11 enable access to those services at the community-based

12 level.

13 CCAP believes that the provision of substance

14 abuse services and other prevention policy and licensure

15 functions would be enhanced through the adoption of

16 legislation that provides statutory authority to a

17 single-county authority and renames them as the Office of

18 Prevention and Addiction Services, which would continue to

19 be the local entity responsible for the planning and

20 implementation of a full continuum of services based on a

21 locally identified need.

22 CCAP also believes that the integrity of the

23 State Lottery Fund must be maintained and assured so that

24 older adults can rely on continued programs and support

25 consistent with the enabling acts. We want to make sure

81 1 that Gus, the scratching groundhog, is actually giving the

2 resources to seniors that they deserve and it's not being

3 diverted off for other purposes.

4 Again, we must emphasize the strong role that

5 counties must continue to play in the delivery of human

6 services going forward. Thank you again for allowing me to

7 appear before you here today. And I would be happy to

8 answer any questions.

9 MAJORITY HEALTH CHAIRMAN BAKER: Thank you very

10 much. We appreciate your testimony, George.

11 CCAP COMMISSIONER HARTWICK: Thank you.

12 MAJORITY HEALTH CHAIRMAN BAKER: We appreciate

13 all the information from CCAP. There's a lot there to

14 digest. I believe there's some very good recommendations

15 there.

16 Thank you.

17 CCAP COMMISSIONER HARTWICK: Yes.

18 MAJORITY HEALTH CHAIRMAN BAKER: Hannah, all

19 these County Assistance Offices --

20 MS. HANNAH WESNESKI: Yes.

21 MAJORITY HEALTH CHAIRMAN BAKER: -- is it your

22 belief that the consolidation plan -- and I think it's been

23 overlooked by some members -- is to eliminate them and

24 basically have five regional centers, call centers, and that

25 further is it your testimony and belief that by default if

82 1 these close in the counties, that the members' offices,

2 Senators, Representatives, are going to end up being the

3 caseworkers for complaints in applications being filed for

4 various services within the medical assistance footprint?

5 Is that correct?

6 MS. HANNAH WESNESKI: They're being reduced to

7 storefronts, which hasn't really been explained as to what

8 that means yet. They haven't come out with anything to say

9 how many staff members there will be.

10 But with them being shipped off to processing

11 centers, yes, I believe that your local citizens are not

12 going to have anywhere to go other than your offices to

13 complain because there's not going to be anyone at the

14 Assistance Office to help them.

15 MAJORITY HEALTH CHAIRMAN BAKER: And these are

16 very complex forms. I've personally experienced it in

17 trying to help my own late mother and father who were both

18 -- my mother was in a nursing home for five years and my

19 father a couple of years.

20 It's pretty extensive, the paperwork process. I

21 know in order to help them I had to make several calls to

22 the caseworker in charge at the Assistance Office. And

23 that's just not the end of it. That's somewhat of the

24 beginning of it because every year you have to go through

25 this evaluation screening process and resubmit a very

83 1 lengthy -- I can't remember how many pages it was, but it

2 was pretty extensive. And then you have to have the

3 financial information. You have to submit proof of income

4 resources, so on and so forth.

5 MS. HANNAH WESNESKI: Right.

6 MAJORITY HEALTH CHAIRMAN BAKER: I'm very, very

7 concerned that if the County Assistance Offices are

8 essentially closed and you only have one or two people

9 remaining behind in some storefront, that is not going to

10 serve the people of our counties very well at all.

11 This is one of the most concerning, disturbing

12 proposals that I've heard thus far. Tioga County you said

13 has 800 such people involved in this casework. That's

14 probably a small number compared to other counties since

15 it's a six-class county. I'm just very concerned about the

16 quality and it being citizen friendly.

17 MS. HANNAH WESNESKI: Right.

18 MAJORITY HEALTH CHAIRMAN BAKER: A lot of people

19 in rural areas and other areas, they don't have computers.

20 They don't like call centers. They don't like answering

21 machines. And they don't like being put on hold. They want

22 to be able to go into an office and get their services taken

23 care of and, most importantly, get their questions answered

24 correctly so they don't make a mistake and then there's an

25 audit or there's some kind of recovery action because of

84 1 some flaw.

2 So I appreciate you bringing all this information

3 to our attention. It's one of the most concerning issues

4 that I have. And we have a lot of needy people out there.

5 I'm very, very troubled by that.

6 With that, I will stop.

7 Representative Hennessey.

8 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

9 HENNESSEY: Thank you, Matt.

10 Hannah, you mentioned in your testimony -- I

11 couldn't get it all down -- that Compass is a very difficult

12 website to navigate. And as the Chairman just pointed out,

13 a lot of our seniors either don't use computers, don't have

14 access to computers because it's simply not available, or

15 can't afford the monthly service fees.

16 But there is some part of your testimony that

17 said one-third of the applications are what? Do they fall

18 through the cracks or what?

19 MS. HANNAH WESNESKI: Less than one-third are

20 Compass. So the rest are paper applications.

21 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

22 HENNESSEY: Say that again.

23 MS. HANNAH WESNESKI: Less than one-third are

24 electronic applications, the Compass applications.

25 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

85 1 HENNESSEY: Okay.

2 MS. HANNAH WESNESKI: The rest are paper

3 applications. So they're either coming into the office and

4 filling out the application with the worker or they're

5 mailing it in. But less than one-third actually use the

6 Compass system.

7 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

8 HENNESSEY: Okay.

9 The filling out of the PA -- is it a PA 60 Form

10 or PA 600? I understand that's the form that pretty much is

11 a hurdle for many of our seniors because it requires, like,

12 a history of five years of your banking transactions and

13 things like that.

14 MS. HANNAH WESNESKI: For long-term care.

15 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

16 HENNESSEY: I'm sorry?

17 MS. HANNAH WESNESKI: For long-term care, yes.

18 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

19 HENNESSEY: Okay.

20 And a lot of the elderly just don't have access,

21 don't know how to get that access. How is it -- if this

22 consolidation were to go through, how do you envision that

23 the elderly would be able to finish that application just to

24 get reviewed to see whether or not they qualify for

25 services?

86 1 MS. HANNAH WESNESKI: I think it would be very

2 difficult because now they're not going to be able to come

3 into the office and sit with their worker to have them

4 explain what actually is needed of them.

5 I think a lot of it is going to be pushed towards

6 electronically applying, which can be very confusing,

7 especially for our elderly population. I think you're going

8 to see a lot of errors and wishful results and overpayments

9 and things like that.

10 So I think it's going to be very difficult for

11 them if this goes through.

12 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

13 HENNESSEY: Thank you.

14 Mr. Edley, you said that you're part of this new

15 group, this combined group. I forget exactly what it was.

16 RCPA PRESIDENT & CEO EDLEY: RCPA.

17 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

18 HENNESSEY: RCPA.

19 How large were your organizations, the two

20 organizations that merged?

21 RCPA PRESIDENT & CEO EDLEY: Roughly maybe one

22 was 150 agencies and hospitals. The other was 100. Now

23 we're about 330 because more have joined.

24 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

25 HENNESSEY: Okay.

87 1 RCPA PRESIDENT & CEO EDLEY: But also when I say

2 one, that can be a hospital system in 15 counties with

3 thousands of employees that counts as one. So it's a bigger

4 number than 330.

5 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

6 HENNESSEY: Okay.

7 How long did it take you from the time that

8 people posed to you the merger to the time they actually got

9 it done? How long? How much time passed?

10 RCPA PRESIDENT & CEO EDLEY: We put aside exactly

11 six months. January 1 and then on July 1st it was

12 effective. But it also goes back to my comment earlier that

13 I'd have to give it some thought. But I know we're doing

14 things today that we never envisioned on July 1st in 2013.

15 So it goes back to that whole thing of it being a

16 starting point. We knew it was the right thing to do but

17 then had to learn. And in particular, the six months I

18 would say, as you could probably guess, it was mostly six

19 months because of legal work and legal issues.

20 The real work was in working with the members and

21 the operations and finding efficiencies. And none of that

22 happened until after the merger really.

23 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

24 HENNESSEY: We've heard testimony from other people in other

25 hearings that this is the beginning of a journey and July

88 1 1st is simply the first step down that path. The fact of

2 the matter is, we have people who are dependant on these

3 services. And sometimes it's life or death and, you know,

4 we really have to think it through first.

5 We can't, you know, start on a journey and start

6 to make changes on an ad hoc basis as we move forward.

7 Certainly there will be some changes that would occur should

8 this merger go through. But it seems to me that we really

9 have an obligation to think it out thoroughly and in detail.

10 We're 70 days away from the Budget deadline. And

11 as you've heard, we in the Legislature haven't had a lot of

12 detail. So, you know, I understand how everybody can be

13 supportive of a merger if it's going to be a good merger, if

14 it's going to save money for the taxpayers, whatever. Some

15 mergers are really not.

16 I think it's the AARP Magazine this month that I

17 saw had an article about bad mergers, things that were

18 proposed that didn't occur or didn't occur well when they

19 were merged. So, you know, I think we're all looking at it

20 trying to figure out if it's a good idea or a bad idea and

21 whether or not it can be done in the short time frame that

22 we're faced with.

23 Mr. Hartwick, I think you mentioned the term

24 silos. I was waiting for someone to mention that, because I

25 think of silos as bundles of regulations that come from CMS

89 1 or the Federal Government or whatever Federal department,

2 some may be from the State Departments.

3 People have talked about this merger will be

4 great because we can break down those silos. It seems to me

5 that if they are regulations that silos don't get broken

6 down. The silos simply get moved from one department to

7 another. If a silo is the bundle of regulations that the

8 Department of Aging has to deal with on a particular program

9 and that program is now going to be moved to a different

10 department, the regulations will follow it.

11 So you don't really break down the silos. You

12 simply move them from one location to the other.

13 CCAP COMMISSIONER HARTWICK: The only thing I

14 would challenge in a creative thought process, the ability

15 to coordinate across those lines and to even request in some

16 cases ways to do innovation and ask for waivers and

17 regulatory relief.

18 In an area where you're closely communicating

19 with individuals from agencies that can look at issues from

20 multiple angles, including, you know, a lot of the Medicaid

21 and Medicare services have already been moved over to DHS .

22 The idea of trying to communicate and coordinate those

23 efforts across departments and coming up with innovative

24 ideas to try to request regulatory relief certainly are

25 conversations that need to be occurring. And hopefully they

90 1 are occurring within this structure of government. But a

2 lot of the cases that we're even mentioning here, there is

3 the discussion of regulatory relief, relief in licensure,

4 and offering some solutions rather than taking just the

5 regulatory requirements as the absolute facts.

6 I think if we can figure out ways to serve people

7 better, more efficiently in a people-centered way, I think

8 we would be recognized and hopefully be able to have some

9 level of conversation with CMS to receive some relief from

10 those regulations, particularly, you know, in the

11 environment where we're currently in.

12 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

13 HENNESSEY: Well, it seems to me, you know, from -- I think

14 it was your testimony, but it might have been Mr. Edley's,

15 that we can do this without a merger. You know, our

16 department heads can speak to each other. Our staff in the

17 various departments can speak to each other and try to work

18 out these problems and cooperate.

19 The only benefit to doing this and disrupting the

20 whole system would be to have a much more efficient and

21 cost-saving operation. I don't think we've heard a whole

22 lot of testimony about how that can actually be accomplished

23 in the short time frame that we're faced with.

24 CCAP COMMISSIONER HARTWICK: Again, I hope that

25 we're able to address some of these issues that we brought

91 1 forward here in an aggressive way and hopefully improve the

2 system ultimately for the people that we're all here for,

3 and it's the taxpayers and the consumers that should receive

4 better service when we had these kinds of ideas to move

5 forward.

6 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

7 HENNESSEY: Okay. Thank you.

8 Thank you, Mr. Chairman.

9 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

10 Chairman DiGirolamo.

11 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

12 Thank you, Matt.

13 Hello, everyone. Welcome.

14 Hannah, you did a great job. Thank you for your

15 testimony.

16 George, you did a good job also. Thank you for

17 your good work. A lot of the County Commissioners,

18 especially when it comes to human services, are on the front

19 line, making sure that our most vulnerable citizens and

20 constituents get the help they need. I share your concerns

21 about the budget cuts.

22 I'll just take you back five or six years ago.

23 The previous Administration proposed a 20 percent cut to

24 Human Services to the counties. We were able to get it down

25 to 10 percent. But that 10 percent cut was $80 million

92 1 almost. And that's five or six years that you probably

2 lost, the counties probably lost close to a half a billion

3 dollars in funding that would have gone to our most

4 vulnerable citizens.

5 Thank you for the good work that you do. I know

6 Medicaid expansion, I applaud the Governor for doing that.

7 That's made a tremendous difference in taking the pressure

8 off the counties. Let's hope we're able to keep it with

9 this debate down in Washington.

10 CCAP COMMISSIONER HARTWICK: I want to thank you

11 for your leadership. I know that the voice of individuals,

12 particularly in drug and alcohol for individuals who

13 oftentimes don't have a voice, regardless of any party

14 affiliation, you always stand up and make sure that those

15 voices are heard loud and clear in a direct way. So thank

16 you.

17 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

18 Thank you.

19 And, Richard, thank you.

20 RCPA PRESIDENT & CEO EDLEY: Sure.

21 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

22 Thank you for the good work that your

23 organization has done, again, taking care of the most

24 vulnerable. And in my 20-plus years here, I don't think

25 I've disagreed with your organization one time. This is one

93 1 issue that we're going to part company on because I just

2 think this is a terrible idea.

3 Now, I guess you came to this conclusion, your

4 Board of Directors -- and I don't want you to give me any

5 inside information. But was there any pushback from any of

6 the members that maybe this wasn't the right thing to do?

7 RCPA PRESIDENT & CEO EDLEY: I don't know if

8 pushback is the right term. But I think the issues that I

9 listed, I in part got from those discussions, so people were

10 asking. So when we met with the drug and alcohol providers,

11 for example, they did say, in this structure, how can we

12 make sure it isn't lost? How do we make sure that the work

13 that DDAP is doing gets improved? That's why we had people

14 like Jen Smith and Ted Dallas come in and answer some

15 questions like that.

16 I think the other thing is that our providers

17 deal a lot with HealthChoices. You know some of my history.

18 I used to run an MCO for many years in the State, a

19 behavioral health MCO. It seemed like a strange bifurcation

20 to have some offices of policy and direction where the money

21 management and the services were all being provided here.

22 So not getting into the politics or anything like

23 that, it always made more sense to me, why don't we put it

24 together so we have all the people in the same room rather

25 than OMHSAS is going to have this initiative, DDAP is going

94 1 to have this. Not that they're both not good, but could it

2 be done better or more efficiently? So I think that was

3 some of the conversation.

4 And we're even concerned about the new Community

5 HealthChoices Program, (inaudible) you have aging. Could it

6 be done differently or better rather than like that?

7 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

8 Would you say the smallest percent of your

9 membership is drug and alcohol as compared to mental health

10 and work disabilities and autism and intellectual

11 disabilities? Would you say the smaller percentage of

12 membership is drug and alcohol?

13 RCPA PRESIDENT & CEO EDLEY: I don't have the

14 numbers in front of me. Gosh, I might. But I will say that

15 mental health and intellectual disabilities are larger. But

16 we also have others like brain injury, pediatric rehab,

17 medical rehab, which are very small.

18 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO: So

19 most of what your members do, the services that they

20 provide, are probably already in the Department of Human

21 Services. Would you agree with that?

22 RCPA PRESIDENT & CEO EDLEY: That most of the

23 providers are already --

24 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

25 Most of the services that your providers provide,

95 1 most of those are already in the Department of Human

2 Services.

3 RCPA PRESIDENT & CEO EDLEY: They would be a lot.

4 I mean, a lot of them do commercial business even and

5 county-funded work and things like that. But certainly DHS

6 is a major funder of Medicaid.

7 And I did get the number, by the way. We have 70

8 drug and alcohol agencies with 170 licensed drug and alcohol

9 facilities or sites.

10 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO: In

11 your membership?

12 RCPA PRESIDENT & CEO EDLEY: Yes.

13 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

14 Okay. And again, I mean, I don't know if you've

15 been made available -- have you got any of the details of

16 how this is going to work? I mean, it seems to me that you

17 and your organization more than anybody else has had

18 meetings, stakeholder meetings, have met with people from

19 the Administration. Are you privy to some of the details of

20 how this is going to work?

21 RCPA PRESIDENT & CEO EDLEY: No. I think I may

22 have alluded to it earlier. I've been happy with the

23 openness and transparency and the willingness to talk and

24 meet and so forth and being invited to the Governor's

25 stakeholder group. But I'm hopeful that -- okay. We've

96 1 gotten past that. That was Phase 1. We have a meeting

2 Thursday. I think Rebecca said hers is Wednesday. What

3 will we see at those meetings? Will we get to the next

4 level, some plans, some details? We did raise in the first

5 meeting, whether we're supportive or not, in that room, we

6 all can degree on the issues, sort of as you said,

7 Commissioner.

8 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO: So

9 even without the details, your organization was comfortable

10 in supporting this, even though you didn't have the details.

11 So I guess you're comfortable supporting the concept and the

12 details are to follow. You expressed some concerns in your

13 testimony. You might have a lot of concerns moving forward

14 once the details are out. Would that be an accurate

15 statement?

16 RCPA PRESIDENT & CEO EDLEY: Well, we felt

17 confident enough in the concept and what we were hearing

18 from the Administration. I suppose it's always possible you

19 learn information in the future which could reverse that.

20 Through our discussions, I think I would be surprised at

21 that. I think that they are taking our feedback seriously.

22 I should mention that similar to what the

23 Commissioner has noted, we were asked by the Governor's

24 Office to come up with our list. So what efficiencies do

25 you think we can gain? What should we be looking for? We

97 1 should have that even this week. We've been compiling that.

2 Each of our divisions have been coming back to us with,

3 well, if this was done, maybe we could finally get X, Y, and

4 Z done and really put more dollars to care, less to

5 administration, all around the licensing and audits and all

6 those kinds of things.

7 So when we start to propose that to the

8 Governor's Office, I would hope that would also be taken

9 very seriously.

10 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

11 That's all I have.

12 Thank you, Mr. Chairman.

13 MAJORITY HEALTH CHAIRMAN BAKER: Thank you, Gene.

14 Representative Brown, Vanessa Brown.

15 REPRESENTATIVE LOWERY BROWN: Thank you, Mr.

16 Chairman.

17 Ms. Wesneski, you made some very clever comments

18 today. One was just stating that our offices could turn

19 into the next local services. We'd be the providers.

20 Fortunately, my office has been doing that. And

21 in Philadelphia County, the caseloads are so overwhelming

22 that many times our constituents leave the office and come

23 into our office and they are seen quickly because, you know,

24 they don't have the long lines. We have direct calls. We

25 can expedite a lot of their issues.

98 1 I just wanted to put that on the record, that

2 I've even had a staffer, because we've done so many

3 applications on Compass, decide that he'd make more money

4 working for the Department of Human Services, left my office

5 and became a caseworker. And he's doing really well today.

6 So the impact of what we're talking about with

7 the mergers will only put more pressure on our local

8 offices, especially within Philadelphia County, to provide

9 services and to bridge that gap where we already are

10 bridging that gap with an enormous amount of constituents

11 that are coming in on a regular basis.

12 And I just want to put on the record, one of the

13 most challenging issues for the constituents is coming up

14 with food and applying for SNAP benefits. That is the most

15 prominent issue, when you wake up in the morning and you're

16 belly is hungry, you're going to go wherever you can to find

17 services. And often our office, as far as geographically,

18 is closer than the local County Assistance Office.

19 One of the challenges for many of our

20 constituents is travel and coming up with money for

21 transportation. Some of them have to take two and three

22 buses to get to a local county office.

23 So I'm very concerned about the merger. Where

24 would the office be? The five mega centers, how would

25 people get there? Who's going to give them the tokens to

99 1 get back and forth? And when we have local State

2 Representatives offices that are right there in the

3 neighborhood, there are going to be long lines at our

4 offices.

5 So thank you for bringing that out and

6 acknowledging what it is that we have to deal with to make

7 sure that our constituents are served well.

8 Thank you.

9 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

10 Representative Kaufer.

11 REPRESENTATIVE KAUFER: Thank you, Chairman

12 Baker.

13 I want to preface this, because I didn't say it,

14 before my last question. But I do appreciate all the hard

15 work by our Secretaries. I didn't get a chance to say that

16 before. And I do know that you're all excellent advocates

17 on behalf of the different constituencies you represent. So

18 I want to thank you for that.

19 I do want to say though that I have concerns. I

20 still want to find a way to get onboard with this. But I

21 still have concerns about cost savings versus services being

22 provided. And in a similar question to my last question

23 that I asked to the last panel, with waiting list money

24 being absorbed by DHS, difficulty fixing licensing to

25 streamline billing private insurers instead of taxpayers,

100 1 the 25 percent rule that was for our sheltered workshops,

2 which was under a lot of question, can you give me an

3 example of DHS that will alleviate my concerns for

4 prioritizing people with autism and intellectual

5 disabilities under this merger?

6 RCPA PRESIDENT & CEO EDLEY: I think I got the

7 question. You focus particularly on autism services at this

8 point. Well, I have seen just a tremendous amount of work

9 in that through the Bureau of Autism, which is under the

10 Office of Developmental Programs.

11 But I think again when you think about

12 consolidation, when it was more of sort of a silo

13 (inaudible) of autism, a lot of people didn't know about it.

14 Now that it's from the integrated Office of Developmental

15 Programs, they've come to our meetings to present it to

16 mental health providers, for our brain injury providers,

17 pediatric rehab providers. There's a lot of people in all

18 sorts of the system that are very interested and have some

19 great ideas around autism.

20 I think that, again, consolidation isn't the

21 cure-all for anything. But you can see how, when you bring

22 different people, you can really start to share some best

23 practices, best ideas. So when we even internally have a

24 meeting about autism, it's adult providers, children

25 providers, IDD, mental health, as I said, brain injury, all

101 1 of them can attend and share. And that's the kind of thing

2 that we want to see in a consolidation.

3 REPRESENTATIVE KAUFER: Can you elaborate a

4 little more? Like I said, I'm really looking at this glass

5 half full. I want to be convinced. But I have yet to hear

6 the real reasoning of giving me faith in what is already

7 going on within these departments and not to be lost in the

8 mix.

9 I truly want to find a way of being there. I

10 just have yet to hear that reason to be there yet. I mean,

11 I know you're talking about some of these silos breaking

12 down. Can you give me more concrete examples?

13 RCPA PRESIDENT & CEO EDLEY: Well, the best I can

14 say is you take some of the other examples. I was

15 questioned about drug and alcohol services. Well, in a

16 solid approach you would have drug and alcohol over there.

17 You'd have mental health over here. You'd have criminal

18 justice over there.

19 When we have our meetings, we bring all those

20 providers together. And it can be anyone from Secretary

21 Dallas to Secretary Wetzel presenting. We're really trying

22 to break down all those kinds of walls to better address

23 what the issues are.

24 And as I said earlier, it's not that it's a

25 problem. But I don't know that it's the best way to run

102 1 things when you have a group within DHS managing so much of

2 the dollars for services and having sort of their own vision

3 and way of doing it. And then you can have departments over

4 there not necessarily with competing visions but perhaps

5 other priorities and other things. And the worlds don't

6 come together. So that does worry me and maybe wouldn't be

7 the best use of funds instead of getting everyone under one

8 umbrella.

9 An example that I mentioned to the Senate last

10 week -- and I'm not even talking about any of the politics

11 involved. I'm just a citizen attending these meetings.

12 There was one of the Centers of Excellence. And

13 I remember thinking to myself at the time, I didn't even

14 realize how it was funded at the time. I should have, but I

15 didn't. I said, so we have DHS here and OMHSAS. Shouldn't

16 DDAP be here? I then later learned it's not a DDAP program.

17 That kind of thing seems a little funny to me and

18 maybe not the best way to run programs.

19 REPRESENTATIVE KAUFER: And I appreciate that.

20 And, Richard, I appreciate everything you do. I

21 really do appreciate the work that you and your organization

22 provides throughout the Commonwealth.

23 Like I said, I still have concerns. I don't know

24 if I'm going to get onboard with this. I really don't.

25 I've yet to hear the explanation from the providers' end,

103 1 from the administrative end. I do share a lot of these

2 concerns on advocacy for the vulnerable population that I

3 represent.

4 Thank you.

5 CCAP COMMISSIONER HARTWICK: Just from the County

6 Commissioners' perspective, I want to thank the openness of

7 all of the Secretaries, the ability for us to meet and

8 really gain a better understanding, a better working

9 relationship. Particularly Secretary Dallas has really been

10 forthright in trying to talk about partnerships and give

11 sort of the defining vision of saying, hey, if you had the

12 brass ring for a day and you would be able to really talk

13 about how could we make these things more efficient, how can

14 we actually come together around developing these plans? all

15 four Secretaries have been open. We have been regularly

16 meeting with them. They have provided access and a certain

17 level of engagement to the County Commissioners,

18 particularly in the autism services area. Deputy Secretary

19 Thaler has done a phenomenal job sort of redefining, you

20 know, what the County's role is in autism services and

21 figuring out ways to try to provide better access and a

22 broader perspective even at the local level.

23 So this shouldn't all be negative. The idea that

24 there is planning going on is, in fact, the case. And we

25 would hope that the idea of this conversation will not end

104 1 if there's a choice to not have a merger, we should

2 continually, you know, be talking about, how can we provide

3 these efficiencies?

4 Unfortunately, this is not an opportunity for us

5 to be able to talk about 38 and growing proposals that can

6 offer regulatory relief that we should be having ongoing

7 dialogue with. And for that reason, I think we're grateful

8 to be able to be sitting in front of you.

9 MAJORITY HEALTH CHAIRMAN BAKER: Representative

10 DeLissio.

11 REPRESENTATIVE DeLISSIO: Thank you, Mr.

12 Chairman.

13 Ms. Wesneski, the agenda doesn't say -- I heard

14 you say you were a former LIHEAP worker. But what do you do

15 currently?

16 MS. HANNAH WESNESKI: I'm currently

17 self-employed. I run a business.

18 REPRESENTATIVE DeLISSIO: Currently

19 self-employed. Well, thank you for coming today to testify.

20 A couple years ago, maybe four or five years ago,

21 I sent out an e-mail to my colleagues. I think it was

22 Budget season. I sent out an e-mail to everybody asking if

23 anybody else's district office felt like the satellite to

24 their local County Assistance Office. And maybe we should

25 track those hours more carefully so we could bill back the

105 1 Department.

2 And you'd be surprised the number of e-mail

3 responses I got, not from my good colleagues seated here,

4 but from their staff saying, amen, Hallelujah, you got it,

5 all of that.

6 So I am actually not overly -- I'm concerned

7 about all of this in terms of all the moving pieces.

8 There's no doubt about it. But I look forward to the

9 opportunity, I think, to take a good look at how the County

10 Assistance Offices are working.

11 I mean, I have had this personal experience, not

12 identified as a State Rep, although I was at the time. I

13 had an older aunt who needed Medicaid in a nursing home.

14 And that was a fascinating experience and not in

15 Philadelphia County.

16 And I had to reproduce paperwork several times to

17 get it through. So that tells me right then and there,

18 there's something wrong with the process. And I'm an

19 informed consumer. I see it -- or I hear it from our

20 district office staff all of the time, some of those

21 challenges for it.

22 So I think it might be everything from

23 simplifying that Compass system to maybe taking a good hard

24 look at the back end of operations. I like using the words

25 front of the house, back of the house, back end, front end,

106 1 to see that we can't enhance and improve that.

2 And this may be just that opportunity because I

3 think the staff, who are trying to deliver those services,

4 have to be as frustrated as our constituents as well as, you

5 know, our district office staff in trying to deliver those

6 services.

7 I think Representative Brown's example of she

8 lost the staffer to the system because that person got that

9 good at it is indicative of needing to do that.

10 And I think both Mr. Hartwick and Mr. Edley, it

11 is important. We should have been doing this kind of

12 continuous quality improvement in a big way, in a macro way,

13 and working our way down to a micro way for a long time. It

14 is past due. It's costing providers money. It's costing

15 counties money. We talk about unfunded mandates.

16 So I think good will come of this or I sincerely

17 hope good will come of this, not knowing what that will be.

18 But I'm going to continue to push for this discussion to

19 keep happening because all of the things that you testified

20 about need to be addressed and need to be remedied.

21 Thank you, Mr. Chairman.

22 CCAP COMMISSIONER HARTWICK: Can I address that?

23 I probably shouldn't step up and address it. I usually

24 stick my foot in my mouth. But I will tell you two things.

25 I feel like the County Assistance Office, not just for my

107 1 county but the State, at times. But Dauphin County was a

2 county that had some of our backroom operations. Because

3 we're in Harrisburg, there's high turnover and an

4 opportunity for folks to not be in the position for long

5 related to training. A big portion of our back office has

6 already been moved to Cambria County. We have really not

7 seen a significant deficiency related to processing and the

8 ability for us to address concerns.

9 So, you know, just because the idea -- you can

10 see bad sides to it, I think. We need to examine them based

11 upon how you can improve process, reduce turnover, and see

12 how it works in cases versus, you know, the potential --

13 change is always difficult.

14 REPRESENTATIVE DeLISSIO: Always.

15 CCAP COMMISSIONER HARTWICK: And the idea of

16 doing things more efficiently sometimes is painful. But to

17 try to make sure that we're examining them based upon what's

18 actually occurring versus our feelings is also something I

19 think we should be careful about.

20 REPRESENTATIVE DeLISSIO: Well, thank you for

21 sharing that.

22 CCAP COMMISSIONER HARTWICK: Thanks.

23 MAJORITY HEALTH CHAIRMAN BAKER: Representative

24 Schlossberg.

25 REPRESENTATIVE SCHLOSSBERG: Thank you, Chairman.

108 1 And, Commissioner Hartwick, this question is for

2 you and somewhat related to the last thing that you said.

3 CCAP COMMISSIONER HARTWICK: I knew I shouldn't

4 have opened by mouth.

5 REPRESENTATIVE SCHLOSSBERG: I was going to ask

6 it anyway. You just made the transition easier.

7 CCAP COMMISSIONER HARTWICK: Okay.

8 REPRESENTATIVE SCHLOSSBERG: The Administration's

9 last hearing cited as part of their case for the merger some

10 counties in Pennsylvania that had previously merged some of

11 the similar functions that we're talking about today.

12 I'd be curious -- and I'd understand if you're

13 not sure but if off the top of your head you can think of

14 any similar experiences that Pennsylvania counties had with

15 these mergers, where they went right, where they went wrong,

16 and maybe what lessons we can learn from that.

17 CCAP COMMISSIONER HARTWICK: Are you talking

18 about counties or State-level mergers?

19 REPRESENTATIVE SCHLOSSBERG: Counties.

20 CCAP COMMISSIONER HARTWICK: Well, obviously

21 Allegheny County is a great example of a model that has

22 worked. They've invested significantly in a data warehouse

23 that allows them to engage. First of all, they consolidated

24 all operations of their Human Services Department largely.

25 They also have invested in a way for their

109 1 counties to have interaction with School Districts, hospital

2 systems, and accurate data related to folks that touch their

3 system. Ultimately, we'd like to be in that same vein, and

4 we're trying to get there in consolidation of both, the

5 Finance Office, the ability for us to have, you know,

6 interagency cooperation across systems that deal with

7 multi-disciplinary, high-cost approaches. Ultimately we

8 need the data to be able to do that.

9 The County Commissioners Association has recently

10 invested in a data system to look at the criminal justice

11 touches. It would be great to also overlay that for all the

12 places that people are currently coming through and touching

13 our system so we could have both an idea of cost and

14 inefficiencies where access to services becomes a challenge.

15 In order to do that, you have to make that

16 investment in a data system. Similarly, I can use the best

17 analogy, just like Pinnacle Health had taken a look at, you

18 know, the (inaudible) apartment building which was using a

19 significant amount of their emergency room time instead of

20 as primary care physicians. Instead of them using and

21 blocking up the emergency room, they now disperse nurse

22 practitioners into the (inaudible) apartment complex to be

23 able to do people-centered care.

24 You can't find that out unless you can use the

25 data and be able to track where folks are coming in

110 1 engagement with your system. And I think for us to be able

2 to have that kind of look from a data perspective is going

3 to be critically important for counties.

4 MAJORITY HEALTH CHAIRMAN BAKER: Representative

5 Murt.

6 REPRESENTATIVE MURT: Thank you, Mr. Chairman.

7 I just wanted to commend the Commissioner because

8 in your written comments -- I don't believe you read them --

9 you talked about how important it is for our professionals

10 in human services to have career progression and career

11 opportunities. Those of us who are aware of this, many of

12 our professionals in the human service areas are master

13 prepared social workers, therapists, and so forth, and

14 they're woefully underpaid sometimes, competing with

15 salaries at fast food restaurants and so forth. But we know

16 the work they do is very, very important.

17 I wanted to say that we haven't heard much about

18 caring for adults with intellectual disabilities and

19 developmental disabilities. And this is one of the biggest

20 challenges I think facing Human Services today across the

21 country. Everyone is living longer, including our

22 constituents, our brothers and sisters, who have

23 intellectual disabilities.

24 And I'm not exaggerating when I say this. But

25 there are families in all of our Legislative Districts where

111 1 there are parents that are literally 85 and 90 years old and

2 they're caring for a son or daughter at home who may have an

3 intellectual disability and they're on a waiting list and

4 the parents have always cared for their son or daughter.

5 The parents are struggling with health and

6 age-related issues. Their son or daughter might be

7 struggling with their disability as well as some other

8 issues, sometimes a lack of stimulation. And sometimes

9 these issues are even more profound in some of the rural

10 areas where there's just no programs for some of these

11 individuals.

12 This is a great concern for me and for all of our

13 colleagues here. And I think it would be unfair to not

14 mention that we've made great progress in this area even

15 during the austere Budget years of the prior Administration.

16 Governor Corbett ponied up the money. He was

17 fully committed to taking care of adults with special needs.

18 There was never a cut for this specific line item.

19 And I guess this might best be answered by you,

20 Rich. If this merger goes through, what will it mean to

21 adults with special needs? What will it mean for people

22 with intellectual disabilities that either have waivers or

23 are awaiting services on the waiting list?

24 That's a hard question. I know that.

25 RCPA PRESIDENT & CEO EDLEY: Yes. And it sort of

112 1 goes into I can answer what I think the consolidation and

2 how it would be related to that. But a large part of the

3 issue really is probably outside of this and it comes down

4 to, how do you fund a wait list for fourteen, fifteen

5 thousand people when you chip away at maybe 1,000 a year and

6 1,000 more join on.

7 And you're absolutely right. It's a tremendous

8 problem. So if I would really answer that question in a

9 vacuum, not even think about what we're testifying today, I

10 think I've been on record, we'd have to look at things like

11 raising more revenue, whether it's personal income tax or

12 something or biting the bullet and putting in some

13 additional managed care programs, which would allow more

14 flexibility in trying to develop services, as we did with

15 HealthChoices. So I think that's going to be a whole other

16 discussion that's needed.

17 But in terms of consolidation and focusing back

18 on that, it goes back to what I was saying and how we deal

19 with it on a provider level. I think if you went back in

20 time, there would have been IDD meetings. Well, then

21 everyone realized that especially in this State, you might

22 have Children's Services, providers who do a lot of work

23 with autism. These people are aging out and so now there's

24 adult ID providers who are providing these services. You

25 have aging providers who are very interested.

113 1 Because of children even surviving more deficits

2 at birth, I mentioned pediatric rehab. They're working with

3 children with autism. So we're able to bring all those

4 different areas together and say, what are we doing? What

5 are the best practices? How would we approach the lifespan

6 of autism and IDD and so forth?

7 I think that generates a better discussion and

8 some better ideas, what regs are missing, what regs are on.

9 We even talk a lot about, well, how come in this silo here,

10 providers are allowed to do X, Y, Z but they're not here.

11 So I think consolidation can certainly help.

12 And then we also can't get around -- we've

13 alluded to -- if you talk to providers and say, what's the

14 -- if you had to pick one, what would the consolidation

15 achieve? It's all of the duplicative audits and oversights

16 that's coming at providers from so many angles, DOI, DOH,

17 DDAP at times, DHS and OMHSAS, all the MCOs.

18 And they're getting quality audits. They're

19 getting corporate compliance audits. One right after the

20 other. If you think of all the administrative time being

21 taken in the system on that, that could be freed up for

22 services. And I'm not saying that you eliminate those, but

23 putting everyone in a room and figuring that one thing out

24 would be helpful.

25 And realize most of these providers already have

114 1 JCAHO accreditation and others so they already are meeting

2 really high standards and yet every day someone is auditing

3 them and taking away time that they could have services.

4 REPRESENTATIVE MURT: I appreciate that answer.

5 I just want to conclude with saying that in order for me

6 personally to embrace this merger, I'm going to have to have

7 a level of comfort that our brothers and sisters with

8 intellectual disabilities, adults with special needs, are

9 going to be cared for at least as well as they are now and

10 better in the future, hopefully.

11 Thank you.

12 RCPA PRESIDENT & CEO EDLEY: Thank you.

13 REPRESENTATIVE MURT: Thank you, Mr. Chairman.

14 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

15 And our last questioner is Mary Jo Daley for this

16 panel. We have one more panel.

17 REPRESENTATIVE DALEY: Thank you, Mr. Chairman.

18 Mr. Hartwick, I like the idea of having that

19 brass ring for the day and deciding how you would design the

20 Department of Health and Human Services or whatever

21 iteration of how we provide the services.

22 Unfortunately, we all know that when you already

23 have something in place, it's really much more difficult to

24 figure out how to do it better because it's change. And as

25 you also said, change is difficult.

115 1 So I just think the vulnerable population of

2 fragile citizens should be our focus. That population, it

3 seems to me, is growing larger. At the same time our

4 budgets have been getting tighter with a cut out of the

5 budget that was passed about a week or so ago, $340 million

6 of it just for Human Services.

7 I'm on the Appropriations hearing -- and I hate

8 to bring that in but one of the questions that's always

9 asked of the Secretaries is, what's your complement? And

10 for those of you who don't hear that word complement, it's

11 the Human Resources of the employees of the departments.

12 And there's been concern about that.

13 I agree with Representative Brown about our

14 legislative offices providing a lot of services or acting as

15 intermediaries between our constituents and the departments.

16 This is a constant refrain not just in Philadelphia.

17 I just feel like we can't have it both ways.

18 And, you know, with no new taxes being proposed, then we're

19 really -- we have no other choice really but to look for

20 ways to make things more efficient and more effective.

21 So I just wanted to say to each one of you,

22 because I thought you all brought something really good to

23 this hearing, about really being persistent and raising the

24 issues that are concerns for being able to help these

25 populations.

116 1 I appreciated the positive comments that were

2 made.

3 But I also appreciated, Ms. Wesneski, your

4 comments. Because I think it is important to bring those

5 things to the surface. And this hearing is a great

6 opportunity for us to hear it, but also Secretaries are

7 sitting here. And I'm sure the Governor is paying attention

8 to what's going on here also, which is the only reason I

9 decided to make another comment because I figured I would

10 add my voice to that.

11 I think it is really important. I spoke to our

12 Montgomery -- I live in Montgomery County and I spoke to

13 Barbara O'Malley today about how that transition went from

14 Montgomery County because it seemed that it was rocky for a

15 little while. But it also seems like it is smoothing out.

16 And I had a hearing last week where one of the

17 folks who was an employee of that department said, you know,

18 in Montgomery County we went through this. And it actually

19 helped those of us providing services because we were able

20 to focus on the programs and the people that we were

21 providing services to as opposed to some of the

22 administrative pieces.

23 I checked what she was saying. And that's why I

24 called Ms. O'Malley earlier on my way in today. And she

25 said, yeah, that's actually how we've been experiencing it.

117 1 But she said it does take longer than you think it's going

2 to, which I think, Mr. Edley, your comment about it starts

3 on July 1st, it's not going to be completed on July 1st. I

4 think it's important for us all to recognize that this is

5 something that's going to have to be built.

6 But I think that with what we're faced with and

7 how we're paying for things and what we're willing to do in

8 terms of that, we really have to look at how to make things

9 work more efficiently, more effectively, but always

10 remembering who we're providing the services for.

11 As legislators we need to remember that also.

12 It's the citizens of Pennsylvania that we're standing here

13 and representing. I strongly believe that the Secretaries

14 all have that in mind also. That was what I heard in their

15 testimony last week.

16 I appreciate you being here today. And now I'll

17 be quiet.

18 Thank you, Mr. Chairman.

19 MAJORITY HEALTH CHAIRMAN BAKER: Thank you.

20 Thank you very much, panelists. We appreciate

21 your expertise and your input and being with us today.

22 Thank you very much.

23 Our last panel that will be joining us will be

24 Deb Beck, President, Drug and Alcohol Service Providers

25 Organization of Pennsylvania, and Gary Tennis, former

118 1 Secretary of the Department of Drug and Alcohol Programs.

2 Welcome.

3 At the prompting of Chairman DiGirolamo, we'll

4 have Deb Beck go first.

5 PRESIDENT BECK: Good afternoon.

6 Thank you so much for providing the opportunity

7 to testify here today. My name is Deb Beck. I'm the

8 President of the Drug and Alcohol Service Providers

9 Organization of Pennsylvania. We represent the whole

10 continuum of care that's solely on the issue of drug and

11 alcohol addiction and prevention.

12 Commonwealth Prevention Alliance is also a member

13 of us, as well as the Student Assistance Professionals

14 Association and other associations.

15 My Board Chairman is here in the audience, Steve

16 Roman over in the corner. He came all the way in from

17 Washington County for the day because he thinks this is that

18 important, what you're doing is.

19 I really appreciate how deliberative you have

20 been about all this. It's really important. How government

21 organizations itself do its business is important. It

22 matters how government organizes itself.

23 And I apologize. I have some written notes and

24 my handwriting is terrible. You wouldn't be able to read

25 it. But we can produce something later for you in writing.

119 1 Structure and budgets matter. They establish

2 priorities. They reflect the priorities of Pennsylvania and

3 what you think -- when you talk to your constituents and

4 also among each other what you think matters and what is

5 important.

6 So you have a tough job because everybody gets

7 mad if they disagree and everybody is happy if you go along

8 and do what they're interested in. But I want to say again,

9 government matters. And how government structures itself

10 matters terribly.

11 I'm going to talk too fast because I talk too

12 fast. End of the '60s, an openly recovering alcoholic, a

13 gentleman from the State of Iowa, ran for the U.S. Senate

14 and became a U.S. Senator.

15 And this openly recovering man who I had the

16 privilege to meet a few times before his death decided it

17 was time for America to get it right on the drug and alcohol

18 issue. So he introduced legislation that was enacted that

19 asked the States in order to get Federal drug and alcohol

20 prevention and treatment money, you're going to have to

21 establish a single state authority on drug and alcohol

22 because we want to have some entity to hold accountable and

23 to develop State plans across the states for prevention

24 education and treatment of alcohol and other drug addiction.

25 You could imagine how different these

120 1 single-state authorities are. I mean, we have Rhode Island,

2 folks. It's an hour across. And then many of you drive

3 many hours to get across Pennsylvania.

4 So Pennsylvania's iteration of that Federal law

5 then passed as Act 63 of 1972. And don't worry because some

6 of that is in your packet. You don't have to remember all

7 of that. I was brand new in the field in 1971. So I didn't

8 know about structure and how it related to anything we do.

9 I just didn't understand that.

10 But Pennsylvania's iteration is Act 63 of 1972.

11 It's a visionary statute that lays out authority across

12 departments consolidated in one department. In fact, the

13 very words being used by the Administration to argue for

14 consolidation already exist in the body of this law and

15 we'll be looking at that in a minute.

16 So over the years since '71, as I'm learning

17 about the field, I was vaguely aware that this entity kept

18 being moved around. And it was a deputate at one point. It

19 was an office at one point. And it was a bureau maybe two

20 or three times. I don't know. I lost track of it.

21 The one thing that was clear is it never achieved

22 the statute nor the stability to fulfill the actual mission

23 of the Act, which we've included in your folders today.

24 A few years ago, a fellow named Representative

25 Gene DiGirolamo and Senator Pat Browne in the other Chamber

121 1 decided to lead an effort to elevate Act 63 and all its

2 powers and responsibilities to a department status so it

3 could actually get the job done.

4 And I'm looking around the room here today. The

5 cosponsorship on the House Bill -- I've tried to count. And

6 I started to count. I stopped at 130 cosponsors in the

7 House of Representatives to create a department. For

8 Heaven's sake, 138 cosponsors.

9 The law was enacted. It was enacted by near

10 unanimous votes of the House and Senate, near unanimous. It

11 was, I think, 10, maybe 11 opposed. Near unanimous votes of

12 the PA House and Senate. And the implementation of this new

13 law really just got started in 2012.

14 This was a wise, wise decision of the General

15 Assembly. Senator Yaw asked that question. Did we make a

16 mistake passing this law? I want to answer that. I think

17 you made a very wise decision. I only wish that it had been

18 done many, many years ago. We might not be in the hole

19 we've dug ourselves into with the drug and alcohol problem.

20 Finally, we think that the Department is in a

21 position to get the job done and it's just getting started.

22 So why did we think we needed a department cabinet level?

23 And there were people who came to Harrisburg in teams,

24 parents who had lost their children, pleading for the votes

25 on this law.

122 1 Untreated drug and alcohol addiction cuts across

2 every major department of government and drives spending

3 priorities and unfortunately not particularly useful ways,

4 sometimes tragic ways.

5 I want to give you some numbers to remember.

6 Remember this. That 70 percent of the people involved in

7 criminal justice and involved in sitting in our prisons

8 today have untreated addictions, 70 percent. That's $47,000

9 a year per inmate, folks, or about 1.4 billion out of DOCs

10 budget. If you want some numbers to remember, remember

11 these.

12 How about the Department of Human Services?

13 Well, it's one in five Medicaid dollars that's spent on the

14 damage caused by untreated addiction, not to treat the

15 illness but on the damage that it causes. And, of course,

16 the impact on Children and Youth, foster care, etc., I think

17 goes without saying.

18 If you look at the Neonatal Intensive Care Units,

19 $66,000 is the average cost to care for one of those poor

20 babies, $66,000. PennDOT, DUI, Workers' Comp, one in four

21 families, one in four families in hearing distance here

22 today is at home wrestling to get help for an untreated

23 loved one or to talk that loved one into going.

24 Act 63 of 1972 is a visionary document. It was

25 sponsored by Milt Berkes from Bucks County oddly enough.

123 1 History is kind of repeating itself. It's not called Act 50

2 of 2010. Its express purpose is to end the fragmentation

3 that's there across the systems to streamline, to pull

4 together, to put together, to get rid of duplication, and

5 bring laser focus on the prevention, education, treatment

6 problem, a problem that affects and has killed 3,500 of our

7 citizens in the last year and more are expected in

8 subsequent years.

9 It is the express job -- it is the express job of

10 this Department to address this problem. And I wish you

11 would grab for a moment from your folders this document. I

12 believe you already have it in your folder. And it's

13 highlighted. There's a lot more to it.

14 But let's look for a second. What does this

15 Department do? First, I submit that the Department of Drug

16 and Alcohol Programs, because of the wisdom of a fellow who

17 drafted this bill back in '72, is a silo-breaker. It's a

18 silo-breaker by its nature.

19 I have a little problem wondering why people are

20 so worried about silos. Maybe because I actually saw one

21 once, you know. Its job is to separate grain and then

22 recombine it in ways that are useful. I'm not so hung up

23 about silos as maybe some others are. I think they serve a

24 purpose.

25 Let's take a look at the statute. What this act

124 1 -- this is a brilliant document written by a man who I also

2 got to know before he died. The Department shall develop

3 and adopt a state plan for the control, prevention,

4 intervention, treatment, rehab, research, education,

5 training aspects -- you get the point.

6 The plan shall include, but not be limited to,

7 coordination of the efforts of all State agencies, all of

8 them. Okay. Again, on the same subjects.

9 If you go to the next page. It is to avoid

10 duplication and inconsistency. And you can read more, how

11 they're to set up training and education across all those

12 domains. The formation of local planning councils, that's

13 the statutory basis of single-county authorities, by the

14 way. The guarantee that you have local control -- local

15 control, folks, on prevention and treatment.

16 And I'm going to jump now to the next part, which

17 is several pages back. They are to develop a State plan.

18 They shall consult with and collaborate with the staff and

19 the local departments and other agencies of government,

20 boards, agencies, there's a whole list, and organizations.

21 And according to that state plan, they are to allocate

22 responsibilities across those departments and then

23 coordinate them.

24 If you turn to the next page. They not only

25 allocate the responsibilities, they also had the power to

125 1 delegate responsibility to other departments. And the other

2 departments are supposed to be reporting in on the results

3 of that. So what you see here is a very consolidated

4 agency.

5 It's interesting that many of the words used for

6 the Department also are very much what this does. The

7 Department is a silo-breaker.

8 Now if we could, let's look at the

9 Administration's proposal. You have the chart. I think you

10 also have a copy of the chart inserted in your packet. The

11 red box at the top is the current structure. There's the

12 Governor. And the department reports directly to the

13 Governor of the Commonwealth.

14 Here's the proposed system with no change except

15 the red highlighting and the little figure at the bottom.

16 There we go. The proposed system, the Governor is way at

17 the top. And I think there are ten -- I think I may have

18 counted wrong by one -- ten Deputy Secretaries. Drug and

19 alcohol doesn't even have its own deputy. It's drug and

20 alcohol and mental health. More on that later.

21 By the way, we're more commonly concerned with a

22 whole bunch of other things other than mental health.

23 I also want to note that the Office of Medical

24 Marijuana has a higher level of access to the Governor than

25 the Drug and Alcohol Agency, just FYI.

126 1 How government structures itself matters. It

2 tells us about priorities. Take a good look at that. The

3 Drug and Alcohol Agency would be at the dead bottom. These

4 ten have to get their priorities up to the Executive Deputy

5 Secretary, who then chooses which ones that they're going to

6 carry up to the Secretary, who probably got input from all

7 the other offices with their direct input.

8 So please don't do this, folks. If you do this

9 with drug and alcohol, you're going to make our job even

10 harder than it already is. And working with people with

11 untreated addictions is already quite challenging.

12 The Administrative proposal would rebury this

13 Agency back where it was when I came into the field. We've

14 been there before, folks. It didn't work the first time.

15 It didn't work the first time.

16 I want you to know, kind of responding to the

17 things in the air around this, the Administration has

18 advised us that there were zero savings in moving this

19 Agency, zero savings. So this is about money. Let's get

20 that off the table. The Administration has affirmed that

21 there's zero savings in moving this Agency.

22 I think some of the other things discussed can be

23 done, you know, consolidate IT and HR without moving

24 anything. Since the brief inception of DDAP, it has been a

25 highly successful organization reaching the mission that Act

127 1 63 lays out.

2 Now, I do want to tell you, I think that staff

3 are working very, very hard. And I must tell you, it went

4 from a bureau with 71 staff. And the last time I looked at

5 the organizational chart for DDAP, they were down to 61.

6 So again, I think how government organizes itself

7 is very telling. Is this a priority or is it not? I think

8 you've also seen this sheet of paper. I think it's in your

9 file also. It talks about some of the things that the

10 Governor's -- excuse me -- that DDAP has done already in a

11 short period of time with very little staff, the

12 silo-breaker, established a task force. And out of that

13 task force was catalyzed the development of prescribing

14 guidelines by physicians. That didn't happen out of

15 nowhere.

16 By the way, Act 63 calls for the -- all the way

17 in '72, the visionary man who wrote that law, one of your

18 colleagues, actually figured out that somebody needed to

19 give physicians guidelines on how to handle drugs of

20 addiction.

21 So the new department catalyzed the physician's

22 guidelines. Over 3,000 lives have been saved by this new

23 department because of the promulgation of the other law that

24 you passed. You got Narcan through in record time. Thank

25 God. I'm so thankful for that. But the law would have just

128 1 laid there. The Agency ran with it. Over 3,000 lives have

2 been saved. And there are more things and you'll hear more

3 about that later.

4 I want to address a few other issues that have

5 come up that might be of interest. Drug and alcohol

6 addictions, in case you hadn't had this way of thinking

7 about it, are primary illnesses in their own right, primary

8 illnesses in their own right. The licensed treatment

9 facilities are already required to coordinate other things

10 that we find that you may need as well, to coordinate it or

11 provide it or at least see that it is provided.

12 Some of those other things might be treatment for

13 high blood pressure. It might be dental problems, a big one

14 with drug and alcohol. It might be high blood pressure or

15 liver damage. And it might be a co-occurring mental

16 illness. But you don't want to define the one as the other.

17 In fact, drug and alcohol addiction has a high

18 rate of co-occurrence with having a job. Okay. My guess is

19 you didn't know that, as most people with untreated

20 addictions are in the workforce, not in the public system at

21 all.

22 And the edict of Act 63, now Act 50, would have

23 people develop workplace programs to do early intervention,

24 get people to help before they end up being demoted into the

25 public funding side.

129 1 So we are commonly co-occurring with a job. And

2 also sometimes from criminal justice ends, most people with

3 addictions don't commit crime. But most crime that is

4 committed is committed by people with addictions.

5 One of the advocates for the merger as mentioned,

6 one of the reasons for it, being that 68 percent of people

7 who go to detox get no further service, I don't know how

8 that relates to the merger. But if that's true, and it may

9 be, DDAP developed a Warm Hand Off Procedure, kind of

10 cracked the whip and got the hospitals to work with the

11 SCAs, with DDAP to figure out how do we tighten that

12 referral from the point of admission to a hospital that gets

13 you out into a treatment program of some kind. Have an

14 assessment done and a proper placement done.

15 Now we run into some barriers with that. Funding

16 is a problem, folks. And we also are flat out often out of

17 detox beds and rehab beds, in addition to the fact the

18 patient may slide back into denial, kind of a common

19 phenomenon.

20 Years ago I remember reading the horrific stories

21 from the Middle Ages of the Plague. And it was swept across

22 in recurring cycles because they couldn't figure out what to

23 do about it. Recurring cycles, thousands and thousands of

24 people died and there were nightmare stories of cars being

25 pulled through the streets, creaking through the streets at

130 1 the dead of night or early dawn to pick up the bodies of the

2 night's harvest to take those bodies out to a common burial.

3 Well, friends, 3,500 Pennsylvanians died of a

4 preventable illness here the other year. The numbers are

5 going to go up. This is our modern day Plague, folks. This

6 is our modern day Plague. You hear stories of fast food

7 restaurants, of someone being found dead when you go in to

8 try to use the restroom.

9 And I'm horrified by the stories I'm reading in

10 the press, coroners running out of storage facilities,

11 beginning to do things like buy or rent refrigeration trucks

12 or negotiate for extra room for bodies in funeral parlors or

13 in hospitals or the overwhelmed medical examiners all over

14 the Commonwealth who can't keep up with the number of people

15 who died. And they've had to short (inaudible) some of the

16 autopsies when they're pretty sure the victim had died from

17 drug and alcohol.

18 Funeral directors. I've been talking to these

19 people that have started to stash Narcan in the funeral

20 parlors to handle the overdoses of people who come in to

21 grieve the dead. And some places have money that they set

22 aside to bury people who have unclaimed bodies or people who

23 have died. Those funds are running out, driven primarily by

24 untreated alcohol and drugs.

25 Friends, 3,500 are dead with more coming. And

131 1 the best solution we can come up with is to demote the

2 Agency to the bottom of this chart? This is the best we can

3 do, is to step away from the problem instead of toward it?

4 The clock is ticking on the lives of people in our own

5 neighborhood and we are busy rearranging agencies.

6 You're going to be asked to vote on this. You're

7 going to be asked to vote on whether we back off or move

8 forward. I propose that we run toward the problem, not away

9 from it.

10 You did a wise thing when you enacted Act 50 in

11 creating a new department. Let's give it time to do its

12 job. Let's bolster it. Let's fund it properly. Let's get

13 the staffing levels up, not bury it, not expand it, not

14 demote it. Let's properly fund it.

15 We need the stability and leadership of a

16 cabinet-level Department of Drug and Alcohol programs to

17 handle and help us through the current crisis that we're

18 involved in and also to help prepare us for the next drug

19 crisis, because there will be, I'm sorry to say, a next drug

20 crisis.

21 Thank you for your time.

22 MAJORITY HEALTH CHAIRMAN BAKER: Thank you, Deb.

23 Very good to see you, Gary. Welcome.

24 FORMER SECRETARY TENNIS: Good to see you, Mr.

25 Chairman.

132 1 I want to thank all of you for putting attention

2 to this issue. I want to thank you all, those of you who

3 were here in 2010 passing Act 50, which I think showed

4 incredible foresight and wisdom. This is an area that lacks

5 a voice, as Chairman Hartwick said.

6 Even as we have descended into the worst overdose

7 epidemic in history, the Federal Government has, over ten

8 years, cut the Block Grant funding by 26 percent.

9 I came into this as a prosecutor. I worked my

10 first 26 years in the DA's office in Philadelphia. And I

11 saw the impact of really the terrible neglect of this issue

12 that's occurred throughout our country's history, actually

13 throughout all the history of civilization.

14 This really reflects an enlightened perspective

15 that the General Assembly got in 2010. It took until 2012

16 to implement it. But what it did is -- referring back to

17 Chairman Hartwick, it gives us a voice. It puts the

18 spotlight on an issue that cuts across almost every

19 department in the State. It cuts across most county-level

20 and Federal-level areas.

21 And I'm going to get into a little bit more

22 detail. It gives us an ability as a cabinet-level

23 department to reach across to other cabinet-level

24 departments. And I want to thank my colleagues in the room

25 today who, when I reached across to them, have always been

133 1 so responsive and to actually make sure the drug and alcohol

2 issue is being properly tended to, properly cared for, and

3 we're doing all we can across agencies.

4 Now I'm going to run through some examples of how

5 we break down silos. And by the way, for those of you who

6 have looked at organizational dynamics, take a look at what

7 happens in huge, huge bureaucracies and see how much power

8 somebody three or four levels down in those huge

9 bureaucracies actually has to reach across to other

10 agencies, even to reach across to other offices within the

11 same agency.

12 As a cabinet-level Secretary, I was able to

13 accomplish a lot, even in the absence of any significant

14 increases in funding just because of the position and

15 because of the way you raised the Department up.

16 Deb referred to the prescribing guidelines. Back

17 in 2013, as a cabinet-level Secretary, I was able to reach

18 across to the secretaries of about five different

19 departments, Department of Health, Department of State,

20 Insurance, other agencies, the Federal Government, the

21 Veteran s Administration, the Medical Society, county

22 stakeholders.

23 We were able throughout 2014 to do three sets of

24 discipline-specific prescribing guidelines because we know

25 you all know -- because you've paid such close attention to

134 1 the issue, you know that this current epidemic is completely

2 fueled by the quadrupling of prescription opioids that

3 occurred over the past 20 years.

4 So we had prescribed guidelines for the treatment

5 of chronic non-cancer pain, for Emergency Department

6 prescribing, for dentists in December. And then when Dr.

7 Levine came in, who was so interested in the issue, to her

8 credit, she very willingly embraced taking over the

9 leadership of this issue, which is the best-case scenario.

10 Now, this problem, this problem of

11 overprescribing of opioids, has been going on for almost a

12 quarter century now. It has been driving this epidemic.

13 The Department of Health, during those years up before the

14 Department of Drug and Alcohol Programs, could have done

15 prescribing guidelines. It didn't.

16 It didn't happen until you created a Drug and

17 Alcohol Department that can work across cabinet levels and

18 make things like this happen, work across and bring the

19 right people together because the Department of Health has

20 many, many things to deal with. And it just didn't happen.

21 And that's going to be a recurrent theme.

22 Naloxone. We could have worked to raise funding

23 for Naloxone. Even before Act 139 there was more expanded

24 use of Naloxone we could have been doing. But because first

25 you passed Act 139 -- and God bless you; thank you for that

135 1 -- that allowed more expanded use of Naloxone. And you

2 created a department. We were able to reach across to --

3 actually in this instance, to all of the major health

4 insurers.

5 We didn't have any funding for Naloxone. And we

6 were able -- after Capital Blue Cross gave 50,000, we were

7 able to reach across to all the major health insurers, raise

8 $600,000 for Naloxone for our police. And as you heard,

9 police officers across the State -- and 75 percent of

10 Pennsylvania's population now has police carrying Naloxone.

11 They have over 3,000 saves. There's no other state where

12 that's going on.

13 And I guarantee you as a bureau director or a

14 division director or whatever this might be, I would not

15 have been able to make those calls. I would not have been

16 able to get that done or get those executives like Paul and

17 other CEOs of health insurers on the phone to get that

18 money.

19 Also, when the Pittsburgh Police were a little

20 bit slow getting going with Naloxone, I was able to call

21 Chief McClay in Pittsburgh, get him right on the phone, get

22 a meeting with him. He was very receptive. And the

23 Pittsburgh Police Department carried Naloxone. There is so

24 much that is possible because of what you did.

25 I believe that the Bureau of Drug and Alcohol

136 1 Programs would have liked to have done these things, the

2 office would. The division would. When it was buried

3 within a bureaucracy, I'm sure they would have liked to have

4 done this. They cared about the issue.

5 But there's kind of a reality here. And I'm

6 talking -- because we're hearing a lot of words being thrown

7 around. But what I'm trying to talk with you about now is

8 concrete realities of what occurred because you created a

9 department.

10 Warm Hand-Off. You've been hearing about how

11 critical it is that we get individuals who overdose, where

12 we save their lives, we actually get them to treatment. We

13 have worked with the Pennsylvania Chapter of the College of

14 Emergency Physicians with the Hospital Association of

15 Pennsylvania to develop Warm Hand-Off protocols and have our

16 SCAs reach across to all hospitals.

17 We have in the room, really the leader in the

18 State among our SCAs, George Vogel, and his hospital,

19 Reading Hospital, which is one of the leading -- do you mind

20 raising your hand and taking a little credit here? They're

21 getting instead of one out of ten to treatment, overdose

22 survivors, they're getting three out of four overdose

23 survivors into treatment.

24 We were able to reach across and bring the

25 stakeholders together because of the prominence you gave us,

137 1 because you gave us a voice, which will be lost if we go

2 back to the way it was.

3 And I know they'll say, well, it will be

4 different. I'm sure that's the intention now while we're in

5 the middle of this opioid epidemic. But we have hundreds of

6 years of history that shows what happens to this issue when

7 it's allowed to be deemphasized and when it gets buried in

8 bureaucracy.

9 We talked about money, how there's zero savings

10 here. We started back early in the Department's history,

11 fall of 2012, we went out to Armstrong County and Clarion

12 County. As the Secretary, I was able to reach over to the

13 then Secretary of DHS and say, let's do a project to get

14 Medicaid turned on for people coming out of county jails

15 instead of in six weeks, let's get it turned on the day they

16 come out.

17 Now when the Block Grant dollars are used up,

18 which they get used up, and somebody comes out of county

19 jail and it takes six weeks to sign them up on Medicaid and

20 get them into treatment, they are at grave risk for six

21 weeks of relapsing, of overdosing, and if they don't

22 overdose when they relapse, of re-offending and getting

23 locked back up and back into the county jail.

24 As a Secretary, I was able to get the help of the

25 then Department of Public Welfare. We had all of the county

138 1 stakeholders from the President Judge to the DA to the

2 Prison Board to the SCA and others at the table. We started

3 the pilot in Armstrong Indiana to get Medicaid turned on so

4 that when somebody was coming out of jail, we could send

5 somebody in to see if they need drug and alcohol treatment

6 before they come out.

7 Then when they would -- if they needed it, we

8 would make sure the Medicaid paperwork was all done so the

9 instant that they stepped foot out of jail, the instant that

10 they did, Medicaid was turned on. And then they were able

11 to go right into treatment. There was a van ready to take

12 them to treatment.

13 By the way, Federal matched dollars. So that

14 means during that six weeks, we're getting Medicaid coverage

15 for these individuals and bringing in millions more in

16 Federal dollars than we would have.

17 So not only will this not save money, but because

18 of the kinds of -- oh, by the way, that is now a statewide

19 project. We now have that I believe in every county so that

20 anybody coming out of county jail, Medicaid is turned on the

21 second they come out. There was a collaboration between

22 DHS.

23 I'm going to hit one more example. I actually

24 have a list of nine items. I'm only going to do one more so

25 that I don't run on too long. The take-back boxes. Early

139 1 on we went to Bucks County. We saw that they had 17

2 take-back boxes in police stations around the county. As a

3 Secretary, I was able to reach over to the Chairman and the

4 Executive Director of PCCD, actually just a couple days

5 later, to find out if they had any funds that might be

6 available to fund take-back boxes in Pennsylvania.

7 They had $100,000. I was able to get on the

8 phone with Staunton Farm Foundation out in Western

9 Pennsylvania. I was able to work with the Pennsylvania

10 Chapter of U.S. Healthy Water, the Philadelphia/Camden

11 HIDTA. And ultimately we gathered enough funding so that

12 today we have 500 take-back boxes planted in police stations

13 across the State.

14 By the way, the DEA was doing the take-back. And

15 they actually said this is too much. We can't do it for a

16 while. And we were able, as Secretary, to reach across to

17 the Department of Military and Veterans Affairs where we

18 found out we could get the National Guard to do it with the

19 help of the Attorney General's Office.

20 I could not do that as a Bureau Director because

21 you did Act 50 of 2010. Because you gave me the ability to

22 reach straight across to my colleagues, who have all been

23 just very, very helpful, we were able to get that.

24 And by the way, what does that mean? To date we

25 have collected over 200,000 pounds of prescription drugs and

140 1 destroyed them. We had them incinerated across the State.

2 I think, based on sampling estimates, about a third of

3 those, 65,000 pounds, are drugs of abuse such as opioids,

4 benzodiazepines and amphetamines, 65,000 pounds off the

5 street.

6 That is a big deal because we know particularly

7 our young people, our beloved young people, our sons and

8 daughters, are at the gravest risk. You've heard about the

9 pharm parties where the kids will get together and they'll

10 see what they gathered from their friends' families'

11 medicine cabinets during the week and then they are at grave

12 risk of overdose.

13 And I do want to say I've had good cooperation

14 among my colleagues. I saw the press conference last week,

15 I guess it was, where in the Department of Conservation and

16 Natural Resources, rangers are carrying Naloxone. That was,

17 again, an example where I was able to -- I think it was

18 after a cabinet meeting, I talked to Cindy Dunn and said, is

19 this something you'd be willing to do?

20 And typical of the kinds of responses that I've

21 gotten from this cabinet, they were eager. She lit right up

22 and said absolutely and went to work on it.

23 So DDAP with its 62 individuals in the Department

24 right now, or 65, whatever it is, we don't do all of this.

25 But because of where you placed it, we're able to catalyze

141 1 actions all over the State.

2 And by the way, we have much more to do with the

3 Department of Corrections than DPW. I mean, why not merge

4 it with the Department of -- I mean, we have something to do

5 with everybody. We have Department of Education, Student

6 Assistance Programs, K-12 education.

7 There really is -- it's hard to find an agency --

8 there are maybe two or three -- where we don't have

9 something to do to kind of say, here is the drug and alcohol

10 piece we need to take care of. The Bureau Director can't do

11 it.

12 A Secretary of a behemoth agency who has this as

13 one of his 25 major responsibilities isn't going to have the

14 time and energy. As good as Ted Dallas is, I don't think

15 anybody could possibly give the drug and alcohol issue the

16 cabinet-level attention that I was able to give as having it

17 be my sole focus.

18 So I want to thank you for Act 50. I beg of you,

19 please, for me it's the -- I tell people this. I'm doing

20 the job the Governor fired me to do. I'm here. I care

21 deeply about this issue. I know you do, too. You know, you

22 meet with these ten families a day that are being shattered.

23 You know, it's one thing to lose a job. You can

24 replace a job. You can't replace losing your son or

25 daughter, irreplaceable. And it's happening ten times a

142 1 day. This is life and death. This is real. These are

2 concrete examples of what this means.

3 Please, please take the Drug and Alcohol

4 Department. I mean, I have an opinion about the Aging, but

5 I'm not going into that area because it's not my area of

6 expertise. I'm here to talk about drug and alcohol. I beg

7 of you in the name of the ten families a day that are going

8 to be shattered and the ten tomorrow that will be shattered

9 and going forward, please continue to give the issue the

10 prominence and focus that Act 50 gives it.

11 Thank you.

12 MAJORITY HEALTH CHAIRMAN BAKER: Thank you very

13 much, Gary.

14 And thank you for your distinguished service in

15 the past as a prosecutor and as a good servant leader in

16 public service here in the Commonwealth.

17 FORMER SECRETARY TENNIS: It's been a pleasure

18 working with you, Chairman Baker.

19 MAJORITY HEALTH CHAIRMAN BAKER: I have to ask

20 for apologies because I did not introduce the Cabinet

21 Secretaries that are in the room. And quite frankly, I

22 believe they've been here the whole time, the whole session,

23 of the hearing. But I didn't see them because the room was

24 so full. So I apologize.

25 I do want to recognize and acknowledge the

143 1 Secretary of Health, Karen Murphy; Rachel Levine, our

2 Physician General; Ted Dallas, our Secretary of Department

3 of Human Services; and our Secretary of Aging is also there

4 right behind Will, who I can barely see but I know she's

5 there.

6 And by the way, I didn't know you were 70 years

7 of age. You look very good for 70, Will. But thank you for

8 that admission.

9 Anyone else? Brenda Harris is over here, Deputy

10 Secretary, Executive Secretary Jen Burnett. Anybody else

11 I've missed? I apologize. The room is -- I can see now.

12 Thank you for coming. Thank you for being here

13 and listening to all the testimony. We really appreciate

14 it.

15 Chairman DiGirolamo will lead off with questions.

16 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

17 Thank you, Matt, again.

18 Thank you both for your very, very passionate

19 testimony. I think when you talk about reality, it's

20 exactly what you said, Gary, at the end. Ten people are

21 going to die today from overdoses in the State of

22 Pennsylvania.

23 And that's ten families that in two or three or

24 four days are going to be burying their sons and daughters,

25 brothers and sisters, moms and dads. They're going to be

144 1 going out to the cemetery and they're going to be putting

2 them in the ground.

3 And on a number of occasions I can tell you, if

4 you want to talk about something excruciating, go out to a

5 gravesite with a mom that has buried their son or daughter

6 and watch them stand over that gravesite. It is just

7 excruciating and heartbreaking.

8 And it's happening far too much and far too many

9 times in the State of Pennsylvania and, in a large way,

10 across our country.

11 Gary, you just did a phenomenal job outlining all

12 the things that you've been able to do since you've been

13 Secretary.

14 And again, Deb, you did a good job. The history

15 of this Department, we passed it in 2010. Governor Corbett

16 implemented it or started it in 2012, named Gary the first

17 Secretary.

18 Governor Wolf came in and, Gary, I think you were

19 one of the two people he reappointed as Secretary and kept

20 you on, you and Secretary Wetzel in Corrections. I just

21 want to thank you for the good work you did.

22 Needless to say, when I got the call from the

23 Administration that you had been fired, I was just shocked

24 and really heartbroken and terribly disappointed because I

25 know how passionate you felt and what a great job you did.

145 1 FORMER SECRETARY TENNIS: Thank you.

2 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

3 We're here. And we're moving forward.

4 FORMER SECRETARY TENNIS: Yes.

5 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO: And

6 as I say every time, the Governor really cares about this

7 issue. He made this a priority. The Governor is a good

8 man.

9 But why in the middle of this epidemic and why

10 when we're losing so many of our family members and not only

11 the ones that are dying -- I know how devastating it is to

12 families when they have a loved one who's addicted -- why in

13 the middle of the this are we doing away with it?

14 Maybe I'm going to ask you the question, Deb.

15 Why in the middle of this are we doing away with the lead

16 agency that has the responsibility to take care of this

17 problem? Can you answer that question?

18 PRESIDENT BECK: No. It makes absolutely no

19 sense to me. Think about the optics just for a second.

20 Substance aside, what are the optics here? Are we going to

21 lead or are we going to back away? I think we should run to

22 the problem, as I said in earlier testimony, bolster the

23 agency and let's get going. This is a new agency.

24 Senator Yaw raised that in a couple of the

25 hearings. This is a new agency. Let's let it do its job.

146 1 MAJORITY HUMAN SERVICES CHAIRMAN DiGIROLAMO:

2 And for the information of the members, if you

3 get a chance, get a copy of Senator Yaw's testimony last

4 week at the Senate hearing up in Reading. It is really good

5 and really, really compelling.

6 And he said -- he asked the question, did the

7 Legislature make a mistake in implementing this Agency and

8 starting this Agency? Did we make a mistake? It's only

9 been up and running just five years. Did we make a mistake?

10 He says we were very timely in doing it. And I

11 agree with him. I agree with him. Everybody knows how I

12 feel. I just want to caution the members that are here. If

13 we allow this to happen, if we allow this consolidation plan

14 to happen with all of these agencies, not just with Drug and

15 Alcohol, you're not going to go back and get this back

16 again.

17 If it doesn't work, we're not going to go back

18 and recreate these departments again. If this doesn't work,

19 our constituents will be on our doorsteps, knocking on our

20 doors and at our district offices wanting an explanation for

21 why we did this.

22 They're not going to be up here at the Capitol on

23 the doorsteps of the Capitol knocking on doors and asking

24 why we did this. They're going to be at our district

25 offices and we're going to have to explain why we rushed

147 1 into this proposal and why it's negatively affecting our

2 most vulnerable citizens.

3 It's just a terrible idea. We shouldn't be doing

4 this, especially when it comes to the Department of Drug and

5 Alcohol in the middle of this crisis and epidemic that we're

6 all facing.

7 Thank you, Mr. Chairman.

8 MAJORITY HEALTH CHAIRMAN BAKER: Thank you, Gene.

9 Representative Kaufer.

10 REPRESENTATIVE KAUFER: Thank you, Mr. Chairman.

11 I think both of you know I just got appointed to

12 be the Subcommittee Chair for Drug and Alcohol. So I take

13 that with a major role because it's certainly an issue I

14 care deeply about. I appreciate you both being here.

15 FORMER SECRETARY TENNIS: Thank you.

16 PRESIDENT BECK: Thank you.

17 REPRESENTATIVE KAUFER: Secretary Tennis, I do

18 want to say I still -- you're still doing the job the

19 Governor originally hired you to do, I believe. I mean that

20 with all sincerity.

21 I quickly looked through the packet. I know you

22 didn't do an exhaustive list, but here's the Departments

23 that were just some of them that were listed that you have

24 already collaborated with: Department of Education, Health,

25 Human Services, the Attorney General's Office, Pennsylvania

148 1 State Police, Pennsylvania Commission on Crime and

2 Delinquency, Transportation, Aging, Corrections, Insurance,

3 Military and Veterans Affairs, Labor & Industry,

4 Agricultural, Board of Pardons. Those were just a few.

5 That's not an exhaustive list. Those are just a few that

6 popped out to me immediately.

7 I want to say, I know we created this before I

8 was here back in 2010. I wish we had done it ten years

9 before that.

10 PRESIDENT BECK: Yes.

11 REPRESENTATIVE KAUFER: At a time when I believe

12 we need to be bolstering this Department, we need to be more

13 supportive of what we need to do because I don't believe

14 we're doing enough right now.

15 I have just a couple of questions. What do we

16 need to do to support the treatment and prevention? Do we

17 have enough beds, first of all, within what we're talking

18 about? Because if we're talking about consolidated, we need

19 to talk about the expansion of what we need to do to get

20 this under hand. And with a consolidated department, I have

21 concerns.

22 And another one is, I know that as a major policy

23 initiative just a couple years ago, we put forward the

24 Centers for Excellence, of which I have been a stalwart

25 opponent of. I thought it was not the right place to be

149 1 spending money at the time but actually talking about the

2 treatment and prevention services.

3 And if you could both comment on that as well.

4 FORMER SECRETARY TENNIS: Well, I think you're

5 right to identify that treatment is underresourced. And the

6 Surgeon General has documented that. That's historically

7 been the case for a long time. National funding for

8 treatment is at about 10 percent of what's needed. So that

9 creates a couple of problems.

10 One is you can't get a treatment slot and, No. 2,

11 if you do get into treatment, it tends to get cut too short

12 and that hurts the outcome.

13 It needs to be a sufficient length of stay. It

14 needs to have clinical integrity. That means it needs to be

15 long enough and intense enough. So we need more resources.

16 Now that I'm out of the job, I'll tell you I was

17 very -- I would have dearly, dearly loved to have that 20

18 million that went to Centers of Excellence, which is

19 basically Case Management, which duplicates what our SCAs

20 do, and use that instead to expand our treatment

21 infrastructure as matching grants to build up more

22 treatment.

23 Now we do have the Cures money that's coming in

24 from the Federal Government that we're going to be able to

25 do some of that now, but it's later. It's going to be

150 1 coming in a couple of years later.

2 Since I came in actually under both

3 Administrations, I have asked for more resources. And the

4 way the budget process works, you pretty much take the

5 decision that's made and that's what you go with. That's

6 just kind of how it works. You work for the Governor. We

7 need more of that.

8 We also need more intervention. So, for example,

9 Student Assistance Programs where you identify at-risk kids

10 in our high schools, those have faded away because the

11 funding went away. That's an intervention program for kids

12 for high-school/junior-high-school-aged kids that would

13 funnel more people into treatment.

14 We are working -- and Dr. Levine has done a nice

15 job with working with our medical schools on the curriculum

16 so that finally our doctors are getting some training in

17 addiction treatment. So we need more. There are many

18 different ways that you catch, you help people with a

19 disease and you interact with them.

20 I grew up professionally in the criminal justice

21 system. Police all could be trained. That's one of the

22 initiatives we did. We worked with -- actually in Bensalem

23 and Upper Darby and now all of the police in Potter County,

24 of all places, they are -- their police are trained to do

25 interventions.

151 1 They see the folks with serious drug addiction,

2 the homeless on the streets. They can engage with those

3 individuals and get them to treatment.

4 I actually have a -- I know of just some

5 phenomenal individuals who police officers actually engaged

6 them on the street and got them into treatment.

7 So there are many, many ways to cut into this on

8 the intervention. But ultimately you have to have the beds.

9 You've got to have the beds and the occupy slots. And you

10 need to avoid the fight between inmate versus drug free. It

11 needs to be clinical just like with cancer or diabetes or

12 heart disease. We need to allow the patients and the

13 clinicians to work through what is best clinically.

14 It's not a political issue. It's a clinical

15 issue.

16 REPRESENTATIVE KAUFER: I appreciate your answer

17 because I think it's very important. Everybody here I think

18 can sense your passion on the issue. But I wanted to be

19 noted that this is the voice we're drowning out with what

20 we're talking about.

21 This is the person who, since the department was

22 created, was in charge of being that voice, a voice who I

23 think, unfortunately, has not been listened to enough in

24 this current Administration and unfortunately let him go.

25 I appreciate your comments on the Centers for

152 1 Excellence. It sounds like you weren't really --

2 FORMER SECRETARY TENNIS: It's a different issue.

3 But we were certainly in the meetings where it was being

4 presented.

5 REPRESENTATIVE KAUFER: I just -- it frustrates

6 me. Because as somebody who is so knowledgeable -- and I've

7 had many conversations with you -- on these issues, to be

8 drowning out this voice that has been the stalwart defender

9 of people in recovery, of people who need to be in recovery,

10 of all these connections of different dots all throughout,

11 it saddens me. I don't know what other words to use.

12 It is so disappointing to me that we are talking

13 about this voice being gone. I'm sorry. I'm sorry

14 personally as a legislator that we no longer have your voice

15 in our government. I am deeply saddened about that.

16 So I just want to say thank you for all that

17 you've done for our Commonwealth. And I appreciate you

18 being here today because I know it's not easy to be here

19 testifying in front of us. And I greatly appreciate all

20 that you've done.

21 Thank you.

22 FORMER SECRETARY TENNIS: Thank you,

23 Representative. And thank you for your leadership on this

24 issue as well.

25 REPRESENTATIVE KAUFER: Thank you, Mr. Chairman.

153 1 MAJORITY HEALTH CHAIRMAN BAKER: Chairman

2 Hennessey.

3 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

4 HENNESSEY: Thanks, Matt.

5 Deb, Gary, thank you for the work you've done for

6 all those years in the field of drug and alcohol prevention.

7 You were two of the first people I think I met

8 when I came to Harrisburg years ago.

9 FORMER SECRETARY TENNIS: In the '80s.

10 PRESIDENT BECK: You lucky person.

11 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

12 HENNESSEY: You've kept your energy and your enthusiasm for

13 the pursuit of drug and alcohol prevention throughout these

14 years. You know, we can tell today just how involved you

15 are still in it.

16 Thank you, Gary, for explaining the, you know,

17 importance of the position, of having the title, having the

18 designation as a cabinet-level Secretary and just exactly

19 what that means in terms of the gravitas that people assign

20 to you when you pick up the phone and call.

21 FORMER SECRETARY TENNIS: Exactly.

22 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

23 HENNESSEY: They know that they're calling back a

24 cabinet-level officer. I think it's important. You've

25 explained that really, really well.

154 1 FORMER SECRETARY TENNIS: Thank you.

2 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

3 HENNESSEY: Gene asked why we were thinking of doing this in

4 the middle of a crisis, to, you know, merge drug and alcohol

5 into a much larger agency. I think the same question can be

6 asked about why we're doing it for the Department of Aging.

7 You know, in three years, the over-60 population

8 in Pennsylvania will be more than 25 percent of our

9 population. In the ten years that go beyond that to 2030,

10 we're going to be talking about 28 percent of the

11 population.

12 Frankly, if we didn't have a separate Department

13 of Aging already, we would be asking why we don't create

14 one. Now we have it and we're talking about, you know,

15 basically demoting it to a deputate within a much larger

16 agency.

17 Thanks for pointing out the problems that are

18 involved with just making that kind of a step. I appreciate

19 your testimony. And I appreciate the work you've done over

20 the years.

21 FORMER SECRETARY TENNIS: Thank you.

22 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

23 HENNESSEY: Thank you.

24 FORMER SECRETARY TENNIS: Thank you very much.

25 PRESIDENT BECK: And if I may for just a second.

155 1 MAJORITY AGING & OLDER ADULT SERVICES CHAIRMAN

2 HENNESSEY: Sure.

3 PRESIDENT BECK: When you and Aaron Kaufer asked

4 what should we do, I think the blueprint is in Act 63, now

5 Act 50. If you have not read that blueprint, I would highly

6 recommend it.

7 The guy in '72 actually laid out a blueprint for

8 the State of Pennsylvania but if everything was up and

9 running now, we wouldn't be in the position we're in now.

10 It would have meant we had physician prescribing

11 guidelines. We would have limited the sale of opiates. We

12 would have done training across all the other disciplines.

13 It would have already been done. It's time we live up to

14 the mission that is laid out there.

15 And I also wanted to respond to your question, do

16 we have enough beds? Jeez, I'm looking at Representative

17 DiGirolamo. And it was a couple days before Christmas. We

18 were working together desperately to find a single detox bed

19 in the State of Pennsylvania for someone who was in

20 desperate need.

21 No, we don't have enough beds. I think we should

22 be commandeering the empty State buildings and putting them

23 to use to address this emergency. I know you have a bill

24 that approximates that goal. We need to commandeer those

25 empty buildings that are being heated and kept up anyway and

156 1 put them to use.

2 But let's get serious about the problem. I think

3 we need to get serious about the problem, bolster the

4 Agency, don't demote it. Look at the blueprint in Act 63.

5 Act 63 is brilliant. I spent a lot of time trying to figure

6 out who all contributed to that. I wasn't able to figure it

7 out. It's a phenomenal document. Read the statute.

8 There's a blueprint for America in there as well

9 as for Pennsylvania.

10 FORMER SECRETARY TENNIS: And just to follow up.

11 One of my projects that we were just beginning was with

12 Curtis Topper, an excellent Secretary for the Department of

13 General Services, to do that -- it was toward the end of my

14 tenure -- to take a look at empty buildings, both DGS and

15 actually I think DHS empty buildings as well to see if we

16 could use any of those for drug and alcohol treatments.

17 It's the kind of thing that you're able to move

18 on with some facility. It's pretty tough to do, again, when

19 you're buried deep in a bureaucracy.

20 MAJORITY HEALTH CHAIRMAN BAKER: I have a former

21 State hospital in Tioga County that's a prime candidate for

22 that. I appreciated you coming up for that. Oh, my gosh.

23 We could put 300 beds in place and start tremendous

24 treatment.

25 I just wanted you to know we are moving a package

157 1 of opiate bills out of the Health Committee on Wednesday.

2 Gary, you started and then stopped and went into

3 a different direction when you were talking about how you

4 were able to engage the Medicaid program with the county

5 prisoners and then also to leverage Federal dollars.

6 FORMER SECRETARY TENNIS: So Medicaid has, I

7 think, roughly 55 percent Federal match. I think 90 percent

8 for the expanded group. There are two alternatives. You

9 know, I really hand it to the County Assistance Offices at

10 DHS. They did a really nice job. They sent us the right

11 people to do that.

12 When you turn Medicaid on for somebody, that

13 means coming out of county jail, their treatment is going to

14 be paid for 55 percent Federal dollars.

15 If they're using Block Grant dollars, then that's

16 money -- although that's a finite pool of money. So that's

17 going to come out and that's going to be -- although it's

18 Federal match, it's a finite pool that runs out. So it's

19 technically for functionality purposes. It's like 100

20 percent State dollars.

21 And not to mention those who don't get treatment

22 when they come out, if they have that six-week delay, if

23 they recidivate, not only are you going to have more crime

24 in your communities, but your counties are going to be

25 dealing with greater county jail expenses as well.

158 1 We did start back in 2013 to do those same

2 projects. We made an attempt with DPW and the Department of

3 Corrections. It was a slow go. You know, sometimes

4 projects go real fast and easy. And some sometimes it's

5 more challenging.

6 So I'm not in any way faulting anybody or

7 pointing the finger in any way. That project, I understand,

8 because I've heard Ted Dallas and John Wetzel speaking about

9 it, I gather they're getting somewhere, having some success

10 getting that project going.

11 That's something we attempted back in 2013.

12 PRESIDENT BECK: If I could quickly point out

13 that meant people with diabetes. There's no break in their

14 care either. Also people with schizophrenia and other

15 mental illnesses. It's not only just help for drug and

16 alcohol.

17 MAJORITY HEALTH CHAIRMAN BAKER: Part of the

18 argument that we're having over this consolidation issue

19 seems to be engaged in the issue of cost savings. And I've

20 really not seen definitive evidence of the cost savings.

21 Anecdotally I've heard it could be $90 million. Half of

22 that has to do with a pharmacy fee that's subject to CMS.

23 We don't even know if that's going to get approved.

24 So are we doing this as a sound bite, that sounds

25 like good government, we're consolidating, we're trying to

159 1 merge departments? That sounds wonderful. But in effect,

2 are the benefits really there in terms of cost savings and

3 are we at a risk of losing any money as well?

4 I just think there's a lot of issues out there

5 that we do not have answers yet. And I'm not sure if the

6 answers can be provided at this point in time either,

7 depending on the construct of the bill and how that impacts

8 the various line items and departments and what happens at

9 the Federal level.

10 You mentioned SAMHSA. You mentioned Medicaid.

11 It's just a lot of variables here that we're just not privy

12 to in terms of, is there going to be a real cost savings?

13 What's the impact to the delivery of services? We've heard

14 there's not going to be any discontinuation of services.

15 And yet when you hear the health departments or

16 County Assistance Offices being closed, there is an impact

17 to services in one way or another. So it's just a lot of

18 information out there that we do not seem to have definitive

19 information at this point in time.

20 And I'm very concerned about that, especially

21 after talking to some of my Federal colleagues and State

22 colleagues. I heard a remark by the Attorney General the

23 other day at a banquet that we could be seeing -- we may be

24 looking at another 1,000 to 1,500 more overdose deaths from

25 the preceding reporting period.

160 1 PRESIDENT BECK: Yes.

2 MAJORITY HEALTH CHAIRMAN BAKER: And I'm hearing

3 that as well potentially from the DEA. So if we're engaged

4 in the greatest public health threat to Pennsylvania and

5 maybe America, I'm just very cautious about what we're doing

6 here in terms of making sure the focus is where it needs to

7 be and that is the greatest public health threat to

8 Pennsylvania.

9 FORMER SECRETARY TENNIS: He's worked on this for

10 five years. I'm absolutely convinced that if you hadn't

11 made this Department, we would have lost millions of dollars

12 in funding for Medicaid.

13 We'd have millions more in criminal justice

14 costs, not to mention bringing attention to this issue so

15 that people, for example, coming out of -- I'm just taking

16 the one small example of people coming out of county jail

17 and getting Medicaid. That is something that has a huge

18 impact on not only cost, $7 return, by the way, for every

19 dollar invested in treatment if it's done with clinical

20 integrity. So there's those savings.

21 There's savings that kind of ripple through State

22 Government. As you take better care of this issue, you end

23 up -- one of the things that I've sometimes said to my

24 colleagues is, if we do our job well here at Drug and

25 Alcohol, it's going to help you do your job better because

161 1 you're going to have lower Hep C costs. You're going to

2 have lower criminal justice costs. Schools are going to be

3 healthier and more functional. You can go across one agency

4 after the other.

5 MAJORITY HEALTH CHAIRMAN BAKER: Are you aware of

6 any potential loss of funding as a result of consolidation?

7 FORMER SECRETARY TENNIS: We get a Federal block

8 -- and these are very roughly rounded numbers -- of about 60

9 million. You have a Federal maintenance of effort

10 requirement for our Block Grant. So if you were to cut

11 funding -- and I don't think that's being proposed. But if

12 you were to have savings that resulted in cuts, every dollar

13 you cut in State dollars would result in $1.50 in Federal

14 dollars.

15 MAJORITY HEALTH CHAIRMAN BAKER: Okay. Thank

16 you.

17 Representative McCarter.

18 REPRESENTATIVE McCARTER: Thank you, Mr.

19 Chairman.

20 Again, thanks to both these testifiers and to

21 everybody who's testified today. There are a lot of

22 different things that have surely been said here today that

23 I think all of us are very, very concerned with, to say the

24 least, various different elements of obviously all the

25 people who are impacted by not only drug and addiction but

162 1 by death, as we've heard.

2 There's been a lot of passion, a lot of passion

3 that everybody has expressed today. But I think the one

4 passion that I haven't heard today that upsets me more --

5 and I mentioned this at the last hearing as well -- is the

6 passion to appropriate the money to take care of the needs

7 that we identify, whether it's the needs of the addicted or

8 it's the needs of education.

9 The wheel of the body here is the legislative

10 body that we are the ones failing. We can talk about

11 consolidation until it comes out our ears. It may be the

12 way to get to greater efficiencies. It may not be. It may

13 be that if we study it for a year it will have a better

14 effect in terms of how we bring about a consolidation.

15 But the bottom line on all of this is revenue.

16 And when we pass a Budget that is $800 million less than

17 what the Governor proposed and incorporates the savings that

18 we're talking about here for consolidation but no one says,

19 oh, no, let's take that out of the budget, let's appropriate

20 an additional sum of money for each of these departments to

21 allow them to do their job, we have a problem. We can't

22 blame the Governor completely for trying to do his job and

23 then fail on our side when we don't appropriate the money

24 necessary to carry this out. So with all the passion that

25 we want to have for these particular issues, the passion

163 1 also needs to be there to fund these particular programs or

2 else all of that passion is just words and it's not what we

3 need to be thinking about as Legislators.

4 Thank you.

5 MAJORITY HEALTH CHAIRMAN BAKER: Any other

6 questions? Seeing none, we thank the panelists very much

7 for your time and efforts.

8 PRESIDENT BECK: Thank you.

9 FORMER SECRETARY TENNIS: Thank you for the time

10 and opportunity.

11 MAJORITY HEALTH CHAIRMAN BAKER: Thank you very

12 much.

13 Thank you, members.

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3 taken by me on the within proceedings and that this is a

4 correct transcript of the same.

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8 Jean M. Davis 9 Notary Public

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