Performance Oversight Hearings Week in Review March 3-7, 2014

Last week was supposed to conclude the D.C. Council oversight hearings, but thanks to the snow days there will be a couple more scattered through the rest of the month. The schedule was not quite as packed as the week before, but it was still challenging to keep up with every hearing when so many happen at the same time. Councilmember Grosso hustled between hearings by the Committee of the Whole, Committee on Education, and Committee on Health. This is our latest recap—be sure to check out our write-ups for the weeks of February 17th and February 24th.

Quote of the Week:

Public Witness from Americans for Safe Access: “There are no known instances of overdosing on marijuana, and as a Maryland physician testified, you would have to smoke a joint the size of a telephone pole for that to happen.”

The  Committee of the Whole wrapped up its oversight hearings last week with testimony about the Contract Appeals Board, District of Columbia Retirement Board, Retiree Health Contribution, Teacher’s Retirement System, Police Officer’s and Firefighter’s Retirement System, Office of Zoning, and the Office of Planning.

• Councilmember Grosso was splitting his time between the Committee of the Whole hearing and the Committee on Health hearing happening at the same time.  He heard testimony from and asked questions of Marc Loud, Chief Administrative Judge of the Contract Appeals Board (CAB).  The CAB hears both appeals (i.e., adversarial proceedings wherein either the government or a contractor under an existing contract initiate a lawsuit for damages for breach of contract performance or payment) and they hear protests (i.e., adversarial proceedings wherein a disappointed bidder challenges a contract award or solicitation).   The D.C. government is always a named party in either type of appeal because all of the cases have government contracts at issue.
• The three recently appointed CAB Judges inherited a backlog of 41 cases and for those of you who are unfamiliar with this type of work…that is a lot.  The Judges and their staff narrowed this number down to six legacy cases without creating a second generation of backlog appeals.
• All of the Judges and staff attorneys (five in total) are barred and in good legal standing in the District.  We wish this was not a question we had to ask, but with the current climate of not-so-good government it is important that the awkward questions get asked, too.
• There were over thirty witnesses who came to testify about the the Office of Zoning (OZ) and the Office of Planning (OP) prior to the government witnesses.  Most of the public witnesses testified about the Comprehensive Plan and the Zoning Regulation Revisions (ZRR) The ZRR is roughly 1,000 pages of changes and edits meant to bring the regulations into the 21st century.   After more than five years of hearings on the revisions, we are starting to feel like by the time it is complete it will be time to start all over again. 
• With the government’s loss of our former city planner, Harriet Tregoning, the Office of Planning is moving ahead with its plans (no pun intended?) for the city and to continue to accomplish new development while still preserving the city’s historic character.  The Councilmember was not able to stay for the government witness testimony, but his position on the matter is documented in our blog post from last year.  

The Committee on Education also held its final performance oversight hearing last week, with the DC Public Charter School Board (PCSB).

• The PCSB has definitely stepped up its oversight of school discipline policies over the past year and as a result the expulsion and out of school suspension rates are down. While all were pleased with this news, the PCSB said they would look more closely at mid-year withdrawals to ensure that students are not being “counseled out” in lieu of expulsion. Councilmember Grosso asked the PCSB to take a closer look at their preschool school discipline policies. In data provided to the Committee by the PCSB, some charters schools are suspending students in PK-3 and PK-4. Why would a school ever need to suspend a child that young?
• The PCSB recently redeveloped its Performance Management Framework (PMF) tool that helps schools disaggregate their data by subgroups to see where they are falling short in terms of the annual evaluation.
• It does not seem like the PCSB will be working in collaboration with D.C. Public Schools (DCPS) anytime soon to ensure that new charter schools are not opening up right down the street from a DCPS school. Let the competition continue, we guess. Though is that really the most efficient use of taxpayer dollars?
• There seems to be some inconsistency between school evaluations conducted by PCSB and the Office of the State Superintendent of Education (OSSE). The PCSB closed one school for poor performance rating under the PMF that was labeled as a “Reward” school (highest ranking a school can achieve) by OSSE. This isn’t a good situation but there is no obvious resolution right now.

Our week ended spending a lot of time with the Committee on Health on various agency performance oversight hearings.

Department of Behavioral Health

• From recovering addicts, to rehabilitated former criminals, to survivors of the 1977 Hanafi siege of the Wilson Building, this hearing was filled with very impassioned testimony.  Many public witnesses praised DBH’s Certified Peer Specialist Program which they touted as life-changing and extremely effective.
• Councilmember Grosso noted that the depression rate among African-American women is estimated to be almost 50% higher than that of Caucasian women and inquired about the Department’s efforts to reduce the stigma and market its services to this demographic.  DBH said they are addressing this disparity, for example with a program for young mothers who are TANF recipients, and continuing to try to increase access points for communities of color.
• Concerned about the issues facing our homeless residents, Councilmember Grosso asked DBH what they are doing to cut down the wait times (25.1 months) for consumers to access housing.  DBH received 1,068 Housing Waiting List applications from consumers self-reporting as homeless in FY13. Director Baron noted that this area is a challenge due to extremely low supply of affordable housing in the face of high demand.  Currently, DBH offers 1,600 affordable housing units paid for with DHCD capital funds.  Although the waiting list does continue to grow, DBH is actively working with DHCD through monthly calls to address this issue.
• Despite the high number of District residents who receive healthcare through Managed Care Organizations (MCOs), DBH has no full time employees dedicated to working directly with MCOs. However, the Department does frequently collaborate with DHCF to address issues around behavioral health treatment within the MCOs. We are going to keep a close eye on this topic, including during the budget process.

Department of Healthcare Finance

• If you care about domestic policy, you always need to follow the money involved in healthcare. In FY13, DHCF spent nearly $2.3 billion to implement both Medicaid and Alliance programs. The entire budget of the District of Columbia is about $6 billion. DHCF’s Medicaid Managed Care program is the single largest item on the agency budget covering over 160,000 beneficiaries, via managed care organizations (MCOs).
• For the first time ever, DHCF released a performance report for the MCOs (http://dhcf.dc.gov/node/775862). This information will inform DHCF decisions regarding contract renewal.  Councilmember Grosso has been pushing for more oversight of MCO spending and outcomes and this is a welcome first step.
• It’s clear the agency is learning from past mistakes. Currently, MCOs are required to have a risk-based capital level ratio of about 1.50, which ensures that the MCO has reserves to pay for services that have been provided but not yet reimbursed. When Committee Chairwoman Alexander asked Director Turnage why there was a requirement, Turnage’s response was simple: “To avoid what happened with Chartered.”
• Much of the growth in spending can be attributed to the long-term care program which has had year-to-year growth rates of more than six times the levels observed for the entire Medicaid program over the same period in the last few years. You have maybe heard of the Medicaid fraud investigation?
• Speaking of which, the federal fraud investigations for the Personal Care Attendant program has required DHCF to suspend payments for 52% of home health providers, which covers about 79% of the beneficiaries. DHCF is working to ensure that this doesn’t mean people lack access to necessary medical services.
• One of the greatest concerns raised during this hearing centered on the Elderly & Persons with Disabilities Medicaid Waiver program.  Many witnesses testified that waivers have been wrongly terminated rendering them unable to recertify for months at a time, worsening their conditions.

Department of Health

• BIG NEWS on medical marijuana: Director Garcia testified that as a physician he does not believe there should be a list of qualifying conditions for medical marijuana and that it should be a decision solely between the patient and their doctor. No other regulation requires this kind of pre-clearance from the Department of Health of physicians. We look forward to having Director Garcia’s support in moving D.C. law and regulations to that goal.
• DOH has funding ($200K) to provide local farmer’s markets with matching funds for low-income residents who use EBT cards to purchase fresh produce. DOH is working to get that money distribute to local markets before the farmer’s market season starts in April.
• High school students from the Young Women’s Project testified on the Wrap MC peer educator program on sexual health, sponsored by HIV/AIDS, STI, Tuberculosis Administration at the Department of Health. Students recommended some type of sexual health and education program be available beginning in middle school. DOH reported they are in conversations with DCPS about similar Wrap MC programs in middle school. Please don’t clutch your pearls at this idea. Believe it or not, the average age of sexual debut in the District is between 11 and 12 years old, and these young people need to know how to protect themselves and be safe.
• While the infant mortality rate is on the decline in D.C., there are a couple of Wards where the rate is as high as 12%--double the national rate of 6%. Most of these patients are insured, which is most troubling.