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Executive Summary <br />This report calls for the major changes outlined below. Many more recommendations are found <br />in the report summary that follows. The details are in the fall report. <br />1. A transformation of the governance structure is recommended, so that the responsibility of <br />local management is shifted to counties and to groups of counties, acting under long -term <br />contracts with the State to manage services. Local County Programs will coordinate all <br />mental health, developmental disabilities and substance abuse services in community <br />networks. <br />2. Benefit packages for community assessment and acute care services are recommended for all <br />mental health and substance abuse clients entering the State system. <br />3. Specialized services are recommended for target populations which have been served in the <br />State Hospitals inappropriately, for lack of appropriate services. These include individuals <br />with serious and persistent mental illness; those with dual diagnoses of substance abuse and <br />mental illness; clients who are geriatric; children; and adolescents. <br />4. The new County Programs are encouraged to increase local services to target populations <br />through a matching process which will provide additional State funds for service expansion. <br />5. A new Developmental Disabilities Division is proposed. It should attract strong leadership, <br />focus management resources on providing innovative and less costly community services, <br />and restore confidence in the public developmental disabilities system. <br />6. It is recommended that the State hospital system be reduced by 667 beds over the next five <br />years, with the savings going directly to community services. This involves the closure of <br />Dorothea Dix Hospital and the substantial renovation and rebuilding of Broughton, Umstead <br />and Cherry Hospitals. <br />7. The study projects that reduced reliance on State hospitals will save the State $51 million in <br />operating costs. The savings can be leveraged to over $95 million in total resources from all <br />funding sources. <br />8. Most of the resources necessary for the system's transformation should be achieved through <br />State hospital savings and through the reconfiguration of current services, financial <br />operations and administrative costs through the new County Programs. At first, however, <br />"bridge" funding will be needed to strengthen the community as the primary locus of care. <br />Additional funding for target populations may be necessary once the system is better aligned <br />in the new County Program structure. <br />9. The Department of Health and Human Services, the State agency legally responsible for <br />managing the State's Medicaid program, must restructure and unify Medicaid policy and <br />operations across the three agencies responsible for services to persons affected by this <br />report: the Division of Medical Assistance (DMA), the new Division of Developmental <br />Disabilities (DDD), and the new Division of Mental Health and Substance Abuse Services <br />(DMHSAS). <br />Section L Stannimy Report <br />Page 2 of 35 <br />