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Nov. 17, 2011
TOPEKA A Sedgwick County lawmaker wants the 2012 Legislature to undo a recent state welfare agency policy that he says is undermining the state’s mental health infrastructure and keeping some seriously disturbed children from getting the psychiatric treatments they need.
“We’ve put the fox in charge of guarding the hen house,” said Sen. Dick Kelsey, a Goddard Republican, testifying earlier this week before the Joint Legislative Budget Committee. “I’m really ticked about this.”
Others also say they are concerned about the policy change launched by the Kansas Department of Social and Rehabilitation Services in January, soon after Gov. Sam Brownback took office.
That new policy was formalized in a contract signed in September by SRS and Kansas Health Solutions, the managed care company that is the intermediary between the welfare agency and the state’s 27 community mental health centers.
KHI file photo
The policy, state welfare officials say, was intended to decrease the use of inpatient psychiatric treatment facilities (PRTFs).
Gone and won't come back
Between 2009 and 2011, SRS spending on PRTF services went from $36.3 million to $46.8 million, an increase of almost 30 percent. There also were concerns that too many children were being sent to the facilities for too long when they might have been better served in their own homes and communities.
Kelsey and those who run the PRTFs say the state went too far in its efforts to remedy those concerns of cost and “overutilization.” By September, there were fewer than 300 children in the PRTFs. A year earlier, there had been more than 550.
As a result of the new policy, three PRTFs have announced since July that they were closing. Others have reduced size.
“I guarantee that half the (remaining 14) PRTFs will be gone by the first of January,” Kelsey said. “Once they’re gone, they won’t come back.”
The closings, Kelsey said, will harm children who need more services than mental health centers can provide locally. Many of these children, he predicted, could end up in a juvenile detention facility.
Kelsey owns three seven-bed group homes for troubled teenagers. His facilities are not PRTFs.
“Law enforcement, schools, YRCs (youth residential centers), parents and people who work with youth in the community have all reported seeing kids with more severe needs in the community,” said Heather Morgan, public affairs officer for United Methodist Youthville. “Questions are occurring about why these kids aren’t getting the treatment they need to be stabilized to ensure their safety and the safety of the public.”
United Methodist Youthville closed its 56-bed PRTF in Newton last month. Its 44-bed PRTF in Dodge City remains open.
Referrals to the PRTFs began to drop after SRS officials started trimming state spending on mental health services. Funding to the mental health centers was cut by $6.8 million last fiscal year, which ended June 30. Another $17 million in cuts are slated for the current fiscal year.
KHI News file photo
SRS Secretary Rob Siedlecki told budget committee members that he regretted the way the cuts were handled, noting that some mental health centers stopped referring children to PRTFs before alternate services for them were in place.
“We recognize that our directive wasn’t heard in the manner in which it was intended,” Siedlecki said, noting that he’d been at SRS for two days when he approved the Jan. 12 letter that outlined the cuts.
Nonetheless, Siedlecki defended the cuts and the financial incentive SRS put in place for mental health centers that avoided PRTF referrals, noting that the sharp initial drop in PRTF caseloads had since stabilized. He said a department survey showed that most of the children diverted from PRTFs between May and July were being successfully cared for in their communities. The survey, he said, was ongoing.
The incentive, spelled out in the September contract, was that SRS would give Kansas Health Solutions an additional $6.1 million if the PRTF referral rates remained at or below September levels for the reminder of this fiscal year, which ends June 30, 2012. Penalties would be imposed if referrals surpassed September levels.
The contract requires federal approval, which has not yet been given.
Kelsey said he didn’t believe those who stand to gain financially by denying them should make PRTF referrals. He said he would ask the 2012 Legislature to come up with policy requiring independent, third-party evaluations of the children’s treatment needs.
“We’ve had about 500 kids in the (PRTF) system for the last 13, 15 years,” he said. “To go from that number to 300 in a matter of months just doesn’t sound logical to me. How could we fix that many kids that quickly?”
More managed care
But Mike Hammond, executive director at the Association of Community Mental Health Centers of Kansas, said Kelsey’s concerns were off-target. More managed care is coming, not less, he said.
“No one is saying that PRTFs aren’t needed. They are, absolutely,” Hammond said. “But we’re having this discussion within the context of having to do something to slow the growth in Medicaid spending. And whether we like it or not, that means managed care. It’s here. We can’t run from it.
“If we don’t want to overutilize PRTFs, then we need to come up with a policy that discourages overutilization,” he said. “That’s what this does. It manages care.”
Rescinding the September contract and coming up with a new policy, Hammond said, would serve little purpose, noting that Brownback’s recently announced Medicaid reform plan calls for turning the system over to three yet-to-be-named managed care companies in 2013.
“Right now, you have the mental health centers screening kids in or out of the PRTFs,” he said. “That’s one entity. After Medicaid reform, there will be three entities. I don’t think any of us know how that’s going to work.”