INTERNATIONAL CHILD AND YOUTH CARE NETWORK
28 FEBRUARY 2002
Residential treatment centers for mentally ill youth come under sharp criticism in a new state audit that says record keeping is so sloppy it is difficult to tell whether kids get the care they need. Service providers see the report as a ploy.
Youth care centers under fire
WHAT WAS FOUND
From the "Residential Treatment Center Rate Setting and Monitoring" report of the state auditor:
The report also warns Colorado's 74 residential treatment centers that failure to document treatment while billing for services could constitute Medicaid fraud.
Treatment providers attacked the report as nothing but a ploy on the part of the state to avoid paying the costs of mental-health care for Colorado's youth. "I thought the state went to elaborate detail to come up with an excuse to avoid paying what it costs to provide treatment," said Skip Barber, director of the Denver Children's Home, which houses 64. "I absolutely was livid."
Residential treatment centers offer 24-hour care and mental-health services to mentally ill youths up to age 21. They may be placed by county departments of human services or by the Division of Youth Corrections. About 1,600 youth are in care at 74 centers at any given time, according to the auditor's report. At least 200 were on waiting lists for RTC beds when the audit was conducted last year.
Auditors said that of 1,497 claims reviewed from May to November of 2001, 30 percent had at least one error, which could amount to more than a million dollars in inaccurate payments annually. Further, 80 percent of files reviewed from eight residential treatment centers picked to represent a variety of centers lacked complete documentation to show that all mental-health treatment services outlined in treatment plans were actually provided.
Part of the problem with accurate record keeping is that there have been no standard definitions, no defined standards of practice, said Peg Long, director of the Colorado Association of Family and Children's Agencies. Because of that, "some providers were reporting in one way, others provided it in another way."
Colorado's Human Services Department, which monitors the centers, also was criticized. Human services was told to get its $47 million child-welfare computer system, Colorado Trails, operational enough to identify the cost of providing residential treatment.
Designed to contain information on every youth in child welfare and youth-corrections systems, Colorado Trails has only been up a year and is not fully operational.
The department also was told to streamline monitoring of facilities. The audit also said the department should make sure children sent out of state for treatment are visited as often as in-state patients. Hundreds of mentally ill youth get sent out of state for treatment because they either have failed in numerous in-state placements, no in-state facility is willing to serve the youth, or the out-of-state facility can better meet the youth's needs, according to the report. The Division of Youth Corrections had 267 youngsters in eight facilities outside Colorado at the time of the audit; 16 counties had placed 54 youths at 19 out-of-state centers.
Though DYC and the counties make sure each in-state juvenile has at least one monthly face-to-face visit with a case manager, the standard isn't held for out-of-state youths. Whether they are visited by Colorado officials varies by county. DYC visits out-of-state facilities but not on a monthly basis.
Mentally ill youngsters wouldn't have to be sent out of state if reimbursement rates were higher, Long said. She said some members of the Colorado Association of Family and Children's Agencies take children from outside Colorado first because other states pay more for mental-health care. Providers recently testified before a legislative committee that they need to take two higher-paying out-of-state youths for every local child who needs treatment to make up for the financial shortfall. "A side impact of that is fewer beds for Colorado kids," Long said.
Center operators said the audit's record-keeping issues obscure the essential problem that they haven't had cost-of-living rate increases since 1994. While the audit concluded that the state can't tell whether the rates it pays are too high or too low, providers said clearly Colorado is out of line.
Rates from other states listed in the audit all were substantially higher than Colorado's, said Jim Colvin, president and CEO of Devereux Cleo Wallace, the largest nonprofit provider of residential treatment for youth in the state and nationwide.
Colorado reimburses at about $53,527 annually for room, board and mental-health services. That means Denver Children's Home has to raise an additional $700,000 annually for their care, Barber said.
Rep. Brad Young, R-Lamar, said low reimbursement rates for residential treatment centers has been a concern of the Joint Budget Committee for several years. "My hope is we can start doing something to address that, but especially in an economic downturn, we can't turn things around overnight," Young said.
Judy Rodriguez, state human-services manager of county and community supports, said the department was working on auditors' demands before the report was released.
Colorado Trails should be working by 2003; the plethora of monitors sent by various agencies to scrutinize treatment centers will be cross-trained in each other's rules and regulations so that fewer visitors will visit fewer times, Rodriguez said.
Report by Carol Kreck, Denver Post Staff Writer
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