BY JoANNE YOUNG / Lincoln Journal Star
Friday, Dec 12, 2008
With a chorus of families saying mental and behavioral health services are not easy to access, the state Foster Care Review Board recommended Friday creating a single entry point for mental health services.
It is the same topic members of the Legislature’s Children In Crisis Task Force and providers across the state are discussing this month.
The review board, an independent state agency not affiliated with the courts or the Department of Health and Human Services, released its 2007 annual report Friday. In that year, the board tracked 9,623 children in out-of-home care.
The board called for changes within HHS and recommended more access to mental health and behavioral health services for children.
Accessing the right level of care at the right time is always difficult, said board chair Georgie Scurfield.
The Medicaid program and Magellan Health Services, which provides its managed care, looks at the least restrictive treatment and the lowest cost, she said.
According to the report, some children are required to go through a process of placements that involve unnecessary, repeated failure in lower levels of care before Magellan will approve the higher level treatment recommended by a professional.
Children with behavioral disorders do not routinely receive treatment because “they are not deemed by Magellan to meet the criteria for ‘medically necessary’ services,” the report said. More than 11 percent of children who entered state’s care because of their behaviors did not have services in place.
“The term ‘medically necessary’ appears to be used to enable managed care providers to deny treatment for children based upon financial grounds alone,” the report said.
Vivianne Chaumont, HHS Medicaid director, took exception to the board’s view.
Magellan did not invent the term “medically necessary;” it is the underlying definition used for Medicaid and all health insurers, she said.
“There is not an insurer that will pay for treatment that is not medically necessary,” she said. “These are criteria every insurance company has. … (The notion) that it was pulled out of the sky to deny people services is absolutely incorrect.”
If a child behaves badly, it does not necessarily mean the child has a mental illness, she said.
The report also gives the impression Magellan denies services “willy-nilly” to save money, Chaumont said.
Cost-effectiveness is one of eight or nine considerations, she said. Decisions are based on approving treatments and interventions consistent with a child’s diagnosis, not for the convenience of the provider or family.
Magellan approves 99 percent of inpatient hospital care for children, the most expensive per-day care, she said. Residential treatment is approved 82 percent of the time. Outpatient therapy is approved 100 percent of the time.
The report noted the number of children in foster care in Nebraska continued to decline last year. On the last day of 2007, 143 fewer children were in foster care than the same day the year before.
Todd Reckling, HHS administrator of the office of protection and safety, said many of the recommendations of the Foster Care Review Board regarding case workers, foster care and contract oversight are already in place.
Caseloads of workers meet Nebraska and national standards, he said.
The state counts the number of placement changes differently than does the review board, he said. The board’s report for 2007 said 52 percent of children in foster care had four or more placements. But according to federal definitions, 28 percent of children in foster care had four or more placements in the 12 months ending March 31, 2007.
In its report, the board commended HHS for the increased number of children with complete written plans, the high rate of caseworker contact with children and increased adoptions.
The board recommended expediting permanent placements for children in the system.
“We are staffing cases much more aggressively,” said board executive director Carol Stitt, “trying to get cases resolved.”
By the numbers: 2007
* 5,043 children in out-of-home care on Dec. 31, 2007
* 2,536 (52 percent) of 4,907 in foster care had four or more placement changes
* 2,252 (46 percent) in foster care had four or more caseworkers
* 1,057 in foster care in Lancaster County
* 890 in foster care because of methamphetamine abuse by a parent
* 731 (15 percent) had 11 or more placement changes
* 462 adoptions completed
– Foster Care Review Board annual report
Recommendations
* Reduce the number of caseworker changes per foster child to stabilize the management of children’s cases.
* Build a system of rigorous oversight within HHS.
* Create a single point of entry to mental health services and increase access to those services, especially during a crisis.
* Recruit and develop stable placements for children to assure they are not further traumatized by moving from one caregiver to another.
* Expedite permanent placements for children.
