Managed Health Care In Residential Treatment Facilities

MANAGED HEALTH CARE IN RESIDENTIAL TREATMENT FACILITIES

With Managed Health Care in Residential Treatment Facilities, the facilities are over whelmed with all of the red tape they have to get through just to get the funding needed to run the facility; the patients are losing out on the services that they are there to receive in the first place. Before going into to much detail, let me explain to you what a Residential Treatment Facility (RTF) is. Residential Treatment Facilities provide intensive clinical care for psychiatrically and emotionally distressed adolescents who have experienced difficulty in adjusting to a less restrictive environment. The goal is to help children resolve issues which led to placement and to develop self-management skills that lead to greater self-awareness and proficiency. Children referred for participation in the RTF program must be approved by the Office of Mental Health. To establish a child's eligibility, an Interagency Team meeting must be held, with the team being made up of involved agencies, the child and the child's guardians. Residential Treatments Facilities are less restrictive and less intensively staffed than hospital-based programs, the program is to help a child improve his or her daily functioning, develop coping skills, support the family and to ensure appropriate community linkages and supports to ensure successful transition to the community. Residential Treatment Facilities range in size from fourteen to fifty-six beds and serve and average of seven hundred and sixty children per year between the ages of five and twenty one years (NYOMH, 2003). Some people confuse a residential treatment facility with a boarding school or detention center. They differ in several ways and the biggest difference is the qualifications of the staff.

Some centers are licensed through an organization known as the Joint Commission on Accreditation of Healthcare Organizations or (JCAHO). If a residential treatment center is licensed through JCAHO you will have much greater success being able to access insurance benefits to assist you with the payment. Some residential treatment facilities are designed to be only a short term placement which some people believe lessens the success of the treatment. Others feel that if you place a child in a long term residential treatment-style placement you might have the best of both worlds. The biggest drawback to this type of placement is usually the cost associated with it. A combination residential treatment center/boarding school will begin in price at $4,300 per month and go up as high as $8,000 per month. One quarter (twenty seven percent) of the nation's treatment facilities offer residential care (The DASIS Report, 2006). Residential facilities for children with mental illness are owned by a wide variety of public and private entities and are operates under the auspices of various state agencies (Goldstrom, 2001; Pottick, 2004). Many children in State custody are placed in residential treatment because no foster or adoptive families are available. The state officials are obligated to ensure that these children receive effective services (SAMHSA, 2006). Residential treatment facilities are expensive, and most states mental health budgets are limited. Seventy five percent of residential treatment facilities are not-for-profit organizations (The DASIS Report, 2006). That would be where the need for funding and managed health care would come in.

There are several definitions for managed health care. Wikipedia explains it as, "A concept in U.S. health care which rose to dominance during the presidency of Ronald Regan, ostensibly as a means to control Medicare payouts. The rise of managed care was touted by the U.S. health industry as a way to lower the rate of medical inflation in the 1990's. But managed care has not been successful in lowering the rate of medical inflation. In fact, U.S. medical inflation is now two or three times the rate of overall inflation, as it was during much of the 1980's." In short, when the government sets aside money for, let's say residential treatment, instead of just giving the money to the facilities, there is now a managed health care organization (MCO) involved. They receive the money from the government, and make sure that the facilities are providing the services that the client needs. This all sounds great, but managed health care organization's have more strict policies than the government and require more paper work, more tests, and more time for the same services. In the long run treatment facilities are having to higher more administrative staff to make up the work load, and are still struggling for the funding. This is an ongoing problem. Managed care can take credit for restraining the growth in health care costs which resulted from a largely unconstrained market. However, the huge administrative costs required for managed health care cannot be ignored. Funding agencies and policy makers often criticize residential treatment because the cost is typically higher than for outpatient services (PubMed, 2002).

This integration of managed care into treatment facilities is more often referred to as the MA Re-alignment or the Integrated Children's Services Initiative. In Pennsylvania, we have "Health Choices". No matter how you refer to it, the general idea is to prevent fraud in medical assistance. The purpose of this realignment was to identify behavioral health treatment services, both residential and non-residential; those are eligible for Medical Assistance funding and determine how those services could be paid for by the Medical Assistance Program. This realignment fit hand in hand with the Health Choices implementation across our state. As payment was transitioning to Medical Assistance, agencies were directed to adapt services to capture this revenue source.

This is where JCAHO steps in; Health Choices prompted an industry wide cultural shift for providers, bringing additional regulations from accrediting bodies such as this. It also meant additional regulations from the Office of Mental Health and Substance Abuse (OMHSA), Department of Health, Office of Children, Youth and Families, and the Department of Public Welfare (DPW), regarding restraint use, psychiatric services, nursing services, credentialing of employees and so on. The way of running