The CAFCA Brief UpdateCAFCA Children's Treatment Services Committee Minutes

July 21, 2006

Present: Skip Barber (CAA), Bob Cooper (Tennyson Center), Susannah Carroll (CAFCA), David Dillingham and Patty Erjavec (El Pueblo), Jeff Farmelo (Centennial Peaks Hospital), Arnie Goldstein (Excelsior), Jedd Hafer (Children’s ARK), Pam Hricik (Shiloh Home), Perry May (Devereux), John Shue (Southern Peaks), Rodney Stern (Children’s Ark), Tony Welsh and Nan Welsh (Kidz Ark), Karen Yarberry (Jefferson Hills), Dan Zarecky (Southern Peaks)

The meeting was called to order at 10:30 a.m.

1. Welcome & Introductions (Patty Erajvec)

2. Provider Rate Appeals

There has been no word at this time regarding provider rate appeals.

3. TRCCF & PRTF BILLING TRAINING ISSUES

Discussion took place regarding restraints and CAFCA’s position:

Skip provided a summary on this topic.  A literature review was conducted and a lot of information is inaccurate.  According to the JCAHO Report from 1998, the State only looked at 20 cases, deaths alleged, 70% in mechanical restraints, 40% in prone restraints.  Can’t draw much of a conclusion from the data provided regarding prone restraints.  The report didn’t address the dangers of physical holds, and the data was not good or conclusive.  Doing prone restraints, and the danger thereof, was not supported.  Of the two deaths in Colorado, both clients were obese, which is a higher risk situation.   We need to provide better education on how to restrain clients who are obese.  Skip believes it’s not the prone restrain that is the problem.  The British position demonstrates that the prone restraint is not significantly dangerous.  In Colorado, the issue of doing away with prone restraints has been taken off the fast track

Arnie asked the group to come up with a position paper to educate the Medical Services and others regarding restraint and de-escalation.  Jedd agreed we should do a position paper.

Devereux moved away from prone restraints and adopted supine restraints and concluded that facedown is a more dangerous position than face up.  The State of Colorado is going to provide a legal opinion that supports a supine restraint over the prone restraint.   (thought side or supine is okay).  Patty thinks that we should not only do a position paper and training, but also make it a more active process to assure we’re all following the agreed upon position. 

Jed thought we should prepare the position paper for PRTF, the highest level of restraint.  The position paper needs to be done before the next Medical Services Board in 3 weeks.  Patty thinks we should prepare something immediately.  Bob Cooper says that rarely are these reactions about restraints not being best practices; however, that the decision is not based on best practices.

Skip is willing to work with Susannah or Peg to develop the position paper  Jed wants Peg to put her legal spin on it; however, she may not be back in time, and is willing to review what is developed.  Patty offered that each organization could provide data to Skip and Susannah.  John talked about DYC’s position, and indicated that they are moving in the direction of no restraints.  Karen talked with John Gomez last week, and he didn’t say he was developing a new position, but is looking at whether they should use pressure points and a decrease in all restraints.

Skip made it clear that there are different approaches for different agencies.  He will take the lead to have it developed in time for the Medical Services Board.

RATE APPEALS:

No one has information at this time.  10 – 12 have been filed

Skip pointed out that there is some odd things coming out in contracts, Arapahoe is putting in a disclaimer that they will be held harmless in the case of an appeal and also that there can be no claim for the last day of service.  It should also be noted that everyone should let CAFCA know if they are seeing anything odd in the contracts.  Counties will be 1/12th of what they paid in 2004-2005, so should have no liability.  A lot of counties are unwilling to finalize the contract until appeals are resolved.

BILLING:

Jed stated we’re struggling to know what to call different groups.  Are organizations eating the costs of not being reimbursed Medicaid groups.  Skip advised people to be very cautious as Medicaid can come back on us retroactively.  Fremont County believes that they can bill Medicaid for substance abuse, even though it’s only outpatient.  Skip asked if the $23.94 is realistic,  the cost was concluded between $16 - $18.  Substituting an individual session for a family session in which the family doesn’t show.  If the County is disagreeing with medically determined decisions, the State should be notified.  If medically necessary, Medicaid could be billed even if the county disagrees.

FEE FOR SERVICE BILLING

TRCCF – Peg believes Fee For Service is applicable only for TRCCF.  Can a bid in an RCCF be eligible for therapy?  BHO’s are saying one thing and DHS is stating another.  Skip thinks that RCCFs have always had a tax component and now as they transition to TRCCFs, they should be able to handle it through the Child Welfare System.  He sees no reason why that should change.  All RCCFs and TRCCFs rates increased on July 1st.

Jed inquired about the updated rates in TRAILS, and asked when will this be done.  This question will be proposed at the RTC Redesign meeting.  Skip states not to sign a contract until the appeals are settled.

4. Volume 8 PRTF Seclusion & Restraint Rules & CDHS Policy

Skip thinks it will take another 2 months for the counties to trust the State as to their being held harmless for the next 2 years.  Skip will bring up the issues that the counties are non-trusting at the RTC Redesign Meeting.  The appealed rates need to be done in the next few days; however,  Patty was told we couldn’t bill until August 1st.  If counties authorize more sessions than Medicaid will pay for, Skip acknowledged that it can go up to two sessions but they have to be kept separate.

Code 90801 can be taken at intake & if you do a pre-admission, can be billed for as of the 1st day of admission for the time a licensed therapist will have to take the intake call.

CAFCA will write a policy on behalf of the members and submit it to the State regarding our position on seclusion and restraint. 

3. FINAL ADOPTION OF VOLUME 7 RULES

They’ve not been finalized yet.  Arnie asks if Colorado can do an average billing for one kid for one month.  Can bill at a bundled rate. Skip says not for fee-for service.

Indiana was audited 2 years ago and they recommended billing sheets be attached to the case file.

Meeting adjourned at 12:00 p.m.

Respectfully submitted,

David Dillingham