The CAFCA Brief UpdateCAFCA Children's Treatment Services Committee Minutes

Children Treatment Services Meeting Minutes

October 20, 2006

Host: El Pueblo…an Adolescent Treatment Community

Present: Jana Welsh (Kidz Ark); Elaine Crnkovic (Cedar Springs); Patty Erjavec (El Pueblo); Bentley Smith (Devereux Cleo Wallace); Skip Barber (CAA); Susannah Carroll (CAFCA); Dax Charles (El Pueblo); Jade Elder (El Pueblo); Maggie Cignoranelli (El Pueblo); Renee Massey (El Pueblo)

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

1. Welcome & Introductions

2. White Paper re: Use of Restraints:

Patty asked the group if they had reviewed the white paper on prone restraints in Psychiatric Residential Treatment Facilities.  It was mailed to the Medical Services Board on October 10th, to include in their board packets.  The group discussed the issues related to the use of prone restraints in Psychiatric Residential Treatment Facilities, The White Paper.   This issue will be discussed at the November 10th Medical Services Board (MSB) meeting in Cherry Creek.   The request to have individuals knowledgeable of R & S practices at this meeting is desired.  The goal of the committee is to have recommendations by the end of the year.  It was indicated that the Pueblo School Districts are trained to use Crisis Prevention Institute (CPI) restraints.   Susannah asked if anyone would be attending the November 10th Medical Services Meeting.  Bentley Smith or Perry May and Jana Welsh indicated they could be there. Susannah will send out a message of what will occur. 

3. Update on Plan to Re-balance Rates – Meeting with Senator Moe Keller and staff from Office of State Planning & Budget:

Patty distributed copies of the notes submitted by Peg Long, detailing her meeting with Senator Moe Keller, Kate MacLeod, and Luke Huwar, of the Office of State Planning and Budget (OSPB), on Friday, October 13th.  The meeting was held to discuss a plan to rebalance the rates.  Per Skip Barber, the Joint Budget Committee’s perspective is that the door is wide open on this issue.  He believes it will happen if more substantial data is provided.  Peg indicated in her notes that the OSPB wanted to know if CDHS is adhering to the requirements of HB 05-1084.  Initially, if CDHS believes in the cause, it would be hopeful.  OSPB indicated they would meet with CDHS to discuss this issue further. 

4. 1084 Redesign Meeting:

Patty talked about the 1084 Redesign Meeting, formerly the RTC Redesign Meeting, held on Thursday, October 19th.  It was indicated that attendance from the counties and providers was few.   Some of the issues covered included:  The need for TRCCF’s to negotiate rates with the BHO’s since their funding stream is different from HB 1116, which funds the mental health centers in the state.  Concerning co-mingling in TRCCFs/PRTFs, Larry Marsh offered that while no concrete decision has been reached by CMS (Medicaid), he is getting the distinct impression that there should be total separation between the PRTF and TRCCF populations. 

Skip reported that it is becoming increasingly difficult to adequately staff TRCCF schools as districts salaries are uncompetitive.  There is as much as 70% staff turnover in several school facilities.

5. Online Directory:

Susannah thanked everyone for providing updates for the Online Directory.  Kudos to El Pueblo for finishing this process early.  At this time, Katie is notifying counties and state agencies of the available online directory.  Because it is a new system, she is willing to train any agency on how to utilize it.  Patty indicated that CDE mentioned they were looking at compiling a list similar to this.  She asked if Katie would contact Barb Taylor to discuss assisting CDE in this process.

6. Three-Year Outcomes Study Grant:

Susannah mentioned that an associate CAFCA sister was awarded a 501 C 3 three year study grant from the Colorado Healthcare Association.  Data will need to be collected to review functional outcomes and to form public policy.  A sign-up sheet was provided to anyone interested in being a part of the project steering committee.  Providers interested in participating in the grant and would like more information should contact Susannah. The committee will meet with the Colorado Foundation at the end of the month.  A yearly report will also be distributed of the aggregate data.  Patty indicated that El Pueblo would be interested in being a part of this committee.  El Pueblo has already begun tracking this type of data.  Susannah indicated that the report would be web based.

7. Mario Tonti Conference Follow-up:

Patty indicated that she and Clinical Director, Jade Elder attended the conference from El Pueblo.  It was stated that the presentation style was somewhat difficult to follow.  The feeling was that the perception of residential treatment was portrayed as being somewhat negative.   On the other hand, the funding streams help the organizations to learn to do other things.  Jana stated that we need to remember about the continuum of care.  Skip indicated that since therapy is not provided by RCCF’s , group homes are under the licensure of an RCCF; therefore,  BHO’s are not responsible.  If treatment is needed, it must be under a TRCCF.  Susannah indicated that Debra Tonti offered training and consultation to anyone who is interested.  

8. Brown Bag Lunch series with Marguerite McCormack:

Susannah indicated that the date for the brown bag lunch will be set for January 2007.  Notices will be sent to the CAFCA members.

9. Billing for Therapy Outside Facility (HCPF & CDHS Response):

Billing for therapy sessions provided in a car setting was questioned.  Therapy during transportation of a resident is not billable.  Skip disagreed and believes when transporting a resident to court and therapy treatment is provided during the trip, it should be allowed.  You should be able to bill what is in the treatment plan no matter where the therapy is administered.  The group agreed.

10. DORA/provisional licensing

Susannah asked if committee had reviewed DORA’s response about delays in provisional licensing.  Providers indicated that 30 days is the average for getting licenses. DORA staff offered to attend a CTS committee meeting and the committee indicated they would like them to attend the December meeting if possible.

11. Future Meeting Dates:

Patty indicated the need to meet again prior to the end of the year.  Skip agreed and stated that several issues are pertinent to discuss; therefore, a December meeting is necessary.  Bentley offered to hold the next meeting at Devereux Cleo Wallace on December 15 at 10:30am if no other provider is available.

Jana stated they are working with the Colorado Access and Colorado Health Network on placements for the new TRCCF’s.  She provided a list of all residents, including the DD population, which worked out well.  She indicated that fee for services can’t be billed with BHO’s.   Skip asked if BHO’s can enhance the behavior in the TRCCF.  

Patty asked how long before the data on fee for service will be analyzed.  Skip indicated that the State Trails System can collect data indicating the Medicaid fee for service for each county.  Patty believes that we need to be more proactive in collecting the data.  This will provide additional information for the JBC to review to verify the number the state will produce.   The detail of the data collection may include:  collection by month, number of residents, by resident by day, and how they are billed.  The sex offender, DD, and substance abuse population will be run on a separate report.   Susannah offered to create a reporting chart to submit to Patty.   Patty asked that the information be provided to her by Thanksgiving to review, then the committee will submit it to the state.

Meeting adjourned at 12:00 p.m.

Respectfully submitted,

Renee Massey