The CAFCA Brief UpdateCAFCA Children's Treatment Services Committee Minutes

September 15, 2006, 10:30 a.m. – 12:00p.m.

Mount Saint Vincent Home

4159 Lowell Blvd.

Denver 80211

In Attendance: Jeff Farmelo (Arapahoe House/CPH); Karen Yarberry (Jefferson Hills); Terry Rogers (Lost & Found); Dave Dillingham (El Pueblo); Bonnie McNulty (CSFPA); Sister Amy Willcott, Kirk Ward, and Bill Roth (Mt. St. Vincent Home); Skip Barber (CAA); Don Moseley (Family Tree); Arnie Goldstein (Excelsior); Steve Ramirez and Pam Hricik (Shiloh Home); Norma Aquilar-Dave (Savio House); and Susannah Carroll and Katie Mason (CAFCA)

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

Review of White Paper re: Use of Restraints                                  Group Discussion

Everyone took five minutes to read Peg’s draft of the prone restraints white paper.  On page 6, delete “All” at the end of the 2nd paragraph in the last line. (Prone restraints are interventions taught in most of the recognized national programs.)  Arnie asked, “Does this paper apply only to PRTFs?”  The answer was “yes” for the purposes of the Medical Services Board. The issue is also being considered by a committee in RTC Redesign and they will also get the paper. Bonnie McNulty is concerned with the fact that there is no suggested alternative to prone restraints.

On the first page, second paragraph, first sentence, the 1400 kids are only state/publicly sponsored and the number does not include the private pay children.

Karen Yarberry said that the “Feds anticipated doing away with restraints in 2 years.” Terry Rogers had received a timeline from TCI that they plan to do away with restraints this Fall. However, others in the committee have not heard that from TCI.

Susannah asked for committee input on the white paper’s content.  The response was positive. People like the content and feel it is comprehensive and accurate. Susannah asked people to e-mail her (Susannah@cafca.net) or Peg (peg@cafca.net) with any changes/concerns in the next week because the paper is due by October 1. Peg acquired a law student through the Lend-A-Law student program to look up laws and statues on prone restraints.

Skip would like CAFCA to invite representatives from the committee, including Ted Trujillo, to attend the next CTS Meeting to hear from providers about prone restraints.

Review of RTC Re-design Meeting 9-14-06                                   Group Discussion

The new name of the RTC Redesign is “1084 Implementation Committee”

Issues discussed: RCCF is not under Medcap, but it is unclear whether RCCF kids should be treated at all. The issue was referred to a committee. Karen pointed out that there are only a couple of RCCFs that know how to do treatment and many that don’t. How many facilities are straight RCCF? Mt. St. Vincent Home, Arapahoe, Lost & Found, and Dale House.

Jeff Co. would like to see treatment provided in RCCFs because these would see some financial advantages. Karen says that all facilities need to have a couple of RCCF level beds. There was some shuffling of the CBRCCF people among the committees. (Barb Weinstein was taken off the CBRCCF committee) CMS is very adamant that the separation of PRTF from TRCCF beds.  They need to be distinct units.  A meeting will be held with Judy R. and Mike Bishop to make a decision in the next several months.

Contracts. The county contracts will be mailed out electronically and 9/29 is the due date for feedback to Pam Neu.  Judy says there should be a signed contract for each kid. The contracts need to be dated as of July 1 to be able to bill the counties back to that date.  The providers need to be sure review the contracts because they will be generic.

Provisional License. You can’t bill for a clinician who has not gotten their license. If a provider did accidentally bill for someone who does not have his/her license, do a reverse.  When that person gets his/her license, bill again. There is 120 days in which a service can be billed.  IF you bill and it’s wrong, you will be able to get it extended.

DORA meets weekly to expedite their licensure and DORA said they are responding to therapists in two weeks.  Providers are finding that DORA responds in 3-4 weeks. DORA cannot talk directly to employers. Therapists must contact DORA directly with questions.

When billing for emergency services, get permission up front and in those cases where it’s not possible, notify the county caseworker as soon as possible.  Karen Yarberry is crossing it off contracts.

Skip talked about the State not wanting to discuss any issues related to rates and the counties are frustrated as well.  He requested the counties to help us (providers) identify what the needs are and present the findings to the JBC. He thinks we’d have a strong request if we partner with the counties.

Legislative Issues for 2006-2007 Session                                        Group Discussion

Actuarial.  A strategy to get adequate rates is to use an actuarial process.  Will this create anger in counties and frustration in the system?  Skip is concerned that the counties will be upset if it isn’t looked at in total.  There has to be a decision by May for 7/1/07. There are several ways of addressing this. Skip is working on this and getting cost reports from some providers and just started working on this in September.  Get ideas on this to Skip. He recommended that every provider needs to review the minutes that are sent out by Pam Neu and get any critiques of that to him.  There needs to be new money or increasing some of the low cost providers from higher rate providers. The issue was raised that providers can’t wait for the State to inform the Legislature of the rate issues. Skip said it’s clear that the State won’t ask for more money from the legislature. Arnie asked if Fred Yu’s name needs to come up at this time but Skip thinks we have a lot of friends at the legislature right now. Several providers are wanting to be more aggressive and hopefully, with the counties, to go past the State to the legislature. He thinks counties will respond to the timeline.

Advisory Group to Address Creation of Juvenile SOMB and Recommend Its Replacement

Pam Hricik talked to Cheryl Griffith.  The outcomes committee looking at best treatment practices and a meeting will be on Monday 9/25 from 1:00-4:00p.m. (700 Kipling) with counties to address issue.

A subcommittee of county members was created to consider a separate board of Juvenile SOMB issues.  In a few weeks, input will be provided re: whether it should be a separate entity. There is some concern that a separate bed could create more oversight, rules, and regulations

Update on brown bag lunch series for CFOs and Clinical Directors to share strategies for dealing with stress and change.

Peg sent a proposal to Marguerite McCormack about doing some brown bag lunches.  The committee liked Friday, October 13 and Thursday, October 26 as dates.

Next Meeting—October 20, 2006, 10:30 a.m.

   El Pueblo, 1 El Pueblo Ranch Way, Pueblo, CO  81006

Adjourn—Meeting adjourned at 12:00p.m.