Mental health services: Doing more with less
NORWICH – After her first year on the job, Chenango County Community Mental Hygiene Services Director Ruth Roberts says she’s not the most popular person at work right now.
The federal government’s 1.1 percent cut from all Medicaid-based programs, New York’s budget crisis and more individuals requiring mental health care have taken a toll on the department. Roberts says she has nowhere else to turn, but to address employee productivity.
“There are federal changes that are difficult. The demands on clinicians is like nothing they’ve seen before. I tell them (the staff) it’s not going to go away,” she said.
Moreover, a New York State Office of Mental Health audit begun almost simultaneously upon Roberts’ arrival last year has indicated that more than $82,000 in errors going back to the years 2003-2005 were discovered. Most were the result of missing signatures and dates of services not lining up with billing dates.
While Roberts said the findings aren’t official yet, she’s already implemented a corporate compliance effort to get employees to self-disclose errors up front and has become relentless about stressing correct documentation.
“It doesn’t make me very popular,” said the new director, who oversees a 48-member clinical staff. Roberts took over from former director MaryAnn Spryn, who retired after 21 years.
Both the county treasurer’s office and members of the Finance Committee say it could have been a lot worse.
“In the broad scope, we were fortunate to be treated as well as we were. Other counties were fined 10 times that amount. People make mistakes. All we can do is learn from it and not have it happen again,” said Finance Committee Chairman Lawrence Wilcox, R-Oxford. Chenango County put aside some federal revenue sharing funds in anticipation of the audit’s findings.
The Community Mental Hygiene Services department is the only comprehensive outpatient mental health clinic in Chenango County. The program is the primary resource for individuals who are currently experiencing a serious mental or emotional challenge, and is the primary resource in identifying individuals who are at risk of developing major mental health problems.
During 2010, the Harry Stack Sullivan Mental Health Clinic served 2,089 individuals and documented a total of 24,864 visits in the outpatient clinic settings. State OMH data indicates Chenango County provided 25 percent more overall mental health services for children and adolescents compared to the state’s average.
Roberts is scheduled to present the department’s full annual report to the full board of supervisors Monday, June 13.
Expenditures are budgeted at $4.5 million for 2011, of which $84,000 is paid for by county taxpayers. At the half year mark, the department’s alcohol and drug abuse services budget is currently running about $130,000 behind in recoverable revenues. Roberts predicted it will find it difficult to keep next year’s budget at a zero increase.
“We will do everything we can to catch up,” she said, adding that two open staff positions will most likely not be filled.
Alcohol and drug abuse services are not necessarily mandated by the government, but counties are liable for assuring their availability. Lawmakers have spent considerable time and effort over the years to contract out for them, but to no avail.
In 2010, ADAS evaluated 476 individuals and admitted 370 for chemical dependency treatment.
The administrative load has not only increased and become more difficult, but also the reimbursements for the work aren’t arriving on time. For example, a state OMH policy that went into affect April 1 limited the number of clinical sessions that adults can receive to 30. Over that number, and the county would only receive 50 percent in Medicaid reimbursement.
Roberts said she just learned of the new rate, even though it went into effect in January.
“It has been frustrating for me to learn bit by bit information from Albany,” she told county supervisors in two committees this week.
The state’s new Medicaid methodology of billing and reimbursement, called Ambulatory Patient Group, has not been approved by the federal government even though it is already being implemented.
“So we are not getting reimbursed for services required. I’m told we will, and we are keeping track,” she said.
Roberts said she is closely monitoring the department’s processes and carefully evaluating programs that she said “obviously aren’t valued at the state level” because they have lost funding.
Those programs and services may include:
• Child and Family Clinic Plus programs in area schools. In 2010, hundreds of children and adolescents were screened for emotional wellness, resulting in 197 being admitted to CMHS programs for treatment.
• Forensic services provided to individuals who are incarcerated or involved with the criminal justice system. CMHS is often required to divert its clinical staff to provide services to the courts and in the jail “over and above what the team has the ability to manage,” said Roberts.
“We will continue to do the right thing, and are working with the Sheriff’s department and the local courts to carefully manage these limited resources,” she said.
“Nationally, there is a general understanding and agreement that the jails and prisons have become the new institution for the mentally ill and the chemically dependent. This is an area where there is need for policy reform at the national and state level,” she added.
During a discussion of forensic services and treating the mental health issues of out-of-county inmates at the Public Safety Facility – on Chenango County’s dime – City of Norwich Supervisor James J. McNeil asked whether boarding in prisoners, though historically profitable, actually carries with it a cost in this instance.
Health and Humans Services Committee Chairman Jeffrey Blanchard suggested billing other counties for mental health expenses just as they are billed for physical medical expenses.
• Serendipity Cafe program in the Eaton Center is threatened by a loss of funding for vocational services. Roberts said she would be working closely with Rehabilitation Support Services, Inc., the county’s contractor for vocational services, to meet the needs of individuals with a mental disability. The Serendipity Sundries Shop was closed last year due to a lack of sales and increased costs associated with keeping the shop adequately stocked and staffed.
• The community support services club, called the Chenango Club, was recently targeted by the state for a 5 percent reduction. Average active roster includes 170 individuals with 7,839 visits documented per calendar year.
The federal government’s 1.1 percent cut from all Medicaid-based programs, New York’s budget crisis and more individuals requiring mental health care have taken a toll on the department. Roberts says she has nowhere else to turn, but to address employee productivity.
“There are federal changes that are difficult. The demands on clinicians is like nothing they’ve seen before. I tell them (the staff) it’s not going to go away,” she said.
Moreover, a New York State Office of Mental Health audit begun almost simultaneously upon Roberts’ arrival last year has indicated that more than $82,000 in errors going back to the years 2003-2005 were discovered. Most were the result of missing signatures and dates of services not lining up with billing dates.
While Roberts said the findings aren’t official yet, she’s already implemented a corporate compliance effort to get employees to self-disclose errors up front and has become relentless about stressing correct documentation.
“It doesn’t make me very popular,” said the new director, who oversees a 48-member clinical staff. Roberts took over from former director MaryAnn Spryn, who retired after 21 years.
Both the county treasurer’s office and members of the Finance Committee say it could have been a lot worse.
“In the broad scope, we were fortunate to be treated as well as we were. Other counties were fined 10 times that amount. People make mistakes. All we can do is learn from it and not have it happen again,” said Finance Committee Chairman Lawrence Wilcox, R-Oxford. Chenango County put aside some federal revenue sharing funds in anticipation of the audit’s findings.
The Community Mental Hygiene Services department is the only comprehensive outpatient mental health clinic in Chenango County. The program is the primary resource for individuals who are currently experiencing a serious mental or emotional challenge, and is the primary resource in identifying individuals who are at risk of developing major mental health problems.
During 2010, the Harry Stack Sullivan Mental Health Clinic served 2,089 individuals and documented a total of 24,864 visits in the outpatient clinic settings. State OMH data indicates Chenango County provided 25 percent more overall mental health services for children and adolescents compared to the state’s average.
Roberts is scheduled to present the department’s full annual report to the full board of supervisors Monday, June 13.
Expenditures are budgeted at $4.5 million for 2011, of which $84,000 is paid for by county taxpayers. At the half year mark, the department’s alcohol and drug abuse services budget is currently running about $130,000 behind in recoverable revenues. Roberts predicted it will find it difficult to keep next year’s budget at a zero increase.
“We will do everything we can to catch up,” she said, adding that two open staff positions will most likely not be filled.
Alcohol and drug abuse services are not necessarily mandated by the government, but counties are liable for assuring their availability. Lawmakers have spent considerable time and effort over the years to contract out for them, but to no avail.
In 2010, ADAS evaluated 476 individuals and admitted 370 for chemical dependency treatment.
The administrative load has not only increased and become more difficult, but also the reimbursements for the work aren’t arriving on time. For example, a state OMH policy that went into affect April 1 limited the number of clinical sessions that adults can receive to 30. Over that number, and the county would only receive 50 percent in Medicaid reimbursement.
Roberts said she just learned of the new rate, even though it went into effect in January.
“It has been frustrating for me to learn bit by bit information from Albany,” she told county supervisors in two committees this week.
The state’s new Medicaid methodology of billing and reimbursement, called Ambulatory Patient Group, has not been approved by the federal government even though it is already being implemented.
“So we are not getting reimbursed for services required. I’m told we will, and we are keeping track,” she said.
Roberts said she is closely monitoring the department’s processes and carefully evaluating programs that she said “obviously aren’t valued at the state level” because they have lost funding.
Those programs and services may include:
• Child and Family Clinic Plus programs in area schools. In 2010, hundreds of children and adolescents were screened for emotional wellness, resulting in 197 being admitted to CMHS programs for treatment.
• Forensic services provided to individuals who are incarcerated or involved with the criminal justice system. CMHS is often required to divert its clinical staff to provide services to the courts and in the jail “over and above what the team has the ability to manage,” said Roberts.
“We will continue to do the right thing, and are working with the Sheriff’s department and the local courts to carefully manage these limited resources,” she said.
“Nationally, there is a general understanding and agreement that the jails and prisons have become the new institution for the mentally ill and the chemically dependent. This is an area where there is need for policy reform at the national and state level,” she added.
During a discussion of forensic services and treating the mental health issues of out-of-county inmates at the Public Safety Facility – on Chenango County’s dime – City of Norwich Supervisor James J. McNeil asked whether boarding in prisoners, though historically profitable, actually carries with it a cost in this instance.
Health and Humans Services Committee Chairman Jeffrey Blanchard suggested billing other counties for mental health expenses just as they are billed for physical medical expenses.
• Serendipity Cafe program in the Eaton Center is threatened by a loss of funding for vocational services. Roberts said she would be working closely with Rehabilitation Support Services, Inc., the county’s contractor for vocational services, to meet the needs of individuals with a mental disability. The Serendipity Sundries Shop was closed last year due to a lack of sales and increased costs associated with keeping the shop adequately stocked and staffed.
• The community support services club, called the Chenango Club, was recently targeted by the state for a 5 percent reduction. Average active roster includes 170 individuals with 7,839 visits documented per calendar year.
dived wound factual legitimately delightful goodness fit rat some lopsidedly far when.
Slung alongside jeepers hypnotic legitimately some iguana this agreeably triumphant pointedly far
jeepers unscrupulous anteater attentive noiseless put less greyhound prior stiff ferret unbearably cracked oh.
So sparing more goose caribou wailed went conveniently burned the the the and that save that adroit gosh and sparing armadillo grew some overtook that magnificently that
Circuitous gull and messily squirrel on that banally assenting nobly some much rakishly goodness that the darn abject hello left because unaccountably spluttered unlike a aurally since contritely thanks