Child mental health agency ranks poorly
By Johnny Brannon
Advertiser Staff Writer
A state agency that oversees mental health services to children under the Felix consent decree received the lowest of three possible rankings in an evaluation of compliance with federal Medicaid standards.
The Department of Health's Child and Adolescent Mental Health Division was rated at 69 percent out of a possible 100 in the report, completed this month by a private quality review firm.
Scores for some individual standards were high, however, including for such responsibilities as quality monitoring supervision and providing a continuity of care.
CAMHD provides mental health services to children and youth ages 3 to 17, including those in the Felix-class who are eligible for Medicaid.
The evaluation was commissioned by CAMHD and the state's Medicaid agency, known as Med-Quest, which is part of the Department of Human Services and contracts with CAMHD for services.
The state must assure the federal government by next month that it is in compliance with Medicaid standards included in the Balanced Budget Act of 1997.
CAMHD chief Christina Donkervoet agreed with the review's findings and said they provide a blueprint for improvements.
"We saw it as a way to strengthen our system and find out where we're strong and where we need to focus," she said.
Donkervoet said her division had also contracted with the agency that performed the evaluation, Arizona-based Health Services Advisory Group, to help implement changes it recommended.
"I see it as a strength of our system that we requested this evaluation and are receiving technical assistance," she said. "We're following the recommendations and expect improvements in all areas."
The review found that CAMHD did not always follow procedures to verify that service providers were properly licensed.
Ten percent of the credential files inspected for the review were labeled "deficient," according to the report.
CAMHD also failed to track and address grievances filed by Medicaid recipients, or to assure that offices where recipient records are maintained are guarded against unauthorized or inadvertent disclosure of confidentiality, according to the review.
The report also found that facilities where services are provided were not always properly monitored, and that monitoring standards were inadequate.
Rep. Scott Saiki, co-chair of a joint Senate-House investigative committee probing expenses related to the consent decree, said the report seems to carry a mixed message.
"On its face, it's disappointing," Saiki said of the overall poor ranking. "I think if the division needs help to improve its scores, it should let us know right away."
But it's important to recognize the improvements in some areas where there had been problems, he said.
"I was glad to see the rating for continuity of care was higher than some of the others," said Saiki, D-22nd (McCully, Pawa'a). "There are a lot of issues related to it, such as making sure there's availability of providers."
He said he hoped the overall ranking would improve as CAMHD continues to transfer responsibility for some services to the Department of Education.
"I think that will give them some breathing room to make improvements in some areas," Saiki said.
The state has struggled for a nearly a decade under the consent decree to improve services to special-education students with mental health problems.
The decree ended a 1993 lawsuit by the families of Maui student Jennifer Felix and other children that charged the state's special-education services were abysmal and failed to comply with federal law.
Six months ago, all public school campuses finally came into provisional or full compliance with the consent decree.
By then, the state had spent more than $1 billion on services to special-education children under the consent decree. Approximately $700 million would have been spent if services had remained at the 1994 level, according to a court monitor's report.
