Bill seeks to cut out survey on kids' care

Sponsor’s firm cited over filings

140218 Dan Sullivan
140218 Dan Sullivan

A lawmaker who runs one of the largest children's behavioral health service providers in Arkansas is trying to eliminate one of the state's tools for measuring the effectiveness of treatment.

Rep. Dan Sullivan, R-Jonesboro, the chief operating officer of Ascent Children's Health Services, filed a bill to repeal outcome measures testing within the Division of Behavioral Health Services of the Department of Human Services. He said the state has been using the Youth Outcomes Questionnaire to gather information since 2010 but has not used the data to change or improve services for children.

Outcome measures are ways of tracking whether treatment is effective and whether the best services are being provided to patients.

The Youth Outcomes Questionnaire is a 64-question survey that is given to parents, children or both, depending on the ages of the children receiving services. It asks the child or parent to gauge how true statements are with answers ranging from almost never to almost always.

Human Services Department officials said they have been looking at other outcome measures as part of a larger overhaul of the department's Division of Behavioral Health Services rules. But spokesman Amy Webb said department officials believe an outcome measure is a necessary part of provider accountability.

Sullivan's bill is scheduled to be discussed in the House Public Health, Welfare and Labor Committee this week.

Sullivan said eliminating the questionnaire would help his company by reducing paperwork and costs, but would also help dozens of other providers and save taxpayers money. Webb confirmed that 45 providers in the state are required to administer Youth Outcomes Questionnaires in regard to mental health services to children.

"If you're collecting data and not using it to drive services, why do you continue to collect that data?" Sullivan asked. "The state has been collecting these outcomes for five years, and to my knowledge to this day, they have yet to make one suggestion or change to the administration of the program driven by these outcomes."

Sullivan said there are other accountability measures in place. Services must be preapproved and reviews are done later to make sure they were medically necessary services. He said Medicaid does not reimburse providers for services not deemed medically necessary.

Ascent -- Sullivan's company -- collected more than $27.6 million in Medicaid reimbursements in fiscal 2014 and more than $26.4 million in Medicaid reimbursements in fiscal 2013, figures from the Department of Human Services show.

According to information obtained from the Human Services Department through a Freedom of Information Act request, eight of Ascent's 10 outpatient locations were cited during their most recent inspections for not administering Youth Outcomes Questionnaires or for not collecting them on time.

The inspectors look only at samples of patient files in each facility, but the facilities in Batesville, Trumann, Arkadelphia, Benton, Blytheville, North Little Rock, West Memphis and Mountain Home were cited for a total of 28 instances of late or unfiled Youth Outcomes Questionnaires.

Webb said providers overall had a 69 percent completion rate for Youth Outcomes Questionnaires in 2013, up from 67 percent in 2012. She said the state is still compiling data from 2014.

Under Human Services Department guidelines, the questionnaire is required to be given within 14 days of a child starting to receive services. After the initial questionnaire, follow-up surveys are required every 90 days.

Clinicians who treat children are supposed to be able to use the answers to better tailor treatment plans by tracking progress over time. Webb said the Human Services Department has been using the data to get a better overall picture of the effectiveness of behavioral health services offered in the state.

"Measuring outcomes of behavioral health services is essential to ensuring children and adults are receiving quality care in the most efficient and effective manner," Webb wrote in an emailed response. "These measures really empower clinicians to use the information collected to guide and tailor a child's treatment plan."

Webb said the Human Services Department also uses the data to help report overall progress of the behavioral health programs to the Legislature and others.

But Sullivan said that isn't enough of a reason to force providers to administer the costly and time-consuming questionnaires.

Webb said the state's cost of administering the questionnaires has been about $2.7 million since the program began.

Last year, the Human Services Department surveyed providers, who said their average cost to administer each questionnaire was $19.58. The Human Services Department used that average to estimate that it costs providers between $2.4 million and $3.2 million annually to administer the questionnaires.

Sullivan said that number isn't correct. He said each test costs closer to $80 to $100, including indirect costs and remedial costs if the questionnaires aren't administered on time. Failure to comply with the regulations in a timely manner may result in a provider having to pay for staff training and a corrective action plan.

He said the annual cost could be as high as $7 million, depending on what factors are included in the cost estimates.

Sullivan's bill would delete some language in Act 1593 of 2007, which sought to improve the effectiveness of the behavioral health services offered to children in the state. It would delete the mandate to "develop an outcomes-based system to support an improved system of tracking, accountability and decision-making."

After Act 1593 passed, a task force of medical professionals, advocates and providers was formed. It was given the task of, among other things, finding the right outcome-measure tool for child behavioral health services. It settled on the Youth Outcomes Questionnaire, which was first used in 2010.

Arkansas Advocates for Children and Families lists Act 1593 as one of the important changes to children's health services in Arkansas. The group's policy analyst who handles children's health issues was out of the office last week and unavailable for comment on the proposed legislation.

Webb said the Human Services Department began looking for other outcome-measurement tools during a review process that started last year.

"Regardless of whether it is the YOQ or another tool, it is critical that we have some sort of outcome measure in place," Webb said.

Human Services Department spokesman Kate Luck said Friday that if Sullivan's bill passes, the department will implement other outcome-based measures.

Arkansas Code Annotated 20-47-510, part e (2)(D), "requires [the Division of Behavioral Health Services] to annually report outcome data for the system of care in its annual report concerning the operation of the Comprehensive Children's Behavioral Health System of Care. Therefore, we would be required to measure outcomes," Luck wrote in an email.

Metro on 01/25/2015

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