Blog Archives

CO Medicaid Managed Care, Capitation, & Parity: It's Time To Get REAL

2/11/2018

So the HUGE problem under Medicaid Managed Care is that it has in some instances provided incentives for Mental Health Centers to concentrate on the least needy patients at the expense of the most needy patients.
Now we're NOT the only ones that think this -- in fact, the opinion runs across the Mental Health Advocacy spectrum from national conservative advocate D.J. Jaffee with the Mental Illness Policy Organization & Dr. Torrey with the Treatment Advocacy Center to Colorado's own liberal visionary Amy Smith with BrainStorm.
Not everybody agrees with this assessment -- like the Mental Health Centers and States-- and this does quite frankly have a lot of nuances to it.
Nonetheless, there are a lot of built in tensions with Medicaid Managed Care and large-scale financing of "expensive"/intensive community mental health treatment, and that is even though such "expensive"/intensive community mental health treatment is generally less expensive than:

Prisons
County Jails,
Nursing Homes, and
Hospital Beds

Well, why is that? The Community Mental Health Centers don't see it in their financial interests to provide large scale Assertive Community Treatment where "reasonably medically necessary." So there is some being provided and there have even been real efforts by Colorado to increase access to ACT BUT it is STILL woefully inadequate.
THIS IS NOT IN THE BEST INTERESTS OF PATIENTS. This is in the best financial interests of States and Mental Health Centers.
AND from our perspective we've got the results and the trail to prove it -- thousands of poor people with mental illness in jails, prisons, homeless, etc. and a Medicaid system that is still coming to terms with its HUGE role in the problem.
And even with that, Colorado like most States is just flat out AFRAID to address this problem openly and honestly, because there is a lot of complexity to it and there's at least on one side of the balance sheet some real costs involved.
So Colorado does NOT have:

Network Adequacy for Intensive Community Mental Health Treatments such as Assertive Community Treatment.
An Adequate Assessment or Eligibility Tool for Reasonable Medical Necessity for Assertive Community Treatment -- the latest current vagueness continues to hurt vulnerable people.
Mental Health Parity

People we can solve this, but not by pretending this problem doesn't exist.

So what are the missing pieces of information that are preventing "actuarial soundness" in Colorado Medicaid Mental Health Capitation Rate Setting?

ACTUARIAL STANDARDS BOARD: MEDICAID MANAGED CARE

42 CFR 438.6(c)
Actuaries are specifically directed to this section:

(c) Delivery system and provider payment initiatives under MCO, PIHP, or PAHP contracts—(1) General rule. Except as specified in this paragraph (c), in paragraph (d) of this section, in a specific provision of Title XIX, or in another regulation implementing a Title XIX provision related to payments to providers, that is applicable to managed care programs, the State may not direct the MCO's, PIHP's or PAHP's expenditures under the contract.

From the Dept. of Health Care Policy & Financing's Contract with the RCCOs (Regional Care Collaborative Organizations)

7. PAYMENTS TO CONTRACTOR A. Maximum Amount Payments to Contractor are limited to the unpaid, obligated balance of the Contract Funds.

The State shall not pay Contractor any amount under this Contract that exceeds the Contract Maximum.

The State shall not pay Contractor any amount under this Contract that exceeds the PMPM [Per Member Per Month] amount for that month submitted to the State as specified in Exhibit B.

p. 6
https://www.colorado.gov/pacific/sites/default/files/Rocky%20Mountain%20RCCO%20FY%2017-18.pdf

Washington State Study Showing Medicaid Managed Care Led To Incarceration Of People with Mental Illness

Colorado Medicaid Regulations on Capitation Rate Setting from the Secretary of State's website (emphasis added)

42 CFR §438.6 --- Special contract provisions related to payment

<<<<< Well, it sounds good, but if quality measures are NOT enforced this can become a nightmare & in fact it has become a nightmare in Colorado & across the Country.

So There Are A Lot Of Issues For CO Medicaid Assertive Community Treatment: Parity, Network Adequacy, Adequate Planning, Provider Reimbursement, Etc. [& Olmstead]

2/10/2018

Things happen for reasons. Usually a lot of complicated factors.
We don't have Thousands of Coloradans with Mental Illness:

In Prisons & Jails
On the Streets, and
In Nursing Homes

by accident.
We've made some pretty HORRIFIC policy choices as a society, here in Colorado and across the Country.
AND at one time, we thought we could get away with those short-sighted choices refusing to:

adequately fund Housing for people with disabilities; and
refusing to do the REAL PLANNING and NETWORK ADEQUACY WORK for INTENSIVE COMMUNITY MENTAL HEALTH TREATMENT that people in this State need --- NOT just LIP SERVICE to it. [Remember, this is the same Administration that refused to do Olmstead Planning with measurable goals & refused to respond when asked about a waitlist for Assertive Community Treatment]

So our point is essentially without:

some type of specific measure of "Reasonable Medical Necessity" for Assertive Community Treatment
and applying that to the relevant populations

-- How is Colorado going to know if its Network is Adequate?
Of course, the rest of us already know that Colorado Housing and Medicaid mental health services are NOT sufficient to keep people out of:

prisons & jails
homeless shelters
nursing homes, and
mental institutes

This really isn't rocket science folks -- it can just be expensive. While this is going to mean an increase in Community Mental Health Costs, it will mean a decrease in:

Corrections Costs
County Jail Costs
Nursing Home Costs

We're willing to work with people on innovative solutions and we're tired of playing games.

CODE OF FEDERAL REGULATION SECTIONS ON: MEDICAID MANAGED CARE NETWORK ADEQUACY STANDARDS, ETC.

Does Colorado Medicaid NOT know that there are thousands of Coloradans with mental illness in Colorado Prisons, Jails, Homeless Shelters, Nursing Homes, & Mental Institutes, Etc. Okay -- not all of them need ACT -- but don't we need to figure out who does. [Amy Poehler on SNL]

Our Understanding of Medicaid Network Adequacy is:

Expected Utilization of Services
Based on Member Characteristics
& Health Care Needs

(at least that is the way Wisconsin is defining it)

So you can see why refusing to do Olmstead Planning is such a BIG DEAL -- IT ALSO IMPLICATES THE ADEQUACY OF THE STATE'S MEDICAID NETWORK.

Mental Health Parity & Assertive Community Treatment: CMS Guidance, Reasonable Medical Necessity, Quality & Quantity, CMS & SAMHSA, HCPF & OBH

2/9/2018

Mental Health financing in this Country is pretty convoluted and there are divided responsibilities -- BUT the BIG KAHUNA IS MEDICAID, health insurance, for funding of Community Mental Health Treatment.
Further, MEDICAID is an ENTITLEMENT and CMS has issued guidance on MENTAL HEALTH PARITY.
Even further page 36 of CMS' Mental Health Parity Toolkit references "Assertive Community Treatment" and "reasonable medical necessity" as the appropriate standard.
"Fidelity" to the Assertive Community Treatment Model is important and "Prioritizing" relevant populations is important -- BUT we gotta get REAL and move beyond "Prioritization" and make this an ENTITLEMENT under MEDICAID where "REASONABLY MEDICALLY NECESSARY"
Colorado's Department of Health Care Policy & Financing (HCPF) & Office of Behavioral Health (OBH) are in some senses a State reflection of the National division of the Centers for Medicare and Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
National advocacy groups such as the Mental Illness Policy Organization and the Treatment Advocacy Center have demonized SAMHSA we think quite unfairly, especially given the reality that it is CMS that funds most of the community mental health treatment in this country.
Well, Parity has the potential to address the INSANE CONSEQUENCES that D.J. Jaffe and the Mental Illness Policy Organization, the Treatment Advocacy Center, and the rest of us are so concerned about. BUT NOT through SAMHSA -- through MEDICAID.

Response From CO Medicaid Director Gretchen Hammer

The Behavioral Health Organizations are able to make a medical necessity determination for ACT, like all other BHO services. Their requirements for medical necessity determinations are in their contracts. The specific language is:

2.2.10. The Contractor may place appropriate limits on a service:
2.2.10.1. On the basis of criteria applied under the Medicaid State Plan, such as medical necessity.
2.2.10.1.1. All medical necessity determinations must utilize the medical necessity criteria defined in 10 CCR 2505-10 8.076.

The rule was recently updated by the Medical Services Board, the rule making authority for the Department. One can find the current rule on the Secretary of State website.

Orchid's Take: Most States employing a "reasonable medical necessity" determination for ACT specifically define it in Statute or regulation -- not under a general definition of reasonable medical necessity. That may be too vague and many providers likely need additional guidance.

What Colorado is really lacking is a definition for "reasonable medical necessity" for ACT.

AND How does that affect CAPITATION RATES?

There have been all kinds of "insane" incentives for Medicaid Community Mental Health to cost shift their neediest patients to the streets and the jails.
If those Community Mental Health Centers are not adequately reimbursed for Assertive Community Treatment -- one can be sure they are NOT going to be doing it.
Well, what does that mean: LOTS of People with Mental Illness in:

Prisons
Jails
the Streets
Nursing Homes, and
Mental Institutes

Honesty & Creativity in Complying with Mental Health Parity

2/8/2018

Coloradans with Mental Illness DON'T HAVE TO FAIL FIRST in:

incarceration
homelessness
placement in nursing homes, or
mental institutes

without adequate resource to ASSERTIVE COMMUNITY TREATMENT or FLEXIBLE ASSERTIVE COMMUNITY TREATMENT where reasonably medically necessary.

Assertive Community Treatment & Flexible Assertive Community Treatment in Norway and the Need for Colorado to Comply with Parity and Ultimately Olmstead

2/7/2018

Assertive Community Treatment is often a component of US Department of Justice Olmstead Settlement Agreements addressing Mental Health.

Colorado has some Assertive Community Treatment and they've been working to increase it.

Despite these efforts, Assertive Community Treatment is STILL not available to all where "reasonably medically necessary."

Well Colorado's failure to provide ACT where "reasonably medically necessary" is a BIG PROBLEM for A LOT of reasons:

It violates mental health parity under the Mental Health Parity & Addiction Equity Act of 2008 and subsequent CMS (Centers for Medicare & Medicaid Services) Guidance;
Failure to provide or plan to provide adequate Community Mental Health Services for those at great risk of institutionalization or homeless violates the 1999 US Supreme Court Olmstead decision, subsequent caselaw, and US Department of Justice Guidance on Olmstead and Title II of the Americans with Disabilities Act.
Failure to provide adequate intensive Community Mental Health Services including ACT is HORRIBLE Policy and Short-Sighted, leading to more homelessness and incarceration of people with mental illness. The World Health Organization has specifically called out such short-sightedness when it comes to mental health policy.

NOT EVERYBODY NEEDS ASSERTIVE COMMUNITY TREATMENT, BUT ACCESS TO THAT TREATMENT HAS TO BE BASED ON "REASONABLE MEDICAL NECESSITY."

Both the US and Europe have suffered under what Europeans have termed "incompetent" mental health policy after de-institutionalization.

Well, we are decades out from de-institutionalization @ this point. Further, the US went WAY FURTHER than most European Countries in criminalizing mental illness.

The West has had incompetent mental health policies and that includes the US and the State of Colorado.

The Hickenlooper Administration, MIXED BAG that it is, has done great work so long as its their idea --- BUT ask them to comply with the LAW -- say PARITY or OLMSTEAD, and there is PASSIVE RESISTANCE like nobody's business.

Maybe we could just say it's the Hickenlooper Administration's idea to offer Assertive Community Treatment where "reasonably medically necessary" -- AND they might do it.

We certainly wouldn't have a problem giving them a lot of credit for it, AND they would DESERVE IT.

Congressional Research Service: Jan. 19, 2018: Prevalence of Mental Illness in the US

Additional analyses of NSC-R data were conducted to determine the 12-month prevalence of mental illness at three levels of severity: serious,19 moderate,20 or mild.21

Among the 26.2% of adults identified with a mental disorder in the analysis, serious disorders (22.3% among adults with a disorder) were less common than moderate disorders (37.3%) or mild disorders (40.4%).

The estimated 12-month prevalence of serious mental illness among all adults was 5.8%.

https://fas.org/sgp/crs/misc/R43047.pdf

ACT and Flexible ACT in the Netherlands . . .

The two models are outlined below.

ACT for the most severely ill patients ACT provides multi-disciplinary care with shared caseloads for the 20% group of most severely ill patients with SMI.

When a patient under the care of an ACT team stabilizes, he or she proceeds to a lighter form of care such as case management, provided by ‘step-down’ teams.

There are now 35 ACT teams in the Netherlands.

Flexible ACT for all SMI patients Flexible ACT provides multi-disciplinary care for the whole group (100%) of SMI patients in a particular region (50,000 inhabitants).

Continuity of care is provided for these patients. If necessary (in the event of an imminent crisis recurring psychosis, threat of readmission) a Flexible ACT team can provide full ACT care by switching to shared caseload and intensive outreach.

After the crisis a step-down procedure takes place within the same team, which ensures more continuity. Because the area covered is smaller, the team is better able to support social inclusion for these patients.

The teams collaborate extensively with social partners for that purpose.

There are now about 300 Flexible ACT teams in the Netherlands.

Prevalence of Severe Mental Illness & Co-Occurring Substance Abuse in Europe

A European survey estimated the annual prevalence of severe mental illness in two European catchment areas found that approximately 2 in 1000 persons suffered severe mental illness (Ruggeri, Leese et al. 2000).

The majority of people with severe mental illness have schizophrenia and many experience severely impaired functional disability. According to the World Health Organization’s (WHO) World Health Report “New understanding, new hope” from 2001, schizophrenia is the eighth leading cause of disability-adjusted life years (DALYs) worldwide for people between 15-44 years.

DALY is a measure of overall disease burden describing the impact of a health problem as measured by financial cost, mortality, morbidity, or other indicator.

DALYs are the number of years lost due to ill health, disability or early death. Many people with severe mental illness also suffer co-occurring substance use problems. The lifetime prevalence of alcohol abuse or dependence in the general adult population ranges from 13.5% to 22.7% (Regier, Farmer et al. 1990, Kringlen, Torgersen et al. 2001) while 3.4% to 6.1% of the adult population has a lifetime prevalence of drug abuse or dependence (Regier, Farmer et al. 1990, Kringlen, Torgersen et al. 2001).

Amongst persons with schizophrenia, the reported lifetime prevalence of any substance abuse or dependence, ranges from 47% to 60% (Regier, Farmer et al. 1990, Fioritti, Ferri et al. 1997, Fowler, Carr et al. 1998). Current prevalence ranges from 27% to 41% (Fowler, Carr et al. 1998, Ecker, Aubry et al. 2012).

p. 12
https://www.duo.uio.no/bitstream/handle/10852/58886/PhD-Hanne-K-Clausen-2017.pdf?sequence=5

Indiana's Criteria for Assertive Community Treatment and Recognizing Access to ACT as an Olmstead, Parity, & Human Rights Issue

2/6/2018

The Bottom Line is: We Don't Have an Adequate Medicaid Community Mental Health System or Hospital System, if we have a BUNCH of people with mental illness who are:

Incarcerated,
Homeless,
Or in Nursing Homes

AND Colorado does have a BUNCH of people with mental illness incarcerated, homeless or in nursing homes. In fact, we have thousands of them.

Now Assertive Community Treatment and other Intensive Treatments are cheaper than HOSPITALIZATION -- BUT if we're NOT paying for the Hospitalization it can seem CHEAPER NOT to Pay for the Assertive Community Treatment and just shift the costs to non-profits serving people on the Streets and the County Jails.

Now Colorado and a lot of States have really made a lot of progress -- BUT we're in a HUGE HOLE when it comes to adequately providing for Intensive Mental Health needs -- AND that includes Intensive Services & HOUSING.

Well, Parity is going to help FIX THAT, right? Well, only if the States comply with it, and that can be a pretty BIG IF.

We've had a pretty PAINFUL experience with the State over the course of about 3 or more years with the State politely BUT FIRMLY RESISTING what they SHOULD do on Assertive Community Treatment.

When we just had the Olmstead Decision and NOT Parity -- we asked for a WAITLIST about 2 or 3 years ago, and have renewed the question sporadically --- BUT the State has REFUSED to respond.

With Parity -- we want an END to the ARBITRARY TREATMENT Limitations to Assertive Community Treatment, especially since it is such an important treatment for people with mental illness who have Intensive Mental Health Needs --- many of the people who need these services are poor and minorities, and endured suffering that would break most of us.

The failure to provide Assertive Community Treatment where reasonably medically necessary is DISCRIMINATION in so many ways and contributes to the most BRUTAL HUMAN RIGHTS VIOLATIONS in our Country today.

The Logical Long-Term Consequences of Our Failure to Provide Sufficient Intensive Community Mental Health Treatment

Person-Centered Planning

440 IAC 11-1-13 "Person-centered planning" defined Authority: IC 12-21-2-3; IC 12-24-19-6 Affected: IC 12-24-19 Sec. 13.

"Person-centered planning" means a process-oriented approach to empower an individual with a serious mental illness to define the services and supports necessary for recovery.

(Division of Mental Health and Addiction; 440 IAC 11-1-13; filed Feb 9, 2011, 10:24 a.m.: 20110309-IR-440090875FRA)

ACT Admission & Discharge Criteria

440 IAC 11-3-4 ACT admission and discharge criteria Authority: IC 12-21-2-3; IC 12-24-19-6 Affected: IC 12-24-19

Sec. 4. (a) All individuals admitted to ACT must meet the following criteria:

(1) Be at least eighteen (18) years of age.

(2) Meet the division criteria for persons with serious mental illness as defined in 440 IAC 8-2-2.

(3) Require intensive, community based services as specified in the admission criteria for ACT, which shall include an assessment of the following:

(A) Level of need based on the adult needs and strengths assessment tool or its successor.

(B) Discharge from a state psychiatric hospital within the previous twelve (12) months.

(C) Other psychiatric hospitalizations in the previous two (2) years.

(D) Criminal justice or legal system involvement.

(E) Co-occurring substance abuse.

(F) Homelessness or imminent risk of homelessness.

(b) An individual must meet the diagnostic criteria specified in section 3(c) of this rule.

(c) When an individual is discharged from ACT to less intensive services, a discharge plan must provide for the following:

(1) A gradual transfer period.

(2) A plan to maintain continuity of treatment at appropriate levels of intensity to support the individual's continued recovery.

(3) A plan for the individual's return to the ACT team if needed.

(d) Individuals may be readmitted to ACT based on the following criteria: 2017 Edition ASSERTIVE COMMUNITY TREATMENT TEAMS Indiana Administrative Code Page 11

(1) If the individual was discharged from ACT within the past twelve (12) months, any of the following has occurred within sixty (60) days prior to readmission:

(A) A psychiatric hospitalization or emergency room visit.

(B) A hospitalization or an emergency room visit as a result of substance abuse.

(C) An arrest or other law enforcement contact.

(D) Homelessness or risk of homelessness.

(E) Admission to a subacute stabilization facility.

(2) If the individual was discharged from ACT more than twelve (12) months prior to readmission, at least one (1) of the conditions in subsection (a)(3) has been met.

(e) Each CMHC must have specific procedures for the transfer of an individual from one (1) ACT team to another, either within a CMHC or to another CMHC. These procedures must, at a minimum, specify the steps to be taken to ensure that:

(1) the individual meets with the new team; and

(2) information from the individual's clinical record information is appropriately shared with the new team.

(f) Discharges from ACT services shall be in accordance with division-approved criteria, which includes an assessment of the following:

(1) The level of need based on the current division-approved assessment tool.

(2) The criteria for admission to ACT.

(3) The stages of change.

(4) The continued medical necessity for high intensity, community-based care. (Division of Mental Health and Addiction; 440 IAC 11-3-4; filed Feb 9, 2011, 10:24 a.m.: 20110309-IR-440090875FRA)

file:///C:/Users/user/Downloads/A00110.pdf

Mental Health Parity: Finding the Line Between Prohibited "Fail First" Medicaid Provisions and Reasonable Medical Necessity

2/5/2018

The Mental Health Parity & Equity Addiction Act of 2008 prohibits so called "Fail First" provisions.
What does that mean? It means that people can't be required to "FAIL" @ a less expensive treatment, before receiving a more expensive, likely more intensive treatment.
Well, okay --- but not everyone needs the most expensive, intensive treatment.
How are we going to determine who needs which treatments?
Well, we can't do it the old crazy way that has been rife within Colorado Medicaid for years and probably many other State Medicaid Programs:
Colorado Medicaid historically only covered intensive treatments such as Assertive Community Treatment as long as the money didn't run out from the Savings of the Medicaid Managed Care Program.
Well it is these kinds of HORRIFIC policies that Mental Health Parity is designed to get rid of.
That still doesn't mean that everyone needs Assertive Community Treatment --- What we do need are coherent criteria for "reasonable medical necessity" and eligibility for various treatments across the spectrum for example Flexible ACT, etc.

The State has invited me to speak about these issues to the Regional Accountable Entities -- which I very much appreciate.

Ultimately, it's the
State's responsibility to comply with Mental Health Parity Law. Colorado isn't doing that right now.

The State indicates it will have some requirements for "network adequacy" --- Sounds good, but we don't know what it actually means.

Further it does strike us that the State is trying to side-step responsibility for Parity and put it on the Regional Accountable Entities.

The invitation from the State to speak to Regional Accountable Entities is great ---- but it is not sufficient.

We need "reasonable medical necessity" criteria for ACT or a process to get it by the end of this week, or I'm going to CMS Region 8.

The State of Colorado Could Give Lucy A Run for Her Money in Parity Bait & Switch Routines

Alcohol, Dementia and Mental Illness: It's Pretty Complicated & Plenty of Traps for the Unwary

2/4/2018

I grew up in a somewhat extended family situation. My paternal grandmother had taught Latin and French and even in her 80's she was very sharp and read her Latin Bible and listened to French Canadian radio.
One of the things she did every night before bed was have a glass of Port and some Velveeta cheese.
My grandmother was a very slim person, so she wasn't particularly concerned about her weight.
She had a very serious case of osteoporosis -- at the time of her death when she was 88 -- she was totally bent over. I don't think they realized at that time that alcohol was not a good thing if one had osteoporosis.

Well, my Dad didn't really drink or very, very occassionally. He wasn't morally opposed to it -- but he was always watching his weight and he didn't really like it that much. As a child and young man, he had been pretty heavy and worked very hard to lose that weight.
He didn't really eat fish, and he specifically didn't like Salmon.
In high school, he had contracted mononucleosis -- and that has been linked to some adult chronic illnesses.
http://www.thv11.com/news/childhood-kissing-disease-linked-to-adult-chronic-illnesses/369722649
Well @ age 59 my Dad was diagnosed with Parkinson's and that would later change to Lewy Body Dementia.

Now none us really believed the problem with Dad was he didn't keep his mind active. He was a very smart guy and he was still beating us in Trivial Pursuit well into dementia.

It took a long time for the Dementia to destroy his brain, but it finally did.

There are so MANY FACTORS to individual disease processes-- some we think we know and some we don't.

Well, more than a decade ago this stuff started coming out about how alcohol might be protective against Dementia.

"If Dad had just had a glass of wine every night like Grandma Corzine -- this may never have happened," I thought.

So what did I do? Well, I started to have a glass of wine every night @ dinner which often included salmon and spinach and walnut salads.

So they are saying women should only have a glass of wine a day -- BUT I'm like a really short person and I've concluded that's excessive for me. AND now I have osteoporosis -- I just need to avoid it.

Well, right after dinner I would pretty much have to go to bed because of the alcohol -- and then I would get up later -- so it totally disrupted my sleep schedule.

At the time, I didn't know I was susceptible to Bipolar Disorder or a disrupted sleep schedule could put me over the edge.

Then I traveled across some time zones and all the sudden I'm having my first and so far only psychotic episode in an Airport in Washington, D.C.

Of course, I do think there were other factors than the wine and how those factors shake out in any individual person is pretty complicated.

I've talked a lot about recognizing Altitude as a factor. It is important to realize that Altitude is a factor primarily for people who are already vulnerable to certain issues, serving as a kind of magnifying effect.

So needless to say I am very wary of the health benefits claimed by alcohol. In women it can increase the risk of breast cancer.

DRINKER BEWARE.

Alcohol's effects on the body

One of the things that is important to recognize is that Alcohol damages the Immune System and Mental Problems are more and more viewed as concerns of the Immune System.

Alcohol & the Immune System

Altitude

New Science is Amazing and It has huge moral implications now

The Demands of "Realism" are Different in an Emergency than After The Fact Searches for Justice: Current Suffering in AdSeg in County Jails and Coming to Terms with the Limits of Punishment for Long Past Violations

2/3/2018

The capacity to accept reality is not always correlated to the level of current suffering.
There are people NOW who are experiencing gross human rights violations in Colorado Jails through AdSeg or Solitary Confinement.
This is an EMERGENCY Situation and the State should request EMERGENCY FUNDS to deal with it, because this situation is a direct result of the State's failure to provide adequate Housing and Intensive Community Mental Health Treatments and/or bed space.

On the other hand, sometimes the greatest desire for punishment is after the fact, and maybe involving something not quite as heinous as AdSeg but up there.

Maybe such punishment is possible, maybe it's not. But what if it's not and we just can't accept that.

Well, that's going to be very difficult.

For current on-going suffering such as AdSeg in Colorado Jails -- THERE IS NO EXCUSE FOR THE STATE'S FAILURE TO ACT.

Further, we have a DUTY to CORRECT past SYSTEMS FAILURES.

But a desire for "punishment" long after the fact and likely barred by law can prevent us from achieving the important gains we and others are depending upon NOW.

Citizen-Driven Plans of Correction in Cases of Substantiated Abuse, Neglect or Rights Violations with the Power to Address "Root Causes"

2/2/2018

When I think of Plans of Correction, I usually think of Plans of Correction coming out of the State Health Department, Health Facilities Division.
Those are very important but they have often failed to address "Root Causes" of facility problems such as "Insufficient Staffing."
So we've often left the hard stuff for private personal injury attorneys. Well, in a lot ways like Sexual Abuse or Harassment Cases or in fact most cases that are subject to a Settlement Agreement, there is a NON-DISCLOSURE AGREEMENT.
So over decades we can never really get to the "Root Causes" of problems due to 2 very important and powerful de-incentives:

Systemic Problems that require greater reimbursement of providers to solve or other increased funding; and
Providers that don't want to be held accountable for expensive fixes.

Well who loses out on this -- primarily vulnerable populations. Historically, the State and Providers if not happy about this -- can live with it. Unfortunately, the vulnerable populations sometimes can't survive these political realities that are not putting the needs of the Vulnerable Populations FIRST.

As is so often the case before some horrific tragedy happens that is going to get filtered to the High-Powered Personal Injury Attorney --- there were a lot of WARNING SIGNS that essentially got ignored.

LET'S MAKE NO MISTAKE ABOUT IT --it is often cheaper to pay out a large damage settlement or award than it is to FIX THE PROBLEM(S).

So that is what the STATE Of COLORADO as well as a lot of other entities have been doing.

THAT NEEDS TO CHANGE -- and its in the interests of :

Vulnerable Populations
Providers, and
The State

that it change in a number of ways.

If we want this human rights disaster to change, we need to change the SYSTEM.

Colorado Abuse & Neglect Scandals Involving People with Disabilities

Specifically:

State Agencies need User-Friendly, ADA Compliant Grievance Procedures
That include person/family members/etc. participation in Plans of Correction where the Complaints involve Abuse, Neglect or Rights Violations;
The Agencies will do a thorough root cause analysis and make an affirmative finding as to whether the problem is a result of Insufficient Staff with respect to both Quantity and Quality.
If the Insufficient Staffing or other matter amounts to an "Emergency" and cannot be appropriately addressed with existing funds, the State shall seek Emergency Funding.
Each year, State Agencies should make a report to appropriate State Legislative Committees:
- regarding Abuse, Neglect and Rights Violations
- Report of Including the person/family members/etc. in Plans of Correction
- Report as to Complaints leading to Emergency Concerns
- Request for Additional Funding if needed to address Abuse, Neglect or Rights Violations. Request should include need for Funding and analysis of alternatives.

Colorado has HUGE problems in addressing allegations of ABUSE, NEGLECT and Rights Violations of People with Disabilities.

We have picked on the Hickenlooper Administration A LOT and in a LOT of WAYS they've earned it. BUT they are NOT the only ones.

Forward>>

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