May 2, 2013 – In the 28 years that De Paul Treatment Services has provided youth alcohol and drug treatment services, it's only seen a minor increase in reimbursement rates from the state. Now its future, along with the future of other youth treatment facilities around the state, is uncertain, according to Sheila North, executive director.
North traveled to Salem late last week to meet with officials from the Oregon Health Authority, the Department of Medical Assistance Programs and the Oregon Medical Assistance Program to request higher reimbursement rates – for De Paul as well as the four other residential youth drug and alcohol treatment providers in the state.
Although she felt her concerns were heard, North said it remains unclear whether the state will actually increase rates to match the actual cost of treating youth in De Paul's 21.5-bed facility. The per-bed, per-night reimbursement rate for residential alcohol and drug treatment is $135, set in 2009.
North is asking the state to raise its reimbursement rate to $340 per night, which she says is the cost to provide effective treatment to dual diagnosis adolescents (that is, youth who have both a substance abuse diagnosis and a mental health diagnosis). According to Stacy Blumberg, director of marketing and development for De Paul, the organization covers this gap through fundraising and through higher reimbursement rates from insurance companies (since De Paul also accepts adolescents and youth with private insurance).
Blumberg added the state would need to appropriate $5 million to close the gap between what all five residential treatment providers provide and the reimbursement they receive from the state.
Of De Paul's 2012 revenue of $9,569,173, 30.4 percent comes from insurance and self-pay, 7.1 percent from contributions, and the remaining 62.5 percent from county, state and federal government funds.
The slow climb in reimbursement rates has happened even as demand for youth alcohol and drug treatment services has increased – due in part to the growth of Oregon's population over the past 15 years –while the Department of Human Services has changed staffing ratios, making in-patient treatment facilities more expensive to operate. Where initially, the required ratio of staff to youth was 1:10, that ratio is now 1:8. Senate Bill 267, which passed in 2005, also mandated the use of evidence-based practices, which also increased the cost of such centers.
“It's all good. It's all for the greater good of the clients and their families,” North said of the state-imposed changes. “The system is kind of bankrupt. We've had to sort of move mountains to keep it going.”
According to De Paul's website, the cost of self-pay for uninsured patients in the center is $6,500 for 30 days, which averages to $211 per day.
All the youth who come to DePaul – and the four other treatment centers around the state, which operate 71 beds total – are Oregon Health Plan members, and seek treatment through a variety of referrals including parents, schools and the juvenile justice system.
De Paul accepts patients from around the state who stay on average for 61.5 days after sitting on a waiting list that shuffles youth to the first Medicaid-reimbursed facility with an opening; such facilities are also located in Corvallis, Roseburg, Baker City and Prineville.
North isn’t certain how many youth are on the waiting list currently or know the average wait time, but said those wait times do fluctuate throughout the year.
She’s advocating for higher reimbursement rates – on behalf of De Paul and other state-reimbursed treatment centers -- partly on the premise that investing in drug treatment for youth saves money in the long run, by decreasing the number of long-term health problems associated with drug and alcohol abuse, and by decreasing the likelihood of youth interacting with the criminal justice system as adults.
Asked specifically what will happen if the gap isn't closed, North said, “I don't know.”
“We have lost employees to Hazelden (a private alcohol and drug treatment facility in Newberg). We've lost them to private practice, to teaching, to things that can make more money.”
While behavioral health is at the cornerstone of coordinated care – with metrics requiring screening for alcohol and drug treatment programs – North said she and her colleagues in addictions treatment have yet to receive any concrete, detailed information about their role in coordinated care, though the state is expected to release specifics July 1.
Contacted for comment on reimbursement rates, Oregon Health Authority spokesperson Christine Stone said it is the Legislature that sets the state’s Addictions and Mental Health(AMH) budget, including cost of living adjustments. Then, based on that approved budget, AMH sets the rates for counties and providers who deliver non-Medicaid services.
Calls to Sen. Alan Bates and Rep. Nancy Nathanson, who co-chairs Ways and Means' Subcommittee on Human Services, were not returned in time for The Lund Report's deadline.
