Five months after requesting a child psychiatric facility in Logan be exempt from a lengthy review, the West Virginia Department of Health and Human Resources has sent a letter to the man behind Dazzy Vance Mountain Retreat, cautioning that the state plans to reduce its reliance on such facilities.
In the letter, dated Nov. 20, DHHR Secretary Karen Bowling writes that, because the proposed 70-bed facility is so large, it would be ineligible for Medicaid reimbursement unless it were to be broken up into smaller groups of beds, as Psychiatric Residential Treatment Facilities must be licensed at 30 beds or fewer to receive Medicaid dollars.
The letter, sent to R. George Vance - owner of the facility and president and CEO of Trinity Health Care Services, which would operate the facility - goes on to explain that placing a child in a facility similar to Dazzy Vance is "truly a last resort within the continuum of care as the most restrictive option," and that Dazzy Vance should not expect placements from the state.
"This information is being provided to you so that you can make an informed decision regarding whether or not to proceed with the development of Dazzy Vance, given the fact that there is no guarantee that children will be placed in this segregated residential treatment facility," Bowling wrote.
According to its application to the Health Care Authority, Dazzy Vance Mountain Retreat is targeted toward children between 4 and 21 years old who are "at risk for out-of-state placement in Logan County and the surrounding counties within the [DHHR's] Region II Area."
In late June, Bowling sent a letter to the state's Health Care Authority, requesting the proposal not be subject to Certificate of Need review, citing state code that says a Certificate of Need is not required by an entity "proposing behavioral health care facilities or behavioral health care services for children who are placed out of their homes, or who are in imminent risk of being placed out of their homes" should the secretary make "certain findings, supported by appropriate documentation" and recommends the project not be subject to review.
That request was sent just weeks after the Department of Justice issued findings from a yearlong investigation that pointed to "a lack of integrated services" and "a reliance on unnecessary institutionalization" as part of the state's failure to comply with the Americans with Disabilities Act - specifically, the part that requires children and other people with disabilities to "receive supports and services in the most integrated setting appropriate to their needs."
Since late June, the DHHR has received push-back from opponents of the planned facility who say it goes against the Justice Department's recommendations. According to Bowling, the facility plan was not "fast-tracked," as detractors have claimed - exempting facilities from Certificate of Need review is a common tactic and one the DHHR has used several times in recent months for in-home, wraparound services.
"We wanted to make sure everyone was aware of our focus on community-based services - that hasn't wavered from Day One," she said. "Since becoming secretary, I have focused on children's services and the importance of making a change in the child welfare system. This wasn't a departure from that whatsoever; it was a clarification, to make sure everyone understands, because there seem to be a lot of misconceptions about Dazzy Vance, that process and why it was needed."
Bowling said that, despite the name, psychiatric residential treatment facilities are not intended to be long-term residential facilities.
Nancy Exline, commissioner of the DHHR's Bureau for Children and Families, and Cynthia Beane, commissioner of the DHHR's Bureau for Medical Services, said that, between their agencies, nearly 200 West Virginia children are in out-of-state facilities at any given time, adding that children must first "fail" to respond to community-based services before being sent to a residential treatment facility.
"Placement in a [psychiatric residential treatment facility] has to be medically necessary; it is not something where our staff is making that determination. It is something that is medically necessary," Exline said. "I think there are people on both sides of that who either think it is necessary or it isn't, but I believe that, when you have to look at a doctor saying that it's in the best interest of a child, then that's what we have to do."
But Jennifer Meinig, the executive director of American Civil Liberties Union of West Virginia, disagreed. Meinig spoke to Bowling about Dazzy Vance on Nov. 19, the day before Bowling sent the letter to Vance, and said the secretary was "hard to read" on the subject, but emphasized that "she wanted to do what was best for West Virginia children."
"I talked about how, not only is it bad for kids and it's bad public policy, but also how incredibly expensive it would be once it's built," Meinig said. "These [psychiatric residential treatment] facilities aren't short-term, acute-care facilities; they are, by definition, long-term care, and data shows it should be a last resort to send children to facilities like that, and not a first, and West Virginia has made it sort of a first-resort default."
The letter was sent four days after a hearing before the West Virginia Legislature's Joint Committee on Children and Families, where legislators, the DHHR and opponents of the plan debated the need for such a large facility in Southern West Virginia. Emily Read, senior staff attorney for the Judge David L. Bazelon Center for Mental Health Law, in Washington, D.C., attended the hearing, to voice her concerns over the rights of the state's children.
"What we know about children's mental health is that institutional care doesn't work," Read said. "It doesn't make children better, it doesn't help them return to living with their families, it doesn't prepare them to do well in school or become successful adults. What works is keeping them at home with their families, as much as possible, in what are called 'wraparound services' that support them living in their communities and with their families."
That hearing was requested by Sen. Mike Woelfel, D-Cabell, who worked for 30 years for the West Virginia Supreme Court, overseeing cases involving troubled youth in juvenile courts. Woelfel opposes the center and said he didn't know what brought about the DHHR's "change of tone."
"It's still a mystery to me why the full Certificate of Need process was not required," Woelfel said, "but I think there was a real question about whether there would have been Medicaid reimbursement. These are federal funds we're talking about, funding something from the '50s or '60s, where kids are segregated and warehoused. It contradicts current thinking on mental health issues for youth."
While the center would be privately funded, it eventually would gain almost all of its income through public Medicaid dollars.
"It probably was wise to give these developers a heads-up that, 'You might build it, but don't expect us to pay for it,' " Woelfel said.
According to Bowling, the letter was not prompted by anything in particular and not designed to discourage Vance from moving forward with the facility. She said it was sent to ensure that the developer understands that he was not guaranteed placements from the state.
"The letter was just to point out the obvious and to make sure that nobody out there in the public has any misconception about this department, what we plan to do and how we plan to do it," Bowling said. "It is disappointing that there have been misconceptions out there about the Dazzy Vance facility, and I want to make sure it is clarified for everyone what our intentions are."
David Gutman
contributed to this report.
Reach Lydia Nuzum at lydia.nuzum@wvgazettemail.com, 304-348-5189 or follow @lydianuzum on Twitter.