The West Virginia Department of Health and Human Resources has responded to accusations by a special commission that proposed changes to its juvenile residential treatment model were made "in secret," arguing that those changes are necessary to correct problems outlined in an earlier U.S. Department of Justice report.
The Juvenile Justice Commission, created by the state Supreme Court, released findings of fact and conclusions of law Monday about the pending reimbursement changes, which include a 180-day limit on juveniles' stays at the facilities.
The pending DHHR contract, which has been suspended, would replace bundled rates of $250 a day for residential placements to a standard rate of $178 a day for room, board and supervision, while requiring residential care facilities to bill separately for other services provided to each child on a fee-for-service basis.
That change, along with the elimination of three levels of classification of children based on treatment needs, could cause severe financial issues for residential centers that provide more intensive treatment options, according to the commission.
DHHR Secretary Karen Bowling said the proposed changes will align the state with a U.S. Department of Justice report from June 2015 that cites 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.
This refers specifically to the part that requires children and other people with disabilities to "receive supports and services in the most integrated setting appropriate to their needs."
"Given that West Virginia has one of the highest rates of residential placement of children per capita in the country, national experts, as well as the United States Department of Justice, through its investigation, urged immediate changes to our child welfare system," Bowling said.
"The change in the Bureau for Medical Services' state plan was necessary to ensure that all children in need of behavioral health services receive individualized, evidence-based therapy.
"Since October 2015, numerous meetings have been held where these discussions have taken place.
"The West Virginia Department of Health and Human Resources has been open and transparent throughout this entire process."
The commission also noted in its report that no one from the DHHR attended its day-long meeting to discuss the changes in July. According to Bowling, the DHHR declined to attend the meeting, which included more than 75 participants from several impacted agencies, because it was inappropriate for DHHR to argue its case publicly one day before a Kanawha County circuit court hearing on the changes.
But the commission also took issue with the DHHR's apparent refusal to consult with other involved agencies prior to trying to enact its proposed changes.
According to the commission's report, DHHR did not consult with the JJC, approach the Legislature, consult with the West Virginia Intergovernmental Task Force on Juvenile Justice or the Commission to Study the Residential Placement of Children, or alert the state Department of Education.
"The Juvenile Justice Commission is deeply troubled with the testimony provided at the public forum," the report states. "Furthermore, the Commission has taken note that the Department of Health and Human Resources has been provided many opportunities and invitations to explain the aforementioned changes and has refused to do so, seemingly taking the position that no explanation is warranted to the judiciary, providers, educators, and families, among others."
The Juvenile Justice Commission's report called the DHHR's proposals for its residential placement model a "unilateral attempt" to make changes that impact, and potentially violate, state law.
According to the report, Senate Bill 393, passed in 2015, may be impacted by the proposed changes, and that the proposed introduction of a computerized matrix for child placements could impact the role of the multidisciplinary treatment teams tasked by state statute with evaluating individual children's needs.
The matrix could also impact a provider's ability to accept and discharge children from their facilities, according to the report.
Nancy Exline, commissioner for the Bureau for Children and Families, said the matrix is not a new concept, but was developed in 2012 for the Commission to Study Residential Placement of Children as a means to provide information regarding residential providers.
"The matrix will be a tool to ensure workers will match the needs of the youth to the residential treatment provider," Exline said. "The information within the matrix includes location of the facility, number of beds, ages, gender, area of focus for treatment and services, and defines the evidence-based programming or programming used with evidence. This will allow the worker and [multidisciplinary treatment team] to ensure children are placed in the setting that will focus on the individualized needs of the youth."
The Supreme Court has placed a stay on the DHHR's proposed changes, and the agency has until Thursday to file a response.
"We respect the concerns of the judiciary and will continue to collaboratively work with them to improve the child welfare system in West Virginia," Bowling said. "The DHHR will honor the stay issued by the West Virginia Supreme Court of Appeals and is hopeful that the Supreme Court will ultimately rule in the Department's favor."
Reach Lydia Nuzum at lydia.nuzum@wvgazettemail.com, 304-348-5189 or follow @lydianuzum on Twitter.