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'Stuck kids'
at root of lawsuit
(July 2005
Issue)
By Phyllis Hanlon
In Oct. 2001, nine plaintiffs ages five to 16 filed a lawsuit,
now known as Rosie D. vs. Romney, that alleges Massachusetts officials
failed to provide comprehensive and medically necessary behavioral
health treatment mandated under federal Medicaid legislation. This
April, that lawsuit came to trial.
David Matteodo, executive director of the Massachusetts Association
of Behavioral Health Systems, was called to testify at the trial.
He says that the Commonwealth has made some strides in moving children
into community-based acute treatment services. "However, there is
still an average 70 kids stuck in the hospital for many days, weeks
and months," he says. "It is not good clinically for kids who don't
require an acute level of care to remain hospitalized." Inpatient
care continues to be expensive, in spite of increased reimbursement
from the state and Matteodo says that hospitals have consistently
advanced the position of moving children into community-based and/or
home care.
Frank Laski, executive director of the Mental Health Legal Advisors
Committee (MHLAC), points out that statewide efforts to move children
into community-based services is laudable, even though some individuals
still wait inordinate amounts of time for residential, foster or
home care. He cites the decrease in the number of "administratively
necessary days," a term the state applies to pediatric inpatient
length of stay and says that Massachusetts has streamlined the
process between discharge and admission to a residential facility.
"But there is some fluctuation in the numbers and the decrease
in the number of days. This is still a major problem," Laski says.
"At one time there were between 120 and 130 stuck kids. There is
still an indication that there is a tremendous overuse of hospitals
and residential facilities. Our primary goal is to have the state
provide statewide home-based services for kids who are mentally
disturbed through Medicaid."
According to the Rosie vs. Romney lawsuit, Rhode Island, Vermont,
Maine and Connecticut currently fund community and home-based services
as an integral part of their Medicaid programs. These programs include
a variety of services such as trained behavioral staff for home,
school and after-school settings on an as needed basis; psychiatric
and clinical support; professional assessments and crisis intervention,
treatment and case management that allow children to remain in the
home environment.
Massachusetts falls behind these states, although it has implemented
two pilot programs that address pediatric behavioral health needs.
A new initiative, Coordinated Family Focused Care, serves 50 children
in Springfield, New Bedford, Brockton, Lawrence and Worcester. The
grant-funded Mental Health Special Program for Youth was launched
in 1998 and serves 70 children in Cambridge, Somerville, Malden,
Medford and Everett. Laski cites dual benefits of these programs.
"They prevent hospitalization and provide step-down opportunities,"
he says.
He says that these programs are based on the Milwaukee wraparound
model. "We are looking for state agencies and Medicaid to organize
their services to provide intensive services without going into
the hospitals," he says. Children in the state's 341 communities
without programs must depend on the Massachusetts Behavioral Health
Partnership for appropriate services.
According to Laski, the trial was expected to continue through
the first week of June. "That's the period when the judge gets the
post-trial submissions," he says. "We expect a decision before the
summer is over." Plaintiffs anticipate expanded home-based behavioral
health services statewide as a result of the trial.
In addition to attorneys from MHLAC, lawyers from the Center for
Public Representation and the private law firm of Wilmer Cutler
Pickering Hale and Dorr LLP are representing the plaintiffs in this
case.
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