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Sunday, November 18 , 2018, 5:11 am | Fog/Mist 51º


Supervisors Get Glimpse Inside Mental Health Department

Fiscal challenges include a rising number of uninsured patients and a complicated billing/payment system with the state

The Santa Barbara County Board of Supervisors and the public got a glimpse and an annual update Tuesday into the county’s Alcohol, Drug and Mental Health Services Department.

It’s a department mired in years of bad billing practices, and only now seems to be making headway.

ADMHS is facing more challenges, too, with more uninsured people needing treatment. The department saw the number of uninsured patients increase to 38 percent in 2008-09, up from 29 percent the year before. And the governor’s 2010-11 budget calls for additional cuts for mental health departments.

Last year, the county department served about 2,900 children, 5,800 adults and 4,700 clients in alcohol and drug prevention, and has adopted an expenditure budget this year of $76 million.

Tom Alvarez, assistant finance director of ADMHS, on Tuesday walked county supervisors through the basics of why billing has been such a challenge during the past decade.

He said clients come in with Medi-Cal, private insurance or no insurance. Services are performed and bills are submitted to the state, and the state decides whether to accept the service units nearly three months after services are provided.

By the time ADMHS gets paid, it has been about six months since the original service was rendered, Alvarez said.

At the end of each year, the department looks at all of the services it has provided to clients. The department submits that bill to the state, and a year later, the department reconciles those units with the state’s records, which don’t match up many times.

“They have their own records, we have our own records,” Alvarez said. “Theoretically, we would be in sync. Practically speaking, I think that’s a big problem for all counties that that doesn’t actually happen.”

Six months later, the state pays the department or the department pays the state, depending on who owes money.

Confused yet? Even more murky is how much to charge.

In the example Alvarez gave Tuesday, the department calculates a rate in 2008, yet “we don’t know the exact amount of that service until 2014,” after the books are audited, which occurs every five years.

“You’ve got a full six years before you know what you’re getting paid,” he said. “If you think about that one fact, that’s what makes our process so difficult.”

Unlike most businesses, which know how much they’ll be paid for their services, ADMHS may have six years before it knows how much it has earned.

Now, ADMHS is quarterly revising its rates so they reflect current conditions, which help keeps those updated and be of benefit to the department, Alvarez said.

The state is in the process of updating its data system so that Medi-Cal information can be received more quickly.

Just in case, Alvarez recommended that $2 million be set aside for reserves in case a large settlement comes through.

The department doesn’t turn anyone away for service, he said, and many times, indigent people seeking services can’t pay.

They’re treated, but the department isn’t paid back, even though it’s mandated — by the state — to provide some services. People who don’t qualify for Medi-Cal are treated, but the money comes from county realignment funds or the general fund.

“General funds are very challenged,” Alvarez said. “We’re watching that very closely.”

Adding to the billing confusion was a computer snafu when the department converted to a new IT system in 2007.

“The conversion did not go well, to say the least,” ADMHS Deputy Director Marianne Garrity said.

The department spent countless hours to get it up and running, and though officials are confident in it going forward, they’re also looking to conduct an external review of the IT system.

The department closed its 2008-09 budget in line, after some severe cuts, and officials said they’re also closely monitoring contracts going forward — more so than in years past.

“What assurance can you give this board that the errors of the past will not be replicated?” asked Supervisor Joe Centeno, who went on to ask why many of the improvement measures haven’t been looked at until now.

ADMHS Department Director Ann Detrick said the complications of the billing may not have been fully understood in the past.

“I really can’t speak for the past,” she said. “I’m just trying to get things fixed now, and what we’ve tried to do today is tell you how we’re doing that.”

Noozhawk staff writer Lara Cooper can be reached at .(JavaScript must be enabled to view this email address).

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