Wednesday, September 19 , 2018, 6:19 pm | Fair 69º

 
 
 
 

Local News

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).

Support Noozhawk Today

You are an important ally in our mission to deliver clear, objective, high-quality professional news reporting for Santa Barbara, Goleta and the rest of Santa Barbara County. Join the Hawks Club today to help keep Noozhawk soaring.

We offer four membership levels: $5 a month, $10 a month, $25 a month or $1 a week. Payments can be made using a credit card, Apple Pay or Google Pay, or click here for information on recurring credit-card payments and a mailing address for checks.

Thank you for your vital support.

Become a Noozhawk Supporter

First name
Last name
Email
Select your monthly membership
Or choose an annual membership
×

Payment Information

Membership Subscription

You are enrolling in . Thank you for joining the Hawks Club.

Payment Method

Pay by Credit Card:

Mastercard, Visa, American Express, Discover
One click only, please!

Pay with Apple Pay or Google Pay:

Noozhawk partners with Stripe to provide secure invoicing and payments processing.
You may cancel your membership at any time by sending an email to .(JavaScript must be enabled to view this email address).

  • Ask
  • Vote
  • Investigate
  • Answer

Noozhawk Asks: What’s Your Question?

Welcome to Noozhawk Asks, a new feature in which you ask the questions, you help decide what Noozhawk investigates, and you work with us to find the answers.

Here’s how it works: You share your questions with us in the nearby box. In some cases, we may work with you to find the answers. In others, we may ask you to vote on your top choices to help us narrow the scope. And we’ll be regularly asking you for your feedback on a specific issue or topic.

We also expect to work together with the reader who asked the winning questions to find the answer together. Noozhawk’s objective is to come at questions from a place of curiosity and openness, and we believe a transparent collaboration is the key to achieve it.

The results of our investigation will be published here in this Noozhawk Asks section. Once or twice a month, we plan to do a review of what was asked and answered.

Thanks for asking!

Click Here to Get Started >

Reader Comments

Noozhawk is no longer accepting reader comments on our articles. Click here for the announcement. Readers are instead invited to submit letters to the editor by emailing them to [email protected]. Please provide your full name and community, as well as contact information for verification purposes only.

Daily Noozhawk

Subscribe to Noozhawk's A.M. Report, our free e-Bulletin sent out every day at 4:15 a.m. with Noozhawk's top stories, hand-picked by the editors.

Sign Up Now >