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October 21, 2009

Attorney: Autism not fully funded

Lawyer threatens suit alleging consortium is failing to provide adequate services.

By Terrie Morgan-Besecker tmorgan@timesleader.com
Law & Order Reporter
Terrie Morgan-Besecker on Facebook   |   @TLTerrieMorgan on Twitter

An attorney representing parents of autistic children is threatening to file a federal lawsuit against several counties, including Luzerne, that utilize a health care consortium he alleges is failing to provide adequate services to the children.

Attorney Edmond Tiryak of Wayne on Tuesday released a letter he wrote to commissioners that outlines concerns with the Northeast Behavioral Health Care Consortium, a nonprofit organization that coordinates the delivery of mental-health and substance-abuse services for Medicaid patients in Luzerne, Wyoming, Lackawanna and Susquehanna counties.

Tiryak’s allegations focus on the consortium’s handling of services for autistic children and those with serious mental-health issues who are seeking behavioral counseling. He said there are about 2,100 children, roughly half of whom are autistic, who receive behavioral health services through the consortium at any given time.

Tiryak said data he obtained from the state Department of Public Welfare show that over the past three years the consortium has failed to provide 1.7 million hours worth of services it had authorized for those children.

That’s in spite of the fact the consortium was “awash in cash,” Tiryak said.

Income-tax returns filed by the consortium show it had a $4.7 million fund balance at the beginning of 2008. That grew to just more than $7 million by the end of that year. The increase was aided by a significant increase in funding, which nearly doubled from $55.2 million in 2007 to $110.7 million in 2008.

Jim Gallagher, executive director of the consortium, said Tiryak is focusing on only a small section of the services the consortium oversees. Overall, the organization has had great success, including the development of new treatment models that have proven highly successful.

Gallagher also defended the consortium’s fund balance, saying the state Insurance Department requires it maintain a contingency and risk fund. That fund is supposed to be $23 million, he said.

The consortium was formed by commissioners in the four counties in 2006 with the belief it would allow the counties to provide mental-health and substance-abuse services more efficiently, said Joseph DeVizia, director of human services for Luzerne County. Funding from the federal Medicaid program is deposited with the consortium, which authorizes payment for treatment provided by dozens of service providers.

DeVizia, who sits on the consortium’s board, said he also believes the organization has been highly successful. He acknowledged there have been concerns raised regarding some areas of service, particularly the Therapeutic Support Staff (TSS) program. The program, which provides counselors who work one-on-one with clients, is highly utilized for autistic children.

Tiryak said the main problem is providers have been unable to recruit qualified people for TSS positions because the consortium reduced the rate it pays providers for the services from $30 to $28 per hour. The TSS counselor is paid a portion of that, with the rest remaining with the provider.

Tiryak, who also represents one of the service providers impacted by the cuts, said the lack of personnel to fill the positions means the service is not being provided in all cases in which it’s deemed necessary.

“They are not getting these kids the services that everyone agrees they are supposed to get,” he said.

DeVizia agreed the rate reduction has made it more difficult to recruit and retain TSS workers. He said that decision was made, in part, because of the high cost associated with the program.

“TSS was a real issue. Expenditures were very high,” DeVizia said. “We were advised … to look at the rate and it was reduced. They thought that by reducing the rate, it would help manage it because maybe people would not use it as much.”

DeVizia and Gallagher said there are other treatment models in use that have proven to be equally or more successful with most categories of clients.

“TSS involves staff with a bachelor’s level degree who stay with kids in school four to five hours a day. They are not trained clinicians doing therapy. It’s more behavioral monitoring,” Gallagher said. “We feel we need to meet clients’ needs more strongly than we can through TSS workers.”

Gallagher acknowledged those other treatment models have not proven as successful for autistic children, who do require the one-on-one care provided by TSS workers.

While disagreeing with Tiryak regarding the gravity of the situation, DeVizia said he agrees the consortium needs to revisit the issue of TSS services.

“We’re trying to change models to have less emphasis on TSS, but in the meantime we don’t want to hurt those who need TSS,” DeVizia said. “We need to closely look at, can we do anything and to what degree can we do it?”

Tiryak said he has about eight parents who are considering filing suit against the counties. He said he’s willing to work with the consortium and commissioners to try to resolve the concerns, but is prepared to file the suit soon if there is no progress.

Gallagher and DeVizia they’re also willing to discuss the concerns and hope the matter can be resolved without litigation.

“We are certainly open to resolving this without a federal lawsuit. No one wins with a lawsuit,” Gallagher said.

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