DOJ to Investigate National PRTF Operators
If you have a stake in Louisiana’s residential treatment services, you will be interested in two letters Senator Ron Wyden of Oregon sent to the U.S. Department of Justice this week. Wyden is Chair of the U.S. Senate Finance Committee. During the last two years, this committee investigated the PRTF services of our nation’s largest “operators,” which own or operate PRTFs in many states and have received billions of dollars in Medicaid funds for these facilities.
Senator Ron Wyden released two letters on October 9, 2024, related to the results of the Senate Committee on Finance’s two-year investigation into four Residential Treatment Facility (RTF) operators: Universal Health Services, Acadia Healthcare, Devereux Advanced Behavioral Health, and Vivant Behavioral Healthcare.
In his first letter, Senator Wyden introduces evidence sufficient to ask the U.S. Department of Justice (DOJ) to investigate whether these PRTF providers are committing Medicaid fraud by failing to care properly for Medicaid beneficiaries. This letter is about the PRTF providers’ improper treatment of children.
In a second letter, Senator Wyden asks the DOJ to investigate whether states are violating the civil rights of children by placing them in residential facilities rather than providing access to community-based care. This letter speaks to the partial continua of care among the states, which has led to the overuse of PRTF services.
Senator Wyden writes, “RTFs are intended to provide intensive, short-term inpatient therapeutic services to a diverse group of high-need youth, including those who are a danger to themselves and/or others. Prior to placement in an RTF, children should be able to access a continuum of community-based behavioral health services to meet their needs. Following short-term, intensive residential treatment, children should be able to progress to lower acuity settings, like outpatient care in the community. A continuum of community-based care enables children to receive residential treatment only when all other in-community options fail to meet their needs.”
Wyden is correct. Children receive the best care when a continuum of services is available before and after PRTF care.
Louisiana still lacks the full “continuum of community-based care,” leading to children in DCFS custody (who are a small, representative sample of the larger group of children in Louisiana) lacking the proper level of care for their identified needs. While children in DCFS custody without access to the proper level of care for their immediate needs must be maintained in hotels and office spaces, children in the custody of their parents are invisible in their communities until their behavior becomes outrageous enough to attract public attention.
In my opinion, through intention or happenstance, Louisiana has done a good job of preventing the overuse of PRTF services at the broader level. If anything, Louisiana is too restrictive on PRTF placements for individual children, and Healthy Louisiana struggles to achieve the proper balance. I say this because we nearly always have empty beds and a list of individual children seeking admission with extensive clinical histories who cannot secure authorization. I suppose the opposite side of the coin of overuse is when children need PRTF care but have no access.
Also, Louisiana lacks a full continuum of care, which creates real barriers to children’s mental health. Inadequate provider networks sometimes lead to Managed Care Organizations being unable to fulfill their “Care” role after denying authorization for PRTF services. In my mind, “Care” implies an ongoing obligation and process. However, after it denies authorization for PRTF services, there is little surprise when an MCO secures no alternative treatment or suggests treatment services that are sketchy or do not exist.
Our Methodist Aftercare program struggles to help families secure community-based services after their children are discharged from PRTF care. For example, a community may have outpatient clinicians in a child’s MCO network, but the clinicians or clinics limit their Medicaid hours, which adds weeks or months to the time of the child’s first outpatient treatment.
Senator Wyden’s letters point to real problems that must have solutions. Caring for a child is the heaviest responsibility. On one hand, PRTF operators must provide services of the highest quality and continuously seek improvements. On the other hand, states must provide the required, ideal array of services necessary for the well-being of their children because states share the heavy burden of care for their youngest citizens.
There is no sound argument against providing the best possible care to children, and every argument is for ensuring that Louisiana maintains the child well-being infrastructure necessary for our children, including a robust continuum of mental health services they can access as needed.
Senator Wyden’s press release and letters are available at these URLs:
Letter to Department of Justice regarding RTF Fraud:
https://www.finance.senate.gov/imo/media/doc/doj_letter_rtf_fraud_referral1.pdf
Letter to Department of Justice regarding RTF Civil Rights Violations:
https://www.finance.senate.gov/imo/media/doc/doj_letter_olmstead_referral.pdf
In my opinion,
Rick Wheat
Director
Center for Child Well-being