Fayette County Mental Health Care Meltdown
Ask anyone who was around working in the field of community mental health in the mid-1990s why this county
opted to manage its own medicaid mental/behavioral health care monies, rather than let the state continue to mind
the store. Two reasons are quickly rattled off and given.

First and foremost, there was that dangling carrot of being able to boost revenue by being able to keep a small
percentage of "profits" from unused funds for hospitalizations and psychiatric care. That small percentage,  now

The second reason, as vividly recalled recently by quite a few people in that audience that day listening to an
administrator rant about a specific psychologist, who made in excess of $300,000 the previous year. He branched
out with in-home "wraparound" services for children with behavioral challenges.

"That will never happen again!" she exclaimed, vowing to be able to control what private practice professionals
would be able to earn.  A few commissioners' signatures on a 1998 contract later, managed behavioral health care
in Fayette County was then born.

That really is how we got here, folks. Money.

Now, all of a sudden, after coming from open talk at stakeholders meetings and budget information flowing
freely, what we pay hospitals is a big, fat secret.  Says who?

Last Friday, Commissioner Angela Zimmerlink said that she attended a meeting that she tried to arrange with the
director of the county behavioral health deparment and fellow commissioners. Due to the absence of the
department head, the commissioner met alone with that department's Chief Financial Officer.

CFO Harry Franks is a decent man. He so unlikely created the "confidential" status of rates or amounts public
funded entities pay for medicaid recipients for inpatient hospital treatment. Is this coming from the Department of
Public Welfare? We're not asking how much it costs for a specific, named medicaid recipient to receive inpatient
care. Just how much this and that hospital receives for payment.

Of the meeting with Franks, Zimmerlink said that she asked a series of questions that she will confirm the
answers with DPW.

"One question was the difference in rates between the two hospitals, and I was told the amount, but also told it
was confidential," Zimmerlink said. She finds that to be "questionable."

Earlier today, Zimmerlink also commented openly on the contract which was released to media last week:

"Last week I was given a copy of the agreement between the County & VBH.  It was a 1998 redacted agreement
which I found odd that it was redacted given 3 commissioners had signed it.  Therefore, at the July 27th mtg I
inquired as to amendments and was told there were amendments.  When I received the amendments through 2012
those too were redacted.  Again, odd given commissioners had signed them.  I will yet again request complete
information, this being the 3rd time."

One would think that a contract for tens of millions of dollars of annual services and all its subsequent
modifications and addendums would read and appear not so strangely composed and pieced together.

We know what she means. The Right To Know Law response that this column received today to receive the
2012 contract modifications consists of 14 pages of legal contract mumbo jumbo and is referenced as "The Ninth
Amendment To Amended Agreement." Dollar amounts are blackened out in a few places on it was well as the
contract received last week.

While Commissioner Zapotosky this morning spoke of approximate rates, this column did not publish those --
and still won't because he did not have exact figures in front of him to quote. He did confirm that the
Connellsville hospital is paid less than the Uniontown hospital is for inpatient psychiatric care, as previously
reported this morning in Rants&Raves.

Zimmerlink said this evening, "Until I receive confirmation from DPW, I will not disclose the two amounts, but
will say I was told Uniontown Hospital receives a higher rate" than the payment rate paid to Highlands Hospital.

So it seems that -- hint, hint -- unless hospital staff in the know drop some information our way, we may never
really know what exactly the hospitals receive as payment.

One other note which seems odd about all this. Well, there are many, but the one we refer to is the behavioral
health department director's two-week absence from work. Eight employees reported this morning that she was
back at work -- which was welcomed news in this morning's Rants.

So Zimmerlink's statement this evening seemed odd.

"The 3 commissioners were informed yesterday that (Lisa Ferris) was off due to a non work related injury until
8-2, subject to change."

Apparently, that, indeed, was "subject to change."

1 Aug 12
copyright protected

(Editor's Note: Though the referenced psychologist was named that day long ago in public, this editor will not do
so online now. It is noted that he employed a small army of staff, served many, many children and did not net
that amount of income for himself alone.)