Community services director says county could see increased revenues to aid substance abuse services
Saturday, February 15, 2020 - 5:36 pm


North Country This Week

CANTON -- The director of the county’s Community Services Department says it is expecting their reimbursement rates for chemical dependency and mental health services to increase.

However, he told the county Board of Legislators services committee on Monday, Feb. 10 that they would need to add 12 to 19 "revenue-generating full-time equivalents" to have a "revenue-neutral budget." That drew criticism from the legislators.

Jay Ulrich, community services director, told the board that at an 84% reimbursement rate from all payers, meaning all forms of insurance plus self pay, they would need to add 19 full-time equivalents (FTEs) to be revenue-neutral. And at 90% reimbursement, they could do that with 12 new FTEs.

"Typically you want to be around 90% reimbursement rate … we're slightly under that," Ulrich said in a phone interview the day after the meeting. "Part of that is because historically the county has not done well at enforcing the co-pays."

He said people with insurance sometimes aren't able to afford their co-payments, and over time it adds up and causes their reimbursement rate to take a hit.

He said Community Services is one of several county departments that operates at an annual cost.

"We're trying to come up with more creative ways and means of collecting those co-pays. Once we change the expectations of the people we're serving, you do have to pay your co-pays … changing that culture and hopefully those numbers will go up," Ulrich said.

Legislator Kevin Forsythe, R-Lisbon, at the services committee meeting told Ulrich that the personnel increase probably won't happen.

"You say we need 19 more employees to become revenue neutral," Forsythe said, "and the waiting list is zero."

"It is," Ulrich replied.

"Can't be done, based on those numbers," Forsythe said.

Legislator Kevin Acres, R-Madrid, suggested booking more clients may be the answer, rather than hiring more people.

"So when you're talking about adding 19 employees at 84% reimbursement, I look at your clinicians in chemical dependency and mental health, if you could raise the number of visits per day, you wouldn't need those employees" to meet the need, Acres said, reading from a document from Ulrich’s office.

During his presentation, Ulrich said one of the challenges his department faces is outdated provider contracts.

Legislator Nance Arquiett, D-Winthrop, asked how seriously they're looking into the outdated contracts.

"So we're accepting less reimbursement than would be allowed?" Arquiett asked Ulrich. "How outdated are those contracts and why has that not been a priority?"

"I don't know how outdated they are," Ulrich asked, adding that his new office manager is "being tasked to look into that."

He said they are in the process of negotiating, or beginning negotiations with, two of the insurance payers.

"Other ones we need to look at, particularly within our top 10 payers … that could take a year, going back and forth to do that," Ulrich said.