Residential Treatment Services (RTCs)
Residential Treatment Centers (RTC) have been a mainstay in New Mexico in the out-of-home treatment of youth with behavioral health disorders. The safety and wellbeing of youth with behavioral health issues have been addressed by RTCs, and the utilization of this service reflects the concerns of many, including judges, social workers, juvenile probation and parole officers, mental health professionals and advocates. With the absence of other treatment resources, RTCs have been the first choice of many individuals for providing treatment to vulnerable youth with behavioral health issues.
Nevertheless, studies have shown that RTC services for youth with behavioral health issues are proportionately over-utilized in New Mexico compared to communitybased treatment. The Behavioral Health Gap Analysis of 2002 made a recommendation to move toward community-based treatment. The Legislative Finance Committee’s 2006 report of the Collaborative recommended a shift of the system from residential to community-based care.
The data from these studies and information from national reports (Surgeon General Report on Mental Health and President’s New Freedom Commission are two major reports) support a system that is fundamentally built upon a community-based model. In New Mexico, the development of more community-based treatment and supports for youth with behavioral health issues is required in order to move toward a lower utilization of residential treatment services and therefore a more balanced service delivery system.
As part of the move toward evidence-based practices and community-based treatment, OptumHealth New Mexico (OHNM), as the statewide entity for behavioral health in New Mexico, has begun to take a closer look at the utilization of residential treatment for children and adolescents and to identify where community-based treatment and support would be a more appropriate clinical decision. The process by which this increased scrutiny is occurring is consistent with Medicaid regulations and is being reviewed in an ongoing process by the Collaborative. In December 2006, VONM began to scrutinize the utilization more closely and the numbers of denials began to increase modestly. VONM has looked at the medical necessity for RTC services in all cases and whether community-based treatment and support would be a more appropriate intervention for each youth in discussion. The expectation of these changes has moved toward a more balanced service array for youth in need of treatment.
A PUBLIC HEARING to receive testimony on the following rules is scheduled for: October 17, 2012 at 9:00 a.m. in the ASD Conference Room, Plaza San Miguel, 729 St. Michael's Drive, Santa Fe, NM