Contract Dispute Could Threaten Quality Of Mental Health Care In Kansas

Jul 12, 2016

A contract dispute between a state agency and a research center at KU could affect the quality of care at community mental health centers across Kansas.

What appears at first blush to be little more than a contract dispute between a state agency and a University of Kansas research center is actually much more than that.

The state’s failure to renew a contract with the KU Center for Mental Health Research and Innovation is another assault on the state’s mental health system, according to the directors of several community mental health centers.

The CMHC directors say the loss of training and quality assurance services that the KU center provided will make it harder for them to provide evidence-based treatment and track the difference they’re making in the lives of Kansans with mental illnesses.

“You have to have services that are evidence-based,” says Tim DeWeese, executive director of the Johnson County Mental Health Center. “The people at the KU center, through their expertise, have helped community mental health centers provide good-quality services that are evidence-based.”

DeWeese says he was “shocked and disappointed” when he heard that the Kansas Department for Aging and Disability Services was not going to continue a collaboration with the KU center that dated to the late 1980s.

“This is one more policy decision that unfortunately will have a negative impact on community mental health in Kansas,” he says. “Without the KU center, I’m not sure how the state plans to ensure that we continue to maintain the quality of our services.”

The $2.4 million contract proposed by the KU center would have been funded entirely by Medicaid dollars provided by the federal government to match a commitment by the university to dedicate faculty and staff time of roughly equal value. The state’s role was to act as a fiscal agent for the federal money and to administer the contract.

Randy Callstrom, CEO of the Wyandot Center for Community Behavioral Healthcare Inc. in Kansas City, Kan., says his center also would be challenged to maintain the quality of some services without the KU program.

“We don’t know how we’re going to deal with it,” Callstrom says, noting that CMHCs using evidence-based treatments can qualify for higher reimbursements. “Our staff is quite anxious about it.”

Take it or leave it

Contract negotiations between KDADS and the KU center broke down when center officials reluctantly concluded that they couldn’t accept what amounted to a take-it-or-leave-it offer from the state.

Rick Goscha.

The final offer came from Brad Ridley, head of the KDADS budget and financial services division, in an email to Rick Goscha, director of the KU research center, sent at 12:01 p.m. Thursday, June 30, the day before the contract deadline and the start of the state’s 2017 budget year. It gave Goscha two hours and 29 minutes to review a set of final terms that would have required the center to scrap the KU-approved work plan it had submitted in March and agree to provide a limited set of services to be negotiated later at a reduced hourly rate.

“Their last-minute offer was not a viable option,” Goscha says. “They wanted us to agree to a contract with no work plan in place and no direction on work that they wanted to do or not do.”

In addition, he says, the offer included a reduction in funding that would have required him to lay off half of the center’s staff.

“When I asked them, ‘Well, who should I keep and who should stay based on what (work) criteria?’ they had no answer for that,” Goscha says.

In the weeks leading up to the deadline, he sent a series of increasingly desperate emails to KDADS officials seeking a resolution to the contract dispute.

“The work of this contract is built on trust,” Goscha wrote on June 23, noting that in 2013 Republican Gov. Sam Brownback had trusted him enough to put him in charge of a task force formed to develop recommendations for improving the state’s mental health system.

“Our contract is almost entirely structured to carry out multiple recommendations contained within the final report of that task force,” he wrote. “I don’t know how much more we can be aligned with the priorities of this administration.”

Goscha wrote that while he was willing to discuss transitioning to an hourly rate structure in a future contract, such a significant change couldn’t be accomplished only days ahead of the deadline to have a fiscal year 2017 agreement in place.

The loss of the KDADS contract forced Goscha to lay off 12 of the center’s 15 staff and all six students working on the project. He says he also soon must return a separate “supported living” grant to KDADS and close the center.

‘Good faith’ offers

Angela de Rocha, a media spokesperson for KDADS, says the agency made “three good faith offers” to the KU center in the days leading up to the contract deadline.

The first two were made during a meeting on Wednesday, June 29. Each would have required the KU center to fund itself while negotiations continued on the agency’s proposal to restructure the contract. That shouldn't have been a stumbling block, de Rocha says, given that Goscha had more than $1 million in unspent funds from a 2016 contract that totaled $3.8 million.

However, Goscha maintains that he didn’t have the “cost-share match” needed to continue the project past June 30.

“If I had the cost-share match I would have done that in a heartbeat,” Goscha says. “I didn't want to let all my staff go. But I had been telling them (KDADS) since January that we couldn’t accept a no-cost time extension.”

Goscha says tens of millions of dollars in cuts sustained by the university because of the state’s ongoing revenue and budget problems also complicated the negotiations. He says a hiring freeze instituted by the university prevented him from replacing a key researcher after she left for a job in another state. The agency’s desire to restructure the contract also was problematic.

From the state’s perspective, changes were needed to ensure that federal Medicaid money was being spent appropriately, de Rocha says.

“We had some issues with some of the elements of the way the contract was being administered,” de Rocha says. “The way the contract worked before is we gave them money and they just did things. We wanted to devise a work plan based on the agency's needs.”

Pressed for details, de Rocha said in an email, “Suffice to say KDADS funds were being used to pay for some things that were not directly related to KDADS tasks/projects.”

The concerns had nothing to do with the center’s work, de Rocha says, adding that the breakdown in negotiations was “a very disappointing experience for us.”

“We had hoped to continue to work with them,” she says.

Goscha says it didn’t feel that way on his side of the negotiating table. When the third and final offer was made, he said agency officials “had to know” he didn’t have the authority to approve something that university officials hadn't had a chance to review.

“And there is no way the university would have approved a contract that basically said ‘to be determined,’” he says.

Real-life consequences

The KU center is internationally known for its work developing, implementing and tracking the effectiveness of the “strengths model” of treating people with severe mental illness.

Ally Mabry.

The model is designed to help therapists and counselors focus on helping people accomplish self-determined goals. When treatment teams use the model properly, it can transform lives, says Ally Mabry, a social worker and director of evidence-based practices at the KU center.

“We’re going to help you get a handle on your illness and we’re also going to focus on what you want to do with your life,” Mabry says. “Do you want to work? Do you want to go back to school? Whatever it is, we’re going to be highly goal-focused with you. We’re going to look at what you have, not what you don’t have. And we’re going to build on success with you.”

Data compiled by the center to document results show that community mental health centers using the strengths model correctly are achieving better outcomes. Fewer of their patients require hospitalization and more of them live independently, pursue post-secondary education and maintain jobs.

In the nine years she has been at the KU center, Mabry says she has worked with front-line providers at many of the state’s 26 community mental health centers. A lot of that work has been aimed at refining the model and ensuring that treatment teams at the CMHCs are using it correctly by grading them with a tougher new “fidelity scale,” Mabry says.

“This scale does not allow a center to just do this practice at a minimal or moderate level,” she says. “To meet fidelity, you really have to perform at an extremely high level. We’re seeing so much change, it’s really an exciting time.”

Or, at least it was. The prospect of seeing three decades of work with community mental health centers come to an end is “heartbreaking,” Mabry says.

The thought left both Mabry and Goscha fighting back tears.

“You can’t even imagine what this feels like,” says Goscha, who managed a treatment program for homeless people in Wichita before joining the KU center in 1999.

“All of my focus has been on improving the lives of people with serious mental illness in Kansas,” he says. “So, the thought that the state would make a decision that basically says that is no longer valued is absolutely crushing.”

It is valued, said KDADS Secretary Tim Keck in a letter sent last week to CMHC directors.

“It has never been the agency’s intention to discontinue using EBP (evidence-based practices)” Keck wrote. “Our program staff is working to identify the essential tasks that are required to be carried out to provide the most effective services to mental health consumers as a part of Medicaid and the most effective way to accomplish those tasks in the future. KDADS looks forward to continuing to work with our CMHC partners on this important part of our work.”