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This report addresses the reasons why people
referred for behavioral health services from other agencies do not always
receive these services. We found that several factors appear to cause such
service denials. First, we found that disputes over the medical necessity of
services and agency roles in serving clients with special needs often contribute
to interagency disagreements. Second, some officials incorrectly believe some
services, particularly substance abuse services, are not available to all
entitled clients. Confusion also exists over whether clients referred by other
agencies are actually enrolled in entitlement programs. Finally, services may
not be rendered because some are simply unavailable, especially for disruptive
clients or for clients living in rural areas. We offer several recommendations,
ranging from clarifying existing policies to transferring the administration of
behavioral health services for developmentally disabled ALTCS clients, to help
diminish interagency disagreements and improve access to needed services.
This report also recommends that the Division
of Behavioral Health Services play a greater role in providing treatment for
Medicaid-eligible juvenile sex offenders on parole or probation, and
Medicaid-eligible juveniles who are removed from prison for behavioral health
treatment. Such a shift in service provision could help the State save money
since Medicaid dollars are largely provided by the federal government.
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