State fighting Cenpatico's denial of Level 1 treatment for juvenile sex offender

The Arizona Department of Child Safety is going head to head with Cenpatico Integrated Care over the insurance company’s denial of residential sex offender treatment for a Tucson teenager in state custody.

Advocates for the 16-year-old boy — including his father, a Pima County Juvenile Court judge, the boy’s DCS caseworker and his doctor at the Texas care facility — say the residential treatment is necessary and should not be abruptly cut off.

Last month, Cenpatico said it will no longer pay for the teen to finish at the San Marcos Treatment Center in Texas, deeming it not medically necessary.

The Level 1 residential treatment center specializes in sexual-behavior problems for boys and has been the first place where the boy has succeeded since he was taken into DCS custody in 2014, his attorney said.

“This is the one that’s worked for him. I know San Marcos’ medical team believes he needs to finish the program,” said defense attorney Tony Zinman during a Thursday hearing, held at the Pima County Juvenile Court. Zinman represents the boy in the delinquency case stemming from his history of sexually molesting minors.

The DCS is formally appealing Cenpatico’s denial. Juvenile Court Judge Patricia Green ordered Thursday that the boy will stay at San Marcos in the meantime, as “it is in the best interest of the child and the community to complete treatment at San Marcos.”

By corporate policy, Cenpatico can’t comment on any individual member’s case, even if the family gives permission, said spokeswoman Maribel Barrios-Quezada.

At the hearing, Cenpatico attorney Joshua Ernst told the judge, “Cenpatico’s position, first and foremost, is always to provide medically necessary services.”

He said he couldn’t explain the reasons for Cenpatico’s denial, as that information should come from children’s medical director Dr. Tatyana Farietta-Murray, who was not present.

Zinman said Cenpatico recommended the boy return to Tucson for treatment at a Level 2 facility, which — unlike Level 1 — does not offer round-the-clock supervision in a locked-down facility.

If all appeals are exhausted and the denial stands, DCS may have to pay for any treatment that continues past May 16, when Cenpatico intends to cut off funding. The court does not have the power to order Cenpatico to pay for services, but DCS maintains that Cenpatico should pay.

The San Marcos center submitted a letter to DCS saying the boy should finish his treatment, which will end in July, the boy’s DCS caseworker, Lori Leon, told the judge.

“We want Cenpatico to pay, because we believe he needs this level of care,” Leon said.

To leave early would be a major setback for the boy, said his father, whom the Star is not naming because his name would identify his son.

“There’s no plan for continuity of treatment. That’s dangerous and irresponsible,” he said.

DISPUTES MORE COMMON

Disputes over coverage denials have become more common since Cenpatico took over as the regional behavioral-health authority, or RBHA, in Southern Arizona, said Zinman, the teenager’s defense attorney.

In Arizona, RBHAs administer and pay for public behavioral-health services for adults and children, as well as medical care for adults with serious mental illness. In October 2015, Cenpatico replaced Pima County’s former RBHA, the nonprofit Community Partnership of Southern Arizona, or CPSA.

“I don’t want to say we never had these issues with CPSA, but they were uncommon,” lawyer Zinman said. “We’re starting to see it a lot more frequently than it ever was.”

“I’ve been doing this for almost 20 years, and I have never seen the system respond in this way, where they’re just saying, ‘We’re not going to pay,’ ” said Thea Gilbert, a contract attorney with Juvenile Court. She is representing the boy’s father in a related dependency case and has represented hundreds of families in child-welfare cases.

The boy’s treatment at San Marcos should continue in the interest of public safety, Paul Lauritzen of the Pima County Attorney’s Office said at the hearing. The office is prosecuting the boy’s juvenile delinquency case and was advised of Cenpatico’s denial by his probation officer.

“I speak on behalf of the community, and the community needs to make sure we don’t have an adult sex offender,” he said.

Lauritzen said his only role in this case was to file the motion for an expedited hearing, which was necessary to get the issue before a judge quickly. That was important to ensure the boy wasn’t removed from San Marcos before an appeals process could begin.

The teenager in this case is lucky he’s in DCS custody, Zinman said. Otherwise, it would be up to his family to appeal Cenpatico’s decision, and if the family lost, it couldn’t afford to keep him at the San Marcos facility, he said.

PATTERN OF DENIALS

The conflict comes on the heels of a similar Tucson case, which the Star reported last month. Tucson residents Vivian and Don Bacon appealed Cenpatico’s denial of Level 1 residential treatment for their son. After losing the appeal, the couple filed a petition in April to give up custody of their son as a last-ditch effort to force Cenpatico to justify its denial before a juvenile court judge. The couple believes it’s the only way to get their son the help that numerous behavioral-health providers recommend.

Since they now have an open dependency case, the Bacons can no longer discuss the situation publicly, their attorney said.

Zinman said he has another juvenile case coming up this week involving Cenpatico’s denial of coverage for Level 1 residential treatment.

“They’re a for-profit agency,” he said. “It’s our concern that, rather than funding necessary services, to save some money, they’re not funding them.”

Cenpatico CEO Terry Stevens has told the Star she doesn’t believe in institutionalizing children in Level 1 residential treatment centers, which have fallen out of favor locally and nationwide amid oversight problems and instances of harm to children. But Stevens has said that doesn’t mean Cenpatico would never approve Level 1 treatment if medically necessary.

Stevens, who has 30 years’ experience as a child and family therapist, says in the vast majority of cases, a less-restrictive placement is far better for the health of a child and their long-term success. Cenpatico is bolstering intensive, wrap-around service options for families, as well as community-based alternatives to keep children at home, or at least near home.

The Pima County Juvenile Court is on board with efforts to keep children in the least-restrictive setting possible, Zinman said in an interview. But for minors with severe behavioral problems, and who truly need oversight 24 hours a day, the only alternative to Level 1 residential care is the Maricopa County juvenile corrections facility, he said.

“It’s juvenile prison. I’ve been up there, and it’s a horrible place,” he said. “The Pima County bench is good about keeping most of our kids away from there.”

“A DIFFERENT PERSON”

In Texas, the teenager is thriving, his father said.

“He sounds like a different person when I talk to him,” he said. “He’s learning coping skills.”

The teenager has been in treatment for seven months and is scheduled for discharge in July, which is a few months early because he’s doing so well, his father said. That makes Cenpatico’s denial even harder to understand, he said.

San Marcos has a waiting list and doesn’t need to keep the boy longer than necessary, said Gilbert, the attorney with Juvenile Court representing the boy’s father.

She questioned how Cenpatico officials could disagree with the San Marcos facility’s assessment when they haven’t even met the boy.

“How did they determine medical necessity when they’re doing a paper review, but the treatment center is saying, ‘Hey, we need him to stay longer?’ ” she said.

The community should be “up in arms” about Cenpatico’s denials of services and shifting of costs to DCS and individual families, she said.

“If we don’t care about kids in foster care globally, as a society, you should care about them specifically because your children are in the community with these kids,” she said. “If these kids don’t get treatment when they’re teenagers, they don’t ever learn to address those urges and those behaviors. Then they become adults and will continue to victimize.”