The Arizona Department of Child Safety is going head to head with Cenpatico Integrated Care over the insurance companyβs denial of residential sex offender treatment for a Tucson teenager in state custody.
Advocates for the 16-year-old boy β including his father, a Pima County Juvenile Court judge, the boyβs DCS caseworker and his doctor at the Texas care facility β 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.
βThis is the one thatβs worked for him. I know San Marcosβ medical team believes he needs to finish the program,β 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 Cenpaticoβs denial. Juvenile Court Judge Patricia Green ordered Thursday that the boy will stay at San Marcos in the meantime, as βit is in the best interest of the child and the community to complete treatment at San Marcos.β
By corporate policy, Cenpatico canβt comment on any individual memberβs case, even if the family gives permission, said spokeswoman Maribel Barrios-Quezada.
At the hearing, Cenpatico attorney Joshua Ernst told the judge, βCenpaticoβs position, first and foremost, is always to provide medically necessary services.β
He said he couldnβt explain the reasons for Cenpaticoβs denial, as that information should come from childrenβs 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 β unlike Level 1 β 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 boyβs DCS caseworker, Lori Leon, told the judge.
βWe want Cenpatico to pay, because we believe he needs this level of care,β 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.
βThereβs no plan for continuity of treatment. Thatβs dangerous and irresponsible,β 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 teenagerβs 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 Countyβs former RBHA, the nonprofit Community Partnership of Southern Arizona, or CPSA.
βI donβt want to say we never had these issues with CPSA, but they were uncommon,β lawyer Zinman said. βWeβre starting to see it a lot more frequently than it ever was.β
βIβve been doing this for almost 20 years, and I have never seen the system respond in this way, where theyβre just saying, βWeβre not going to pay,βββ said Thea Gilbert, a contract attorney with Juvenile Court. She is representing the boyβs father in a related dependency case and has represented hundreds of families in child-welfare cases.
The boyβs treatment at San Marcos should continue in the interest of public safety, Paul Lauritzen of the Pima County Attorneyβs Office said at the hearing. The office is prosecuting the boyβs juvenile delinquency case and was advised of Cenpaticoβs denial by his probation officer.
βI speak on behalf of the community, and the community needs to make sure we donβt have an adult sex offender,β 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 wasnβt removed from San Marcos before an appeals process could begin.
The teenager in this case is lucky heβs in DCS custody, Zinman said. Otherwise, it would be up to his family to appeal Cenpaticoβs decision, and if the family lost, it couldnβt 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 Cenpaticoβs 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 itβs 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 Cenpaticoβs denial of coverage for Level 1 residential treatment.
βTheyβre a for-profit agency,β he said. βItβs our concern that, rather than funding necessary services, to save some money, theyβre not funding them.β
Cenpatico CEO Terry Stevens has told the Star she doesnβt 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 doesnβt mean Cenpatico would never approve Level 1 treatment if medically necessary.
Stevens, who has 30 yearsβ 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.
βItβs juvenile prison. Iβve been up there, and itβs a horrible place,β he said. βThe Pima County bench is good about keeping most of our kids away from there.β
βA DIFFERENT PERSONβ
In Texas, the teenager is thriving, his father said.
βHe sounds like a different person when I talk to him,β he said. βHeβs learning coping skills.β
The teenager has been in treatment for seven months and is scheduled for discharge in July, which is a few months early because heβs doing so well, his father said. That makes Cenpaticoβs denial even harder to understand, he said.
San Marcos has a waiting list and doesnβt need to keep the boy longer than necessary, said Gilbert, the attorney with Juvenile Court representing the boyβs father.
She questioned how Cenpatico officials could disagree with the San Marcos facilityβs assessment when they havenβt even met the boy.
βHow did they determine medical necessity when theyβre doing a paper review, but the treatment center is saying, βHey, we need him to stay longer?βββ she said.
The community should be βup in armsβ about Cenpaticoβs denials of services and shifting of costs to DCS and individual families, she said.
βIf we donβt 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,β she said. βIf these kids donβt get treatment when theyβre teenagers, they donβt ever learn to address those urges and those behaviors. Then they become adults and will continue to victimize.β
