MASSENA Rose Hill opened in 1987 to provide drug and alcohol rehabilitation services to adolescents regardless of their ability to pay.
And while that philosophy has enabled the facility to help hundreds of youths over the years, it also has made operating in the black a difficult task. Now, the facility is dealing with decreased state aid and insurance companies that are paying only a portion, if any, of the costs associated with treatment.
Rose Hill is owned by Can-Am Youth Services and operated by a board of directors. Joseph D. Gray, board president, said Rose Hill has an operating budget of $2.1 million, while receiving only $229,442 in state aid this past year. Mr. Gray said that is the same amount it has received since 2011.
Other money, he said, comes from Medicaid or insurance reimbursements, with some families paying for their own care. However, Mr. Gray said, those rates are income-based, and while collecting some money is better than receiving nothing, often the payments collected are not enough to cover the facilitys expenses.
We may have people paying $40 a month for treatment that is very, very expensive, he said, noting that in the past three years alone Rose Hill has provided $2.7 million in free treatment.
Rose Hill ended 2013 with a deficit of $131,000, Mr. Gray said.
While Rose Hill has run at a deficit before, Mr. Gray said that in the past the state has provided additional aid to ensure the facility at least broke even.In 2013, though, that was not the case.
We ran at a deficit last year, which isnt unusual, but in 2013, for whatever reason, they said there would be no extra aid available, and now were struggling to make up the difference, he said.
Mr. Gray said the facility had a deficit of $151,741 in 2011 and a deficit of $64,926 in 2012. In both of those years, the state Office of Alcohol and Substance Abuse Services came through with additional aid that allowed Rose Hill to break even.
The reason they gave us was our census was down, he said, noting the facility ran at 78 percent capacity. We dipped below 80 percent for the first time.
Jannette M. Rondo, communications director for the state agency, said she could not comment on Rose Hills situation.
OASAS cannot comment until we receive the final budget numbers from St. Lawrence County related to this provider, which are not due for several months, she said.
Mr. Gray said Rose Hill is certified for up to 30 beds, a number that may decrease.
One of the things weve looked at is, do we have the wherewithal to fill 30 beds? Mr. Gray said.
The loss of state aid from previous years has forced the facility to reduce its staff by 7½ full-time-equivalent employees in recent months, Mr. Gray said, noting things changed for Rose Hill in 2009 when it was reclassified as a residential rehabilitation services for youth facility. Previously Rose Hill had been a residential chemical dependency for youth facility.
That change allowed us to be reimbursed for the treatment of Medicaid patients, he said, adding the agency was allowed to collect back payment for Medicaid patients who had been treated previously.
In 2009 we had a surplus because we were able to collect money from previous years, Mr. Gray said. The downside of that was a subsequent cut in aid.
Rose Hill Executive Director Tina Buckley said the following year Rose Hills aid was cut from more than $400,000 per year all the way down to $29,000.
We have argued for years that New York state should be helping us pay for these services, Mr. Gray said. The question weve been asking the state is, why should a private, not-for-profit be solely responsible for paying for treatment for kids who cant afford it?
Ms. Buckley said Rose Hill is one of five facilities in the state north of New York City that specialize in adolescent services. Most facilities such as the Credo Community Center in Watertown also provide adult services. Other adolescent-only centers are Renaissance House in Buffalo, Connifer Park in Scotia, Hope House in Albany and Arms Acres in Carmel.
Both Mr. Gray and Ms. Buckley also said Rose Hill often encounters difficulties when billing insurance companies.
Elizabeth Martin, vice president of communications for Excellus BlueCross BlueShield, said whether the company pays for rehabilitation services depends on the details of that clients insurance plan.
Should the treatment be covered, and determination is needed whether it is medically necessary, Ms. Martin said the company utilizes evidence based clinical criteria when making a decision on whether treatment is necessary.
Another common practice for insurance companies is to pay for only 10 days of treatment. The level of coverage also is dictated by the individual policy.
Our choice is to treat them for 10 days and then kick them out or treat them until we feel theyre ready to leave, Mr. Gray said, adding Rose Hill does not discharge clients based on the amount of treatment their insurance company will pay for.
Despite the staffing cuts, Mr. Gray said the remaining staff has been very cooperative.
The staff has been great, he said. They have volunteered to work extra hours, and we have administrative workers who had their salaries cut and are still doing the same amount of work.
To help address the facilitys problems, Mr. Gray said he has spoken with both state Sen. Joseph A. Griffo, R-Rome, and Assemblywoman Addie J. Russell, D-Theresa.
Mr. Griffo said he has spoken with state officials on behalf of Rose Hill.
I have intervened at the state level with senior officials at OASAS. Ive asked them to see if they could sit down, make an assessment of the situation and see where things go, he said. Hopefully well be able to work out some of the issues. If not, I told them there would be a follow-up with me.
Ms. Russell said that if insurance companies arent adequately covering this care, perhaps the Legislature should step in.
We need to look at coverage for longer stays, she said. If a young person has a problem with alcohol or drugs they likely need a stay longer than 10 days. That is something I will be looking into to ensure children have the proper care they need to beat their addiction and not care that is artificially dictated by a for-profit company.
That being said, Ms. Russell added that she feels like Rose Hill has taken steps to help address its problems.
I think the facility has made some difficult decisions recently that will help them become financially stable, she said, adding Rose Hill is also looking to increase its census numbers so that it is operating closer to its capacity.
They will be conducting outreach to professionals that could provide referrals to ensure they have an adequate number of patients to have long-term sustainability, she said.