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It's not child's play 

Shortly after Gov. Mike Beebe took office in 2007, he vowed to change the way Arkansas provided mental health care to its children.

He was acting on a study commissioned by the state legislature that had found that the state's policies were out-of-date with current medical opinion, that regulation was fragmented and ineffective and that the state was spending an inordinate amount of Medicaid dollars (according to our figures the second highest in the nation)  on residential mental health care.

What Beebe's reform has sought to do is upend a system created during his predecessor's administration that in part allowed health care providers to regulate themselves. It was a system, which, under Gov. Mike Huckabee, became controlled by providers of health services who tended to share Huckabee's evangelical religious philosophy.

One of the central figures in the Huckabee era was Ted Suhl, the owner of the controversial Lord's Ranch home for kids near Pocahontas and a powerful political player who's been written about in these pages before.

The question:

Is there anything to show for the governor's professed interest in reform as he nears 2010 and a run for a second four-year term?

The short answer:

A little.

One obvious change is that Suhl, thanks to a new Beebe appointment, is no longer a member of the state board that regulates facilities such as his. Structurally, though, the changes have been slower in coming and there's been little shift in Arkansas as a place that spends a disproportionate amount of money on residential care for troubled kids.

DHS has created a Quality Assessment team to coordinate facility reviews by the various Medicaid contractors and DHS units that audit billing practices and do clinical reviews. That big picture look has produced what DHS spokesman Julie Munsell called “active reviews” of three providers of out-patient mental health care, including, as it happens, a Suhl-controlled business.

Under the company name Maxus, Suhl operates Arkansas Counseling Associates in towns across Arkansas. The “deficiencies,” as DHS terms them, reported at Maxus don't rise to the level of abuse, Munsell said. But they do allege rubber-stamped diagnoses for 59 patients and 58 out of 59 treatment plans at its Dumas clinic — something that DHS reform particularly addresses in its efforts to personalize mental health care.

DHS is seeking Medicaid refunds of a total of $134,714 for deficiencies found at Dumas and Benton. It's seeking much more — $294,738.64 — from a non-Suhl agency, Therapeutic Family Services, for deficiencies at its North Little Rock, Hot Springs and Lewisville clinics, and $208,917 from another non-Suhl agency, Living Hope Southeast Inc. of Monticello.

But DHS' Division of Behavioral Health has completed a clinical review at Suhl's Dumas clinic that goes into more detail than the billing deficiencies found by Medicaid's Program Integrity Unit. (Therapeutic Family Services and Living Hope are currently undergoing clinical reviews.)

 Suhl has declined multiple requests to talk to the Arkansas Times on this or any other topic.

Beebe's focus on the state's mental health care system — with Act 1593 of 2007 that created the Arkansas Children's Behavioral Health Care Commission and which has brought about operational change at DHS and its Division of Child and Family Services — did more than change process; it has brought at least some change in politics.

Beebe has changed the face of the Huckabee-created Child Welfare Review Board, replacing Huckabee insider Suhl in 2008 and James Balcom, who urged the creation of the board and supported its move to prohibit homosexuals from being foster parents, earlier this year. Suhl he replaced with Beverly Foti, who is with Medicaid contractor APS Healthcare, and Balcom with Andy Altom, Methodist Family Health president. 

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