The executive director of the Guidance Center, a community mental health center serving Leavenworth and two other counties, described the last year in three very different words.


The executive director of the Guidance Center, a community mental health center serving Leavenworth and two other counties, described the last year in three very different words.

The first word that Keith Rickard used in his annual update to the Leavenworth County Commission Monday was “ominous.” He said the looming changes to Medicaid billing for community mental health centers across Kansas, driven by Gov. Sam Brownback, are already affecting his operations.

“When we look at how our system is developed in Kansas, and how we have formulated our mental health center, it’s really built on the backs of Medicaid,” he said.

Of the center’s $9.4 million budget, $7.1 million comes from Medicaid, according to Rickard.

Because of the change in the state’s Medicaid system to a managed care program as envisioned by Brownback, Rickard said the center has already been asked to reduce Medicaid billing by about $600,000 in its current fiscal year. At the same time, he said the demand for services has taken the opposite trajectory.

“We saw, again, growth in the number of services, growth in the number of clients being served, between 2011 and 2010,” Rickard said.

Percentagewise, Rickard said the center served about 4.1 percent more clients in its three-county service area — Atchison, Jefferson and Leavenworth. The biggest increase, he said, was in Leavenworth County.

Despite the fact that those two trends appear to be working in opposite directions, the second term that Rickard used to describe the past year was “promising.” He said he chose that term specifically because of the efforts that Rickard said his staff have undertaken since those reductions began. He said the center has gone without filling some vacated positions and instead spread the responsibilities among its existing staff.

In fact, Rickard said there are a number of new initiatives on the way for the Guidance Center. One already in place is the no-wait access service, under which Rickard said patients seeking behavioral healthcare services can see someone from the center right away, instead of making an appointment between three and 10 days ahead. Rickard said with a 24-percent cancellation rate on first appointments made 10 days in advance, the new program gets more new patients the treatment they need and frees up time for outpatient care.

The other big change that will come to fruition at the center at the end of this month is an on-site pharmacy. Rickard said the center is leasing space for a full-service pharmacy. Having such a facility inside the Guidance Center will help a patient’s care provider, with permission, to consult with the pharmacist to ensure that health medication and psychiatric medications are in compliance. The pharmacy itself will also ensure proper medication management.

“They do bubble packaging, by dose, by day,” he said, which will help some patients stick to their medication’s schedule.

Rickard said with those advances looms some uncertainty, the reason he chose “confusion” as the third term to describe the past year. A spreadsheet provided by Rickard indicated that Leavenworth County actually pays the lowest per capita public expense for its community mental health center, at $1.38 annually. Jefferson and Atchison counties are also in the lowest 10 Kansas counties in terms of per capita costs.

As they continue to stare down an uncertain future because of potential cuts from the Statehouse, Rickard said the Guidance Center has continued to make changes in its operations in order to adapt without cutting services. With the county’s own budget process coming up soon, Rickard stressed the value the Guidance Center in the community — without community mental health centers, he said more patients could likely end up in the emergency room or in the correctional system.

“We’re the least expensive service that these people can receive,” he said.