SD26 - Review of the Comprehensive Services Act


Executive Summary:
Through Virginia's Comprehensive Services Act (CSA), the I992 General Assembly established one of the nation's first comprehensive systems of care for at-risk children. The system was put in place to provide treatment services for children who exhibit serious emotional and behavioral problems.

Senate Joint Resolutions 123 (1996) and 371 (1997), as well as language in the 1994 Appropriation Act, required the Joint Legislative Audit and Review Commission JLARC to assess CSA's implementation. This report provides findings from that review. As a part of the study, JLARC staff reviewed more than 1,100 files of youths participating in CSA, in order to obtain the data necessary for a detailed analysis of how the program is operating.

The study found that localities have experienced some success with CSA, which has provided a mechanism, although not fully used, for involving agencies at the local level in a collaborative process for making service decisions. Consistent with the intent of CSA, localities are serving CSA children in least restrictive and less expensive environments. Further, once children leave the program, their behavioral problems appear to be stabilizing.

However, to ensure a more efficient delivery of services, both the State and localities will need to address a number of problems with program implementation, including inconsistent use of collaborative planning at the local level, inadequate client assessments, insufficient attention to provider fees, and limited program oversight and monitoring. If not properly addressed, these problems could undermine CSA in the long term. This report makes recommendations to address these problems.

It should be noted that one approach to both increasing CSA program accountability and achieving State and local cost savings would be to use Medicaid as an alternative funding source for CSA. JLARC staff estimate that more than $41 million of the annual costs of CSA could be appropriately paid for by Medicaid, if the State implements such a policy Of these annual savings, approximately 62.7 percent are estimated State savings, and approximately 37.3 percent are estimated local savings (based on the current average CSA State-local match rate).