Increased Precautions We're Taking in Response to COVID-19

LAST UPDATED ON 03/15/2021

As updates on the impact of the coronavirus continue to be released, we want to take a moment to inform you of the heightened preventative measures we have put in place at Sierra Tucson to keep our patients, their families, and our employees safe. All efforts are guided by and in adherence to the recommendations distributed by the CDC.

Please note that for the safety of our patients, their families, and our staff, there are certain restrictions in place regarding on-site visitation at Sierra Tucson.

  • These restrictions have been implemented in compliance with updated corporate and state regulations to further reduce the risks associated with COVID-19.
  • Options for telehealth visitation are continuously evaluated so that our patients can remain connected to their loved ones.
  • Alternate methods of communication for other services may be offered when deemed clinically appropriate.

For specific information regarding these changes and limitations, please contact us directly.

CDC updates are consistently monitored to ensure that all guidance followed is based on the latest information released.

  • All staff receives ongoing infection prevention and control training.
  • Thorough disinfection and hygiene guidance is provided.
  • Patient care supplies such as masks and hand sanitizer are monitored and utilized.
  • Temperature and symptom screening protocols are in place for all patients and staff.
  • Social distancing strategies have been implemented to ensure that patients and staff maintain proper distance from one another at all times.
  • Cleaning service contracts have been reviewed for additional support.
  • Personal protective equipment items are routinely checked to ensure proper and secure storage.
  • CDC informational posters are on display to provide important reminders on proper infection prevention procedures.

The safety of our patients, their families, and our employees is our top priority, and we will remain steadfast in our efforts to reduce any risk associated with COVID-19.

The CDC has provided a list of easy tips that can help prevent the spread of the coronavirus.

  • Avoid close contact with people who are sick.
  • Cover your cough or sneeze with a tissue and then immediately dispose of the tissue.
  • Avoid touching your eyes, nose, and mouth.
  • Clean and disinfect objects and surfaces that are frequently touched.
  • Wash your hands often with soap and water for at least 20 seconds.
  • Stay home when you are sick, except to get medical care.

For detailed information on COVID-19, please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html

A Note on the State of Managed Care

Sierra Tucson – Ranked #1 in Newsweek’s list of Best Addiction Treatment Centers in Arizona for 2020!

A Word from Our Director of Admissions:
Rich Appert

A recent admission to Sierra Tucson had me reflecting on our industry’s current interaction with commercial payers and managed care as a whole. While legislators and advocacy groups continue to trudge forward from a bureaucratic perspective (moderately successfully), it’s hard not to grow mildly disconcerted at the “one step forward, two steps back” nature of the relationship. The downward trend in residential lengths of stay is not really improving despite the apparent progress of both the Mental Health Parity Act (MHPA) and the Affordable Care Act (ACA). While discussing the aforementioned case both internally and with the referral source, the realization that the onus is on us (providers, employer groups, referral sources) to affect positive change has become exceedingly evident. The pushback has to become more severe. The alternative is that the residents we care so much about won’t get the help they so desperately need.

I should mention that we are doing remarkably well at Sierra Tucson when it comes to average length of stay at the residential level of care. Through the first two quarters of the year, we have been right around 27-28 days, which is even better than it seems when one considers that we don’t utilize partial hospitalization or intensive outpatient benefits at Sierra Tucson.

“John,” the admission mentioned above, was referred to us by an advocacy group that works with first responders. John had been going to outpatient for about six months, was unable to stop drinking, had been endangering himself and others by driving intoxicated, and had shown up to his public safety job under the influence. There were some additional co-occurring mood issues as well, and it was clear to anyone with an even moderate level of cognitive awareness that this individual needed significant clinical and medical intervention to prevent anything tragic from occurring.

The employer group involved in this case had decided to outfit their employees with what appeared to be very good mental health and substance abuse benefits. The plan had low deductible and coinsurance amounts and both in- and out-of-network benefits. Obviously these types of plans are far more expensive than most HMO or other baseline plans. While the particular insurance company involved had no issue in selling this plan to said employer group, it did take exception to allowing one of the group members to actually utilize the benefits sold. Residential treatment for John was denied. Sierra Tucson appealed and Chief Medical Officer Michael Genovese, MD, JD, personally handled the peer review. Once again, treatment was denied without one single day being authorized. The recommendation was that John return to the same outpatient level of care in which he was currently failing.

This sort of thing was common not so long ago but it wasn’t supposed to happen anymore. MHPA was passed in the 1990s and basically required that coverage levels (in terms of dollar amounts) provided to medical benefits also be available for mental health. Insurers responded by implementing day limits, higher deductibles on mental health services, and other restrictions on utilization of benefits. In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed, which closed those loopholes but still did not explicitly require that plans offer coverage for mental health treatment; it only required that plans that offer both medical and mental health have equitable coverage levels. Finally, the Affordable Care Act classified mental health coverage as an “essential health benefit” and required that it be covered (still with some exceptions), beginning in 2014. So here we are with nearly all insurance policies including coverage for mental health and substance abuse, but no way to ensure that authorization of covered benefits is actually granted. In fact, many insurers employ completely arbitrary criteria guidelines and can still deny care regardless of clinical presentation.

This is exactly where we found ourselves with John. To be fair, there are some insurance providers that are quick to authorize care and seem to generally do the right thing. Additionally, very few cases are denied from Day 1 like John’s. Nevertheless, we were at a crossroads but decided as a team not to go down without a fight. It was at this point that I contacted one of our Treatment Placement Specialists for Acadia Healthcare and the referent who also happened to represent the employer group. We approached the problem from all angles. I, along with our utilization review manager, called the payer and we worked our way up the supervisory chain. The employer, who represents a very large employer group and also signs the premium checks, called and expressed his significant displeasure at the turn of events. Then he called again…and again. After a couple of days strategizing, our small team of amateur advocates was able to secure an initial seven-day authorization. This happened after the formal appeal process was exhausted. When all was said and done, John left residential treatment after 30 days were authorized.

This particular story ends well (I recently heard from the referent that John is thriving in sobriety), but this is only the beginning. The point here is that there is no real accountability for most of the major payers. We are the accountability. Some will argue for more regulation, others will say lack of competition in the insurance marketplace perpetuates this kind of practice. But really, neither matters in the near term. The reality is that, as providers, employers, and family members, we need to work together to collectively push back when arbitrary decisions are made that can endanger a resident’s or loved one’s life. It works. I have seen it work time and time again. It requires, however, that we all join forces. If we stay quiet, it is unlikely much will change anytime soon. We must remain optimistic, though. There is significant strength in numbers and we have the distinct advantage of knowing that what we are doing is right. As it says when one enters the front gate at Sierra Tucson: Expect a Miracle.