Personal statements of the risks of not getting care
Allowed one day to stabilize a suicidal teenager – can’t do it.
Short List of Recommendations for Reforming Medicaid
During thelast legislative session -- without public hearings and despite the complaints of large numbers of healthcare providers and groups like NAMI -- the Missouri legislature expanded managed care statewide. The result: private insurance providers have been placed in charge of federal Medicaid dollars.Missouri already has serious problems with access to mental health services: Only 10 of 114 counties in Missouri have adequate access to care. There is a serious shortage of expert diagnosticians because there are too few psychiatrists and psychologists available to work with Medicaid recipients. Rural areas are experiencing the greatest crisis in access and expertise. Managed care reduces services to our most vulnerable citizens at a time when we need MORE rather than less access to care.
Compassion and common sense demand that our legislators establish controls and accountability over public funds allocated to mental health services. We know that mental health services enable people to learn to handle their feelings, improve their relationships, and learn the skills they need to become productive citizens. We need to provide high quality treatment by licensed professionals in an efficient, cost effective timely manner. Repeated studies have shown that this is the most effective way to deliver care, and it is also the most economical. Untreated mental illness, substance abuse, and tobacco use costs the State of Missouri some 19 billion dollars a year in lost productivity, healthcare, traffic crashes, crime, and disability costs. Licensed mental and behavioral health professionals have the tools to help resolve all these problems
In order to protect our Medicaid mental health system and those it serves, the legislature needs to pass a law or write regulations that:
1. Increase rather than decrease reimbursement for mental health service providers, most of whom have not received an increase in reimbursement in over thirty years.
2. Protect children and other vulnerable populatiosn from harm.
3. Understand that accurate diagnosis is the keystone of high quality and cost effective treatment. Specify in state contracts and Medicaid waivers that psychiatrists and psychologists, our best diagnosticians in mental health, are essential staff.
4. Require that paraprofessionals involved in mental health work be supervised by an onsite psychiatrist or psychologist.
5. “Carve out” safety net programs from managed care, like children’s inpatient psychiatric services, aged, blind and disabled to prevent their elimination.
6. Avoid medication only approaches to treatment. Require that psychological and counseling interventions by licensed providers be made easily available without undue administrative barriers and paperwork. Mandate that psychosocial issues associated with a child’s inpatient admissions be included in continuation of care criteria.
7. Establish strong controls over how managed care conducts business to ensure that managed care companies actually provide adequate mental health services to patients, particularly for those with serious mental illness not eligible for specialty programs, and work well with providers. We are putting Missouri tax dollars in the hands of companies from out of state.
8. Create a single set of rules for the Medicaid companies and a standardized billing interface for providers to replace the current burdensome four sets.
9. Place managed care under the Department of Insurance, Missouri’s appropriate monitoring agency and levy consequences for failure to perform as contracted.
10. Require managed care and state funded agencies contract and refer to all available, local, licensed mental health providers of Medicaid mental health services to improve immediate access to service.
11. Require that managed care companies continue to reimburse services provided by provisionally licensed psychologists and begin to reimburse provisionally licensed clinical social workers, licensed professional counselors and psychology interns. Although the state-run Medicaid system reimburses provisionally licensed mental health providers, they should also reimburse psychology interns as well.
12. Require that managed care or other state funded companies cover basic psychological testing for children without preauthorization.
13. Improve coordination of care. Provide consultation codes (such as those used in Arkansas), so that licensed providers can receive payment for consulting with other professionals.