Raising the Bar on Medicaid-funded Mental Health Services
Comments Off on Raising the Bar on Medicaid-funded Mental Health ServicesThe following is Campaign Coordinator Margaret Nimmo Crowe’s latest blog post on the Richmond Times-Dispatch’s blog Pundits’ Podium. It is written in response to an August 14 article in the Richmond Times-Dispatch about a former children’s mental health provider who pleaded guilty to conspiracy to commit Medicaid fraud. You can read the original article on the RT-D website.
With as many as 100,000 Virginia children suffering from a serious mental health disorder and only one in five of them receiving necessary treatment, it is repugnant to read that an unscrupulous individual has defrauded Virginia of $1.5 million of the state’s limited resources for child mental health treatment. On August 14 the Times-Dispatch reported that Joseph T. Hackett pleaded guilty to conspiracy to commit fraud in a case that involved unethical marketing practices, unqualified providers, and children who did not actually have serious mental health disorders. Luckily, the Attorney General’s Medicaid fraud unit caught this offender, who will have to reimburse the state as part of his sentence.
The services fraudulently billed by Hackett’s company are intensive in-home services, which provide concentrated counseling and support to children with mental health disorders so severe they are at risk of out-of-home care. These services are part of an array of intensive community-based treatments funded by Medicaid that – when provided effectively – can improve children’s functioning, keep them with their families, and avoid more costly inpatient care or residential treatment.
What the article does not mention are the great strides that the Virginia Department of Medical Assistance Services (DMAS), the state’s Medicaid agency, has made in the last two years to ensure that this type of fraud can no longer occur. First, it tightened marketing regulations so that the recruiting scheme Hackett employed is clearly prohibited. Second, DMAS strengthened the professional qualifications required of providers. Third, at the General Assembly’s request, DMAS instituted independent clinical assessments prior to enrolling children in these intensive services to ensure their needs require this level of care.
These changes have eliminated the most blatant offenses, but they do not go far enough in ensuring that Virginia has the highest quality Medicaid mental health services for children. We should be striving to provide treatment that research shows produces the best outcomes for children, not merely defining the bare minimum required to qualify for reimbursement.
Voices for Virginia’s Children strongly recommends that Virginia adopt evidence-based practice models for intensive in-home and other Medicaid mental health services. Beyond defining appropriate credentials for providers, practice models determine the interventions and outcomes that should be expected from each type of treatment. Providers then must be held accountable to measure and report the progress made by children in their care.
Along with adopting practice models for these services, DMAS must examine reimbursement rates and their impact on service quality. It lowered the rate on intensive in-home services in 2010 to save money; however, being reimbursed below cost is unsustainable for providers. A better idea would be to raise the standards of treatment (thereby weeding out unqualified providers) and adequately reimburse those who meet the new standard.
Effective children’s mental health providers, of which Virginia has many, seem to welcome this approach that leads to the best possible outcomes for children. We need leadership from the state to ensure that our taxpayer dollars are invested wisely for this vulnerable population of children.