Tag Archive: In-Home Services

  1. Raising the Bar on Medicaid-funded Mental Health Services

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    The 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.





  2. Intensive In-Home Services: New White Paper

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    Voices for Virginia’s Children has just issued a white paper authored by Jean Hovey entitled, “Intensive In-Home Services for Children’s Mental Health in Virginia: Time to Focus on Quality.” Read  and download the Executive Summary or the full White Paper here.

    Intensive in-home services are an important part of a comprehensive array of mental health treatment options for children. This paper summarizes the history and recent trends affecting access to and quality of Medicaid-funded intensive in-home services in Virginia. The paper concludes with recommendations for improving these particular services and the entire array of services moving forward.


    1.      The top recommendation of this paper is to improve the consistency and quality of intensive in-home services in Virginia. This can be achieved by:

    • developing Virginia’s practice models, and
    • replicating existing models of excellence.

    2.      In addition, improving the quality of in-home services must be part of developing a more robust array of services to reduce over-reliance on IIHS.

    3.      To ensure the services are leading to positive outcomes for kids and families, Virginia must develop outcome measures on well-being of youth served.

    4.      Finally, Virginia must be vigilant to ensure access to services through the transition to Medicaid care coordination.

    Voices for Virginia’s Children will be working with its Campaign partners and other children’s mental health stakeholders to advocate for Virginia to address the concerns outlined in this paper by focusing on the recommendations.