Nevada Medicaid shift could impact continuity of mental health care

Updated July 31, 2018 - 11:17 pm

When Carrie and Jeffrey Olsen took in their year-and-a-half-old foster child, Daemion, they knew that he would need a lifetime of guidance.

“He’s got a lot of emotional issues,” Carrie Olsen said of her now-9-year-old son. “There’s been lots of doctors, there’s been lots of tests, there’s been lots of trying to figure it out.”

Daemion has made advances after three years of therapy with a licensed clinical social worker paid for by Medicaid.

But now his mom fears that a change in the mostly federally funded, state-administered program threatens to undo that progress.

The state agency that administers Medicaid announced this summer that it would soon limit patients to three therapy sessions before requiring them to obtain pre-approval for continuing treatment.

Mental health advocates and care providers say the change will delay treatment and force some practitioners to stop taking Medicaid, leaving the most vulnerable with fewer options in a state already ranked last for overall mental health and access to care by Mental Health America.

Rationing care

When the change was announced, clinical social worker Pam Roberts realized she would have to ration Daemion’s care until his next batch of visits was approved, so she cut his appointments from twice to once a week.

In the first few days without his regular appointment, Daemion’s emotional issues caught up with him. He sneaked out the dog door while his mom slept in the other room, and he ended up in police custody.

“He’s like a cat with nine lives, and I’m just worried that it’s not going to be just a ride home and talk about, ‘Hey, that’s not a safe choice and something could happen,’” Olsen said through tears during a recent interview in her Las Vegas home.

Current policy allows Medicaid providers to offer up to 26 sessions — six months of therapy for a client who gets help once weekly — before obtaining approval for additional treatment.

But as of Aug. 15, Nevada’s mental health providers who take Medicaid for psychotherapy and neurotherapy services, including individual and group therapy and biofeedback, will need to obtain that approval before a client’s fourth session.

The change directly affects fee-for-service Medicaid recipients — about a quarter of the 650,000 Nevadans insured through the program.

Managed-care groups, which cover the remaining 75 percent, can follow the state’s lead or set their own prior-authorization rules. Of the three organizations active in Nevada, Anthem Blue Cross Blue Shield and SilverSummit Healthplan do not plan to change their policies, while Health Plan of Nevada declined to comment, according to state officials.

Preventing fraud

The change by the state’s Division of Health Care Financing and Policy was prompted by what the state says was a rise in fraud, including overbilling for services and false claims for services not provided.

An October 2017 audit that examined reimbursements for behavioral health outpatient services found the state had improperly paid up to $8.8 million in fiscal year 2016, for example.

But providers, especially those with small practices, say the rule change will inundate them with paperwork.

“It’s less expensive for me not to take Medicaid,” said Adrianna Wechsler Zimring, a Las Vegas psychologist and past president of the Nevada Psychological Association. “It’s just cheaper for me to (provide therapy) for free because of all the amount of time and energy and resources I have to have … to be able to keep up to date on the Medicaid requirements that are constantly changing.”

Psychologists and other mental health providers voiced their concerns about the proposed policy at a public workshop in late June. At the time, the new requirement, called a prior authorization, would have mandated that providers submit the paperwork after one session.

It was changed to three sessions after therapists said they wouldn’t have enough information on a patient after the initial visit to avoid the claim’s denial, said Medicaid administrator Marta Jensen.

“I think one of the misconceptions is this has been a reduction in services. It’s just not,” Jensen said. “It’s just putting the tools up front to ensure the medical necessity is there.”

She also said delays in receiving additional treatment should be minimal, with 99 percent of prior-authorization requests currently processed within five business days.

That may not be the case, however, when claims are denied and must be appealed, said Wechsler Zimring. In that event, she said, an extra hour or two of paperwork per client can easily swell to five extra hours.

And providers argue it has taken up to two or three weeks to resolve appeals in some cases.

“Medicaid can say, ‘Oh, it’s fine, it’s fine. Just have your therapist write a prior authorization,’ but it’s not that simple for the therapist,” said Roberts, Daemion’s social worker. “That requires them to have … an administrative staff, but a small private practice cannot afford an administrative staff.”

While the change will primarily affect children in Roberts’ and Wechsler Zimring’s practices, it will cut across all age groups.

Not ‘hashtag Vegas strong’

Route 91 Harvest festival shooting survivors still in therapy, for example, might have to stop seeing their therapist for a time if they’re covered by Medicaid and haven’t been approved through the state’s prior-authorization process.

“This does not seem very hashtag Vegas strong to me,” Wechsler Zimring said.

Cody Phinney, deputy administrator of the the Division for Health Care Financing and Policy, said the pre-authorizations will help the agency “protect the quality and quantity of services for the population we’re serving.”

State data showed that the $738,084 for neurotherapy services billed to Medicaid in the 2013 fiscal year had risen 2,345 percent — to more than $18 million — in the current fiscal year as of April.

“It’s not just about cost. I find it really personally hard when I see that we’re getting bills that are not attached to any services,” she said. “If there’s no (prior authorization) and there’s no hard stop in the system, those bills just pay and then we have to try to recoup from that provider.”

Chuck Duarte, the state’s former Medicaid administrator and now CEO of Community Health Alliance, agrees that fraud is a problem but said prior authorizations are a poor tool to try to use to combat it.

Now, he said, the burden will fall on providers who legitimately provide services and the patients, whose care is ultimately delayed and whose mental health is allowed to suffer.

“Imagine if in the medical world, you couldn’t do cancer screening and some work with the patient, and you said, ‘We’ll only treat you when you’ve got cancer,’” Duarte said. “That’s kind of how it feels.”

Contact Jessie Bekker at or 702-380-4563. Follow @jessiebekks on Twitter.

Local Videos
Library director talks about library as community center
Ron Heezen discusses his hopes for the new East Las Vegas Library. (John Przybys/Las Vegas Review-Journal)
Property Brothers visit Michael’s in Las Vegas Valley
Twin brothers Jonathan and Drew Scott are the hosts of Property Brothers, the hit HGTV show where they help couples find fixer-uppers and transform them into dream homes. In 2018, the brothers collaborated with Michael's on their first custom framing program. Today they're releasing new frames into that collection that range from natural to bright looking. Jonathan and Drew discuss their brand and why frames was something they wanted to pursue. (Rachel Aston/Las Vegas Review-Journal)
I-15 traffic jam
A semitrailer stopped in the middle of Interstate 15 near Charleston Boulevard has slowed traffic in central Las Vegas Wednesday morning, April 17, 2019. (Mat Luschek/Las Vegas Review-Journal)
Rainy Tuesday
The Las Vegas Valley saw cooler temperatures and rain Tuesday afternoon. (Mat Luschek / Review-Journal)
Tiger Woods Bettor Collects
James Adducci bet $85k on Tiger Woods to win the Masters. He collected his $1.19M from William Hill sports bet in the SLS today. (Mat Luschek /Review-Journal)
Endangered frogs released at Springs Preserve
Dozens of endangered Relic Leopard Frogs were released at the Cotton Grove inside Springs Preserve in Las Vegas, Thursday, April 11, 2019
Vintage World War II aircraft arrive at Henderson Executive Airport
The Collings Foundation Wings of Freedom tour comes to Henderson Executive Airport with a B-17 Flying Fortress, B-24 Liberator, B-25 Mitchell, P-51 Mustang and a P-40 Warhawk. (Michael Quine/Las Vegas Review-Journal)
Honoring Pearl Harbor veteran
Ed Hall, a Pearl Harbor veteran in Las Vegas, is honored with Quilt of Valor during an event in a Las Vegas. (Erik Verduzo/Las Vegas Review-Journal)
UNLV Anthropology professors excavate Maya ruin site of Caracol, Belize for 36 years
The husband-and-wife team of UNLV anthropologists has spent several months a year at the remote site of Caracol in the jungles of Belize, excavating ruins and uncovering secrets from the region’s once-dominant civilization. (K.M. Cannon/Las Vegas Review-Journal) @KMCannonPhoto
Things to remember when adopting a rabbit this Easter season
As Easter and spring time approach, some people may be tempted to adopt a rabbit for the holiday. But like adopting any animal, it is important to be responsible and know what a rabbit requires to be a happy, healthy pet. (Mat Luschek / Review-Journal)
Bike Giveaway in Las Vegas - Piero’s Italian Cuisine
Evan Glusman of Piero’s Italian Cuisine hosted a party in the restaurant’s parking lot to distribute over 150 bikes to local kids. (Al Mancini/Las Vegas Review-Journal)
New Charleston/I-15 ramp configuration
The new Interstate 15/ Charleston Boulevard ramp configuration was unveiled Tuesday morning. (Mick Akers/Las Vegas Review-Journal)
Northwest Vegas farm's abandoned pig problem
Someone abandoned a several hundred pound pig at Sharon Linsenbardt's farm. Her farm is a rescue for animals, but she doesn't have room or resources to take on another such creature, so she's asking the community for help. (Mat Luschek / Review-Journal)
Chalk Talk: Black Student Union
Students talk about the Black Student Union in the latest episode of Chalk Talk. (Angus Kelly and Amelia Pak-Harvey/ Las Vegas Review-Journal)
Individuals with Parkinson's participate in dance class
Pamela Lappen leads a dance class for individuals with Parkinson's Disease at the Nevada Ballet Theatre in Las Vegas, Thursday, March 28, 2019. Caroline Brehman/Review-Journal
Animal Foundation Preps Pups For Best In Show
The Las Vegas Animal Foundation is preparing its prime pups for their 16th annual Best in Show event, which takes place at the end of April. (Mat Luschek / Review-Journal)
Dog Yoga At Hydrant Club
The Hydrant Club in downtown Las Vegas, is a social club for dogs and their people. Recently the club started hosting dog yoga. (Mat Luschek/Review-Journal)
Butterflies At The Springs Preserve
The butterfly habitat is now open at the Springs Preserve. Learn about butterflies and take in the peaceful surroundings. (Mat Luschek / Review-Journal)
The Bellagio Conservatory's spring display has a Japanese theme
The Bellagio's conservatory is hosting around 65,000 flowers, to form a Japanese theme this spring. (Mat Luschek / Review-Journal)
Bonnie Springs closes (Caroline Brehman/Kimber Laux)
Bonnie Springs Ranch near Las Vegas officially closed its gates Sunday, March 17, 2019. (Las Vegas Review-Journal)
Honoring a fallen North Las Vegas Police officer at his namesake school
The 20th Annual Raul P. Elizondo Honor Day celebrates the fallen North Las Vegas Police officer's legacy at his namesake school. (K.M. Cannon/Las Vegas Review-Journal) @KMCannonPhoto
Windy day in Las Vegas Valley
The Review-Journal's camera on the under-construction Las Vegas Stadium the was buffered by high winds on Wednesday, March 14, 2019. (Las Vegas Review-Journal)
March gloom falls on Las Vegas
After a rainy overnight, gloomy skies hover over Las Vegas Tuesday morning. (Mat Luschek/Review-Journal)
John Katsilometes gets his head shaved at St. Baldrick's
Las Vegas Review-Journal man-about-town columnist John Katsilometes gets his head shaved by former Las Vegas Mayor Oscar Goodman during St. Baldrick's Foundation shave-a-thon on the Brooklyn Bridge at New York-New York in Las Vegas Friday, March 8, 2019. (K.M. Cannon/Las Vegas Review-Journal) @KMCannonPhoto
The Blue Angels take flight over Las Vegas Strip
The Blue Angels’ U.S. Navy Flight Demonstration Squadron flew their signature Delta formation over a part of the Las Vegas Strip, McCarran International Airport and east Las Vegas and were scheduled to fly over Hoover Dam. (Michael Quine/Las Vegas Review-Journal) @Vegas88s
Gross World Records
A group of about 20 children gathered around a TV at Sahara West Library on Feb. 27 for a history lesson on the most disgusting world records.
Graduation for Renewing HOPE program
The Renewing HOPE program graduation for homeless who spend nine months in Catholic Charities program. Graduates are preparing to enter the workforce. (Bizuayehu Tesfaye/Las Vegas Review-Journal) @bizutesfaye
Car crashes into Starbucks near Las Vegas Strip
Lt. William Matchko of the Las Vegas Metropolitan Police gives details about a car crashing into a Starbucks at Sahara Avenue and Paradise Road, near the Las Vegas Strip, on Friday, March 1, 2019. (Jessica Terrones/Las Vegas Review-Journal)
Car crashed into PT’s Gold
A 60-year-old man who police believe was impaired drove into a PT’s Gold at Silverado Ranch and Decatur boulevards Thursday night, Metropolitan Police Department Lt. William Matchko said. The driver was hospitalized and is expected to survive. A man inside the bar was hit by debris but drove himself to the hospital, Matchko said. (Katelyn Newberg/ Las Vegas Review-Journal)
Driver crashes vehicle into PT’s tavern in south Las Vegas (part 1)
A driver suspected of impairment crashed a vehicle into the wall of a PT’s Gold tavern, at 4880 W. Silverado Ranch Blvd., in Las Vegas on Thursday, Feb. 28, 2019. (Katelyn Newberg/Las Vegas Review-Journal)
It is a rainy Valentine's Day in Las Vegas - Video
These scenes come from the Las Vegas Stadium LiveCam (Las Vegas Review-Journal)
Life Videos
MAGIC fashion convention showcases men's clothing trends
The MAGIC fashion convention has come to Las Vegas at the Mandalay Bay Convention Center to showcase some of the hottest clothing trends for men. (Nathan Asselin/Las Vegas Review-Journal)
Former Army medic’s Afghanistan story told in new book
The graphic novel “Machete Squad” is based on journals written by Las Vegan Brent Dulak.
Las Vegas man talks about losing his wife
Dwayne Murray, 37, lost his wife, LaQuinta while she was at Centennial Hills Hospital. A jury awarded him $43 million last week after it said the hospital failed to perform the standard of care in administering a drug for her sickle cell disease.
Home Front Page Footer Listing