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 jbekker@reviewjournal.com or 702-380-4563. Follow @jessiebekks on Twitter.

ad-high_impact_4
Local
Metro Asst. Sheriff Brett Zimmerman on Aug. 8 officer-involved shooting
Metropolitan Police Department Assistant Sheriff Brett Zimmerman met with media Monday to discuss the details of the 14th officer-involved shooting of the year. (Madelyn Reese/ Las Vegas Review-Journal)
Matt Kelly Elementary School hosted its third annual Back-to-School Red Carpet Program
Matt Kelly Elementary School hosted its third annual Back-to-School Red Carpet Program where community and business leaders joined to welcome students back with an inspirational welcome. Bizuayehu Tesfaye/Las Vegas Review-Journal @bizutesfaye
Star Trek fans on show’s enduring popularity
Star Trek fans at the Star Trek Convention 2018 talk about why they think the show has stayed popular across the years Thursday, August 2, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Nonprofit provides clothing for homeless
Sydney Grover of Can You Spare A Story?, talks about how she founded the non-profit organization. (Marcus Villagran/Las Vegas Review-Journal)
Family remembers deceased mother
Family members of Adriann Gallegos remember her. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Camp Broadway teaches kids how to sing and dance
The Smith Center's seventh annual Camp Broadway musical theater program gives 150 kids ages 6-17 an opportunity to learn musical theater skills from industry professionals over a five-day period. Marcus Villagran/ Las Vegas Review-Journal @brokejournalist
Restoring classic Corvettes to perfection
Members of the National Corvette Restorers Society Convention talk about what it takes to earn the NCRS Top Flight Award for a restored Corvette at South Point in Las Vegas on Tuesday July 17, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Watch Ruthless! at Las Vegas Little Theatre
The musical Ruthless! will be playing at Las Vegas Little Theatre from July 13-29. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Cadaver art and sword swallowing at The Dark Arts Market
Curator Erin Emrie talks about her inspiration for The Dark Arts Market at Cornish Pasty Co. in Las Vegas Tuesday, July 10, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
'NO H8' Campaign comes to Las Vegas
Hundreds of locals participate in the NO H8 campaign founded by Adam Bouska and Jeff Parshley as a response to Proposition 8, a California ban on same-sex marriage. The campaign has since evolved to represent equal treatment for all. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
What to expect at Station Casinos' Fourth of July celebration
Station Casinos' is hosting its annual 4th of July celebration with Fireworks by Grucci. Fireworks scheduled to go off on Wednesday, July 4 around 9 p.m. at Green Valley Ranch Resort, Red Rock Resort, Fiesta Rancho and Texas Station. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Star Wars and Golden Knights mashup at downtown art shop
Star Wars and Vegas Golden Knights fans attend the Boba Fett Golden Knight Paint Class at The Bubblegum Gallery in Las Vegas, Friday, June 29, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Tourists and locals enjoy Independence Day fireworks at Caesars Palace
Hundreds of tourists and locals gaze at the Independence Day fireworks show at Caesars Palace on Saturday, June 30, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Clark County recount votes in commission’s District E primary
Clark County staff begin the recount requested by candidate Marco Hernandez in the democratic primary for the County Commission's District E seat on Tuesday, June 26, 2018. (Marcus Villagran/Review-Journal) @brokejournalist
Long-running local hip hop producer wants Vegas rappers to shine
Las Vegas Hip Hop producer and co-owner of Digital Insight Recording Studios Tiger Stylz reflects on 30 years of music production in the city. (Marcus Villagran/Review-Journal) @brokejournalist
"Pawn Stars" fans visit Richard Harrison's memorial at Gold & Silver Pawn
"Pawn Stars" fans from around the world visit the Gold & Silver Pawn Shop in Las Vegas following the passing of Richard "Old Man" Harrison on Monday, June 25, 2018. (Marcus Villagran/Review-Journal) @brokejournalist
Construction for new 51s ballpark underway
New home of the Las Vegas 51s is planned to be finished by March 2019 in Summerlin according to team president Don Logan. (Marcus Villagran/Review-Journal) @brokejournalist
Life
Kids become firefighters at Fire Station 98 open house
Henderson residents wore fire hats, learned about CPR and met firefighters at the Fire Station 98 open house Saturday, August 11, 2018. (Marcus Villagran Las Vegas Review-Journal) @brokejournalist
People from all over the world attend RollerCon 2018
RollerCon 2018 is a five-day convention focused on the roller derby community and culture at Westgate in Las Vegas. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Camp Broadway teaches kids how to sing and dance
The Smith Center's seventh annual Camp Broadway musical theater program gives 150 kids ages 6-17 an opportunity to learn musical theater skills from industry professionals over a five-day period. Marcus Villagran/ Las Vegas Review-Journal @brokejournalist
Las Vegas police officer on being PETA's Sexiest Vegan Next Door
Las Vegas police officer David Anthony talks vegan lifestyle and how he feels about being voted PETA's sexiest Vegan next door from his home on Monday, July 9, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
'NO H8' Campaign comes to Las Vegas
Hundreds of locals participate in the NO H8 campaign founded by Adam Bouska and Jeff Parshley as a response to Proposition 8, a California ban on same-sex marriage. The campaign has since evolved to represent equal treatment for all. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Over 40,000 People Attend The 4th Of July Parade In Summerlin In Las Vegas
Over 40,000 People Attend The 4th Of July Parade In Summerlin In Las Vegas. (Janna Karel Las Vegas Review-Journal)
Star Wars and Golden Knights mashup at downtown art shop
Star Wars and Vegas Golden Knights fans attend the Boba Fett Golden Knight Paint Class at The Bubblegum Gallery in Las Vegas, Friday, June 29, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Bark-Andre Furry meets Capitals superfan Ovie the Bulldog
Two of NHL's furriest fans met at the Forum Shops in Caesars Palace on Tuesday, June 18, 2018, in Las Vegas. Vegas Golden Knights superfan Bark-Andre Furry and Washington Capitals superfan Ovie the Bulldog shared a plate of meatballs and spaghetti with help from Logan, "The Girl with the Hat." (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
TOP NEWS
News Headlines
Add Event
Home Front Page Footer Listing
Circular
You May Like

You May Like