Medicaid payment changes worry mental-health care providers in Ohio

A group representing dozens of mental-health care providers across the state is concerned that changes in the way claims are paid for Medicaid patients could lead to limited programming options in an era when services are needed more than ever.

According to numbers gathered by the Ohio Council of Behavioral Health & Family Services Providers, behavioral-health care providers were paid about $522 million for services from January through June.

A year earlier, the number was about $65 million more, topping $587 million, said Lori Criss, chief executive officer of the Ohio Council, which represents about 150 providers.

The timing, she said, is troubling as drug-overdose deaths in Ohio are at an all-time high and the suicide rate is edging up.

“It’s just stunning to see that, now that we’re in the middle of a growing storm, that the administration (of Gov. John Kasich) would do less, not more, to turn the tide,” Criss said.

In January, the Ohio Department of Medicaid asked providers of behavioral health care to bill with an updated set of codes to match a national system of designating what services are provided. The Medicaid department, which had long been handling the mental-health care claims, continued to do so through June, when the responsibility was transferred to managed-care plans.

Tom Betti, press secretary for the Ohio Department of Medicaid, said that the data used by the Ohio Council — from the Ohio Legislative Service Commission — is not related to actual claims and that numbers have jumped since managed-care plans took over.

“Ohio’s work to modernize and rebuild the state’s behavioral health system, coupled with a healthy economy, makes it unfair to compare 2017 to 2018 numbers for several reasons,” he added.

Among them, Medicaid enrollment is down 3.65 percent, or by more than 39,000 patients; claims are being processed more accurately; more claims are being paid through other coverage, such as Medicare or private insurance; and urine drug-testing costs have been moved from providers to labs.

Of the roughly 3 million Medicaid clients in Ohio, 26 percent have been diagnosed with a mental-health or substance-abuse condition. Managed-care plans had long handled Medicaid claims for physical health-care services before moving into the mental-health arena.

It is part of a behavioral-health redesign plan that began in 2012 and included, in 2014, an extension of Medicaid coverage to 630,000 low-income Ohioans with mental-health care needs.

Among the goals were to center care on patients, tie reimbursement rates to a provider’s qualifications and performance, expand rehabilitation options and access to care, and increase collaboration among providers.

Betti said that $61 million in additional funds went to Medicaid-covered behavioral health services in July and August than in January and February.

“Medicaid staff have been very closely reviewing the ‘before and after’ spending for Medicaid behavioral health services,” he said. “Ohio Medicaid believes our analyses are based on more accurate data.”

Criss believes her numbers are solid and fears that the situation has gotten worse since July 1 as providers have continued to struggle to get claims paid. The Ohio Council, concerned about timely reimbursement, had asked that the switch-over be postponed; that was denied.

“No matter how you slice and dice the data, less money is going to client services for addiction and mental illness,” Criss said. “There is time for this administration to course-correct and make good on its promised investment; otherwise, this does not end well for Ohio’s families.

The Department of Medicaid numbers include advance payments of more than $110 million made by managed-care plans in July, August and September. These payments are not connected to specific claims but are loans made to help the providers who need them transition to the new system as kinks are ironed out.

Additional payments will be made in October, and providers are to begin repaying the loans in November. The Ohio Council has asked that the payments be extended and repayment delayed.

Miranda Motter, president and chief executive of the Ohio Association of Health Plans, said managed-care plans have been meeting weekly with the Department of Medicaid, provider associations and consumer advocacy groups to monitor claims-payment information.

“Managed-care plans remain committed to ensuring consumers continue to have access to the critical behavioral-health services they need, and are committed to working with providers who continue to need technical assistance,” she said.

David Royer, chief executive officer at the Alcohol, Drug and Mental Health Board of Franklin County, said he has heard from local providers large and small that technology problems are causing payment delays. If payments aren’t timely, he said, providers could face the prospect of layoffs. That could lead to reduced programming or taking out bank loans, which could mean interest payments and less cash available to expand needed services.

“The extension of the advances is so important so that not only can we sustain care, we can look to the future and how we can expand access to care,” Royer said. “We can’t afford to have these nonprofits fail … because it puts people at risk.”

Shawn Holt, president and chief executive officer of Maryhaven, a central Ohio mental-health care provider that specializes in addiction treatment, said he’s a little disheartened that delays in payments continue, making it difficult to consider ways to meet rising demand for addiction services.

Maryhaven opened a 55-bed Addiction and Stabilization Center in Merion Village in January and has since served 1,300 people, quickly filling beds, indicating that more are needed, Holt said. People are not being turned away, he said, but he’s concerned that further payment delays will force him to make “some very tough decisions.”
JoAnne Viviano, The Columbus Dispatch, October 1, 2018
Medicaid payment changes worry mental health care providers in Ohio