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SEPTEMBER 04, 2015

Behavioral Health Subcommittee Struggles With Applying Medicaid Rate Increase

A subcommittee of the Behavioral Health Partnership Oversight Council struggled Wednesday with how best to distribute a potential $8.3 million increase in Medicaid rates to more than 100 clinics throughout the state.

But lawmakers and Gov. Dannel P. Malloy had already cut $8 million in grant money to the clinics that serve patients with mental and behavioral health issues. An $8.3 million increase to the Medicaid rates, if it goes through, would be a consolation prize of sorts after the cuts that have left clinics to question how many patients they can treat.

Heather Gates, CEO of Community Health Resources, said she would like to know how much it would cost the state to bring the Medicaid rates for all the services up to the Medicare rates. Some of the services in the draft proposal were slightly above the Medicaid rates, but most remained below even though a majority saw increases from the current rate.

For example, one of the family psychiatry codes is reimbursed $108 under Medicare, but under the proposal will only increase from $76.40 to $84.43.

The calculations the Department of Social Services presented to the subcommittee Wednesday increased all the rates for children to the Medicare rate, but rates for things like adult group therapy were decreased as a result of some of the tinkering with the various formulas.

Even though children cost more to treat, Gates said that’s not why the rates were being raised. She said the rates were being raised because the state cut $8 million from the grants it gives providers of mental health services and substance abuse treatment facilities.

Those grants, according to Jeff Walter, interim president of the Connecticut Community Providers Association, offer more flexibility in the number of wrap-around services that could be provided to clients. He said the Medicaid dollars can only be spent on medical treatment, but there is other support for a patient that’s necessary, such as transportation to the clinic.

Gates said this rate increase, which ends up being $5.4 million for adults and $2.9 million for children, was supposed to go into effect last July.

She said the Medicaid rate increase, no matter what it ends up being, still won’t be enough to make up the loss of grant money. She said the Department of Mental Health and Addiction Services grant money is used on the neediest clients, but the Medicaid rate increase can be used on a larger universe of patients, so it still “harms the poorest and neediest.”

William Hasley, director of integrated care in the DSS Division of Health Services, said he would go back to the office and run the numbers again for the council.

“I don’t want to push something through when there’s not a consensus on the plan,” Hasley said Wednesday.

The amendment to the state Medicaid plan is due to the federal Centers for Medicare and Medicaid Services by Sept. 30. If the council misses the deadline, then the increases won’t be approved in time for them to claim reimbursement.

The subcommittee plans to hold a meeting on Sept. 9 before the full Behavioral Health Partnership Council meets to make a recommendation.

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