February 1st, 2017

Possible rate cuts of concern in Maine

The Maine Psychological Association’s (MePA) top legislative priority for 2017 can be found on page two of a consultant’s report studying reimbursement rates for mental health services through the state’s Medicaid program.

The hourly reimbursement rate for neuropsychological and psychological testing through publicly funded MaineCare health insurance would decrease from $79.20 to $60.41 under a recommendation in the March 2016 report by Phoenix consulting firm Burns & Associates.

“The waiting list for Maine-Care for those types of services are already a year long. So if you cut the reimbursement rate dramatically, nobody will offer the services,” said MePA Executive Director Sheila Comerford.

In 1997, Maine had 445 psychologists and psychological examiners enrolled as Medicaid providers. In 2004, that number had dropped to 179 and last year, there were fewer than 100, according to MePA.

MePA will focus its attention on blunting or reversing any rate cuts, Comerford said, adding that the association responded “vociferously” during a comment period last spring after the release of the rate study commissioned by the Department of Health and Human Services.

The association argued that when the consultant surveyed psychologists in the state for the rate study, the survey questions were directed at psychologists in agency or hospital settings.

As a result, the proposed new rates were not based on a representative sample that included the experience of those in private practice and the overhead costs they face.

In a letter to Burns & Associates last May, MePA President Elise C. Magnuson, Ph.D., LCSW, said a Maine neuropsychologist “would quickly ‘run in the red’ with a proposed rate of $60” when taking into account the costs associated with renting office space, disability, malpractice and other business insurance and retirement contributions.

“We have heard from neuropsychologists that the overhead expenses per billable hour for them are between $46 and $50,” Magnuson wrote.

In 2015, the State Legislature called for a review of how much mental health providers are paid for services in the MaineCare Benefits Manual. The rate study was commissioned after Republican Gov. Paul LePage’s administration proposed millions of dollars in rate cuts for child mental health service providers.

The rate study includes both reductions and increases, depending on the service. For instance, the hourly rate for a psychological examiner would increase from $50.22 to $52.01.

DHHS was scheduled to submit a completed rate study report to the Joint Standing Committee on Health and Human Services on Jan. 2. The Legislature declared a moratorium on any MaineCare rate changes until at least 60 days after the report’s release.

“We anticipate, and we’ve heard via the grapevine, that there are going to be huge cuts for services and so we’re just really going to be vigilant around that kind of thing,” Comerford said.

“We don’t have any huge legislative issues that we’re addressing beyond just watching what this rate cut is going to be,” added Diane Tennies, Ph.D., LADC, chair of the MePA Legislative Committee, which meets once or twice per month when the Legislature is in session.

Tennies said the association will continue to educate its members about a bill passed last year that requires the completion of a 20-minute online DHHS Office of Child and Family Services training course for mandatory reporters, who include psychologists, when they suspect child abuse and/or neglect.

“This bill has been interesting because it doesn’t say when one is supposed to have done the training, only that it’s sometime in the next four years. And we can’t figure out if you have to start it in the next four years or you have to do it every four years. It doesn’t specify,” Tennies said.

While MePA isn’t pursuing new legislative initiatives this year, Comerford said the association recently joined a Behavioral Health Coalition organized by state Rep. Joyce (Jay) McCreight (D-Harpswell), a retired social worker and clinical counselor who spent much of her career working in Maine public schools.

Coalition members include the Consumer Council System of Maine, the Maine Association of Substance Abuse Programs, Maine Human Rights Commission and providers like Auburn-based Health Affiliates Maine.

By Janine Weisman

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