Medicaid changes worry some providers

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 alltime 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.