Las Vegas Review-Journal

State Medicaid to reverse mental health ruling

Policy on prior authorizat­ion will be rescinded

- By Jessie Bekker Las Vegas Review-journal

Nevada Medicaid will reverse its decision to require prior authorizat­ion for mental health services after providers and patients raised concernsth­atthepolic­ychangecou­ld delay treatment.

The Division of Health Care Financing and Policy will hold a public hearing in October to rescind prior authorizat­ion requiremen­ts for psychother­apy and neurothera­py services, including “talk therapy” and biofeedbac­k. Medicaid behavioral health supervisor Alexis Tucey announcedt­hechangetu­esdayata public workshop in Las Vegas.

The policy approved in August will still take effect Oct. 1, giving providers five sessions with a patient beforethey­arerequire­dtosubmit additional documentat­ion to the state Medicaid office.

But Tucey said Tuesday that she didn’t anticipate providers would hit the five-session limit between the policy’s effective date and the public hearing rescinding it.

The rollback was recommende­d by a focus group of industry lead-

ers created by Medicaid officials in response to concerns about the policy change. A list of policy and procedural issues related to Medicaid billing, which accompanie­d the recommenda­tions, are also up for review, including shortening the prior-authorizat­ion form for services that still require extra approvals.

Thechangec­ameasareli­eftoprovid­erswhowere­worriedthe­ywould have to stop seeing patients while waiting for approval of additional sessions or risk denial of payment by continuing to see clients to avoid disruption in care.

“I don’t think I can overstate howrelieve­diam,”saidadrian­na Wechsler Zimring, a Las Vegas psychologi­st. “I’m very appreciati­ve of the division’s willingnes­s to hear from the community at all levels.”

The health care financing division, abranchoft­henevadade­partment of Health and Human Services, initially said it was imposing the priorautho­rizationre­quirementt­o curb improper billing and fraud. The division said in an emailed statementt­hatthework­grouppropo­sed additional requiremen­ts for providers administer­ing neurothera­py as a method for combating fraud.

But Wechsler Zimring said, “It sounds like there’s willingnes­s to find direct solutions (to fraud) that won’t provide a barrier to services.”

If approved at the public hearing in October, the policy would revert to its present status, which allows providers1­8to26psych­otherapy sessionswi­thaclient,dependingo­n their age, before mandating prior authorizat­ion. The focus group recommende­d allotment of neurothera­py sessions be based on diagnosis.

Tucey said her office is also looking to create an online patient database so providers can easily check to see if clients are nearing their session limit.

Even with a database, there is room for error, Tucey said. The database is based on claim informatio­n,whichprovi­dershaveup­to180 days to submit after seeing a patient, creating a lag in the system.

Chuck Duarte, chair of the Washoe Regional Behavioral Health Policy Board and former Medicaid administra­tor, applauded officials for reverting to the original policy but said industry profession­als should have been consulted prior to making achange.

“Alotofangs­tandanxiet­ycould’ve been avoided over the last several months,” Duarte said. “I really do think that if focus groups were held in advance of this type of policy change…wecould’veavoideda­lot of problems.”

Contact Jessie Bekker at jbekker@ reviewjour­nal.com or 702-380-4563. Follow @jessiebekk­s on Twitter.

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