The leaders of some Kansas community mental health centers say they are having trouble getting paid for some Medicaid services they believe their clients need.
Brenda Mills, CEO of Family Service and Guidance Center, a Topeka-based community mental health center that serves children, spoke Thursday at a meeting of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight.
Mills told committee members that some of the three private insurance companies that run KanCare, the state’s privatized Medicaid program, had raised objections to the center’s psychosocial treatment practices. Psychosocial treatment uses games and activities that are part of daily living to help children learn to manage feelings like frustration and anger in appropriate ways.
The insurance companies, also known as managed care organizations or MCOs, have authority to look for outliers in prescribing patterns, which is appropriate, Mills said. But she said some MCOs flagged a problem when they saw an increase in psychosocial treatment during the summer — which reflects the fact that children aren’t in school and are available for more intensive therapy.
One MCO told the center to cut the amount of psychosocial therapy this summer to half of what it provided last summer, Mills said. She declined to specify the MCO and said the center didn’t comply because of concerns it wouldn’t be meeting children’s needs.
“Upfront, we were told, ‘Don’t provide as much psychosocial (therapy) this year,’” she said.
Mills said she and other center employees have tried to explain why they provided that level of service and sent the MCOs documentation of the sessions. She hasn’t received much communication on the subject, but she said she hopes the center won’t have to repay the reimbursements it has received.
“We’re always going to err on the side of the kids and to provide what’s needed, and not just 50 percent of what was provided last year,” she said.
“It's simply difficult to be accountable to three masters and, in the case of the state, maybe a fourth master.”- Marilyn Cook, executive director of ComCare in Wichita
Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas, said during Thursday’s meeting that some other centers have had problems with reimbursements. In some cases, the MCOs decided not to pay for an entire hour of psychotherapy, he said.
Setting limits on reimbursements puts centers in the difficult position of not providing services that patients need or not getting paid for them, Kessler said. It also may run afoul of federal law forbidding greater restrictions on mental health care than on medical care, he said.
Marilyn Cook, executive director of ComCare in Wichita, said her center has been providing some services that it can’t bill for but help keep clients out of the state hospital. For example, ComCare can’t bill for times when a client in a crisis stabilization bed is asleep but requires safety monitoring — and sleep may be helpful to the person’s mental condition, she said.
The center also isn’t reimbursed for the time employees spend trying to provide different types of documentation each MCO wants, Cook said.
“It's simply difficult to be accountable to three masters and, in the case of the state, maybe a fourth master,” she said.
Not all of the comments on KanCare were negative, however.
Mills said the MCOs have assisted with getting children treatment in another state when they needed a service not available in Kansas, and Cook said they had supported efforts to treat clients’ physical and mental health needs together.
Kessler also pointed to a proposal to start covering grief counseling as a promising sign.
“I would be remiss by not mentioning some of the promise we believe that still exists for KanCare,” he said.