Share

Archives: KHI News Service

On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

Feds: Kansas mental health screenings require reforms

Governor vetoed provision that would have restored screenings in question

By Meg Wingerter | March 11, 2016

Feds: Kansas mental health screenings require reforms
Photo by Dave Ranney Gov. Sam Brownback vetoed a provision that would have reinstated mental health screenings after federal officials threatened to reduce the state's Medicaid funding.

Federal officials found fault with the way Kansas had screened people for admission to psychiatric hospitals, but left the door open for the state to divert patients if it reforms the screening procedure.

Gov. Sam Brownback vetoed a section in Senate Bill 161 that would have reinstated a requirement that Medicaid recipients be screened before admitting them for inpatient psychiatric treatment. Brownback said he supports the screenings, but the Centers for Medicare and Medicaid Services have threatened to reduce state funding for health programs by up to $1.8 million because of the requirement.

The issue is parity. Under federal law, insurers, including Medicaid programs, can’t put restrictions on mental health and substance abuse benefits that don’t exist for a comparable medical or surgical benefit. A CMS official, who declined to give his or her name, said it appears to be a violation to require a person to be screened before he or she can be admitted for inpatient psychiatric care, but not to require a similar screening for a person being admitted for a physical condition.

CMS didn’t rule out requiring mental health screenings, but the state would need to have other, unspecified “criteria” that would ease concerns about parity, the official said. Both CMS and Brownback’s office said they are discussing ways that the state could conduct some form of screening without violating parity.

“Other states use a prescreening process to make recommendations regarding admission, but more often whether to divert to community services,” the CMS official said. “Our understanding is that Kansas proposed to use this process to make a decision regarding admission to an inpatient facility, and payment for that admission. There was no such requirement on the medical/surgical side for any inpatient admissions.”

Angela de Rocha, spokeswoman for the Kansas Department for Aging and Disability Services, said CMS considers the screening for Medicaid recipients a form of prior authorization. KDADS changed its screening policy in October 2015 so that screenings wouldn’t be required before a person covered by Medicaid could be admitted for inpatient mental health treatment in a private or community hospital, she said.

“Kansas received anecdotal feedback that the screens, in some instances, were creating unnecessary delays in access to treatment for hospitals with psychiatric units,” she said.

Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas, said he was disappointed in Brownback's decision to veto restoring the screenings, and hopes Kansas will make the case that its screenings are an appropriate way to place people who need mental health treatment in the least restrictive setting possible.

"We would argue the screening process has been diversionary," he said. "It seems like this is something that can be fixed."

The current procedure is for medical staff at the hospital to determine if the person needs to be hospitalized, de Rocha said. The three managed care organizations that administer KanCare still could determine that a hospital stay wasn’t necessary and decide whether to pay fully for the care, she said.

Kessler said he has heard some concerns that private inpatient beds have been filling up, because the people present at the screenings aren't also aware of what community resources are available. In some cases, that leads to people being admitted to state hospitals, because local inpatient facilities don't have space, he said.

Kansas’ community mental health centers still are required by statute to screen people before they are admitted to the state psychiatric hospitals at Osawatomie and Larned. Medicaid also doesn't pay for care in psychiatric hospitals are most conditions.