In April, at a legislative budget hearing, Lori Criss described the “growing pains” associated with the state’s ambitious Behavioral Health Redesign as “tremendous.” The new director of the Ohio Department of Mental Health and Addiction Services did not overstate the situation. The transition has been rocky during the past year, the fallout harming providers who have struggled to get paid and patients in need of care finding services curtailed and even denied.
Fortunately, something has been done to set things on a better path. Mike DeWine signed an executive order, effective Thursday, making changes to address the assorted flaws and shortcomings. It is telling that many in the behavioral health community who rightly blew their whistles applauded what the governor’s team has accomplished.
At the front have been Criss and especially Maureen Corcoran, the director of the Department of Medicaid. The DeWine team inherited a challenge defined a year ago when the John Kasich administration made clear its wish to complete by the end of its term in office the complex work of implementing new billing rates and codes — while shifting Medicaid behavioral health to managed care. The result wasn’t pretty, the rush allowing insufficient time to work through the inevitable bugs and unintended consequences.
Consider the trouble for group counseling, viewed as a best practice, and cost-effective, too. The billing rate was set at an inadequate level. Thus, availability narrowed, denying patients timely access to the care they needed. A similar problem affected crisis intervention and the nursing corps. The governor’s order takes the logical step of increasing the reimbursement rates for such services, better reflecting the high level of skill and revenue required, adding $50 million a year for the biennium.
The DeWine team also is looking to narrow the window for reimbursement. Medicaid typically paid claims within two weeks. Managed care operates on 30 days or longer, and the insurers have been paying a smaller share of claims. That tends to put the squeeze on many providers already facing fragile finances.
It is worth stressing that there long has been wide agreement on the need for the Behavioral Health Redesign. The changes are seen as part of achieving necessary parity for the treatment of mental illness and addiction, integrating behavioral health into Medicaid managed care, achieving efficiencies, raising quality and expanding services. That said, many providers warned, correctly, that moving too fast would jeopardize treatment and care.
Which gets to what has been distinctive about the approach of Maureen Corcoran, Lori Criss and colleagues. They have looked to include the many stakeholders in the discussion from the start, listening, taking cues from the collective expertise and presenting changes before moving ahead. It’s hard to exaggerate the extent of the departure from the heavier handed, more top-down approach of the Kasich team.
The result is the praise expressed in an open letter by Terry Russell, the executive director of the National Alliance on Mental Illness of Ohio, calling the executive order “a turning point” in successfully implementing the redesign.
Russell notes the state also makes advances for mental health in the new state budget. That includes investing in the home visiting program to help at-risk mothers care for infants, plus a program that ensures parents do not have to give up custody to the state so they can get residential treatment for their child.
Not that the state has addressed all the priorities regarding mental health and addiction. NAMI Ohio has its own worthy agenda, from additional state hospital beds to expanded options for crisis care. Yet mobilizing to repair the Behavioral Health Redesign has been the urgent need across the state. Now it has been launched.