Oklahoma mental health agency places moratorium on Medicaid contracts for some therapists

June 27--Newly licensed therapists in private practice, other than psychologists or psychiatrists, no longer will be reimbursed by the state for treating Medicaid patients.

State Mental Health Department leaders say the move will save the agency thousands of dollars, but also comes at a time when the state faces a mental health crisis and a lack of trained professionals to help those in need.

The Oklahoma Department of Mental Health and Substance Abuse Services board voted at its meeting Friday to approve a moratorium on any new contracts to licensed professional counselors, social workers, marriage and family therapists or any other master's-level clinicians who work in private practice and want to provide services to SoonerCare patients.

The board also approved a rate change for the same group of providers.

The agency estimates the changes will save about $500,000, helping to balance its budget after not receiving its full appropriations request from the Legislature.

About five years ago, the Oklahoma Health Care Authority, which administers SoonerCare, the state's Medicaid program, changed its policy to allow master's-level clinicians to be reimbursed for care they provided in private practice, rather than at community mental health centers, substance abuse treatment facilities or other agencies.

State mental health deputy commissioner Carrie Slatton-Hodges said the health care authority originally changed the policy for two reasons; there weren't enough mental health providers in rural Oklahoma and the state lacked professionals to provide specialty mental health care.

But in the last five years, the policy change did little to relieve either problem, Slatton-Hodges said.

"As we've analyzed the data, what we've seen is that the vast majority of these are in Oklahoma City and Tulsa where we already have plenty of access, and they're not providing specialty care," Slatton-Hodges said. "So there really hasn't been an added boon to anybody for access."

Three years ago, authority over mental health services transferred to the Oklahoma Department of Mental Health and Substance Abuse Services, which started overseeing SoonerCare patients' mental health and substance abuse care.

If the Mental Health Department sees that more of these clinicians are applying to provide specialty care or wanting to work in rural areas, they would reassess the moratorium, doing so on an individual basis, Slatton-Hodges said.

Questioning effectiveness

Paul Davis, community engagement director at Mental Health Association Oklahoma, said mental health and substance abuse provider agencies have long been opposed to the private practice reimbursement policy, arguing that it gives clinicians no incentive to work at agencies, where they could serve more people.

Also, there's a concern that these clinicians graduate from college and go into private practice without the experience they need, he said.

Davis said he wasn't opposed to the move but that it brings up questions about what role individual practitioners play in providing services to SoonerCare members.

"It's a little bit of an aggressive step in my opinion for them to come out and do a moratorium like this," Davis said. "It's essentially them trying to shut the individual contracting down without going through the rules process, and granted, they're not going backward, but through attrition, you'll lose a lot of those contracts."

Lowering rates

The mental health agency's board also voted to approve a rate change for some providers.

Currently, master's level clinicians who work in private practice are paid more for services to SoonerCare patients than the same clinicians working in agencies. However, the board approved a change that equals out that rate.

"It will lower the rate that the individuals currently contracted are paid slightly, and those two changes together will yield us about $500,000," White said.

Newly licensed therapists in private practice, other than psychologists or psychiatrists, no longer will be reimbursed by the state for treating Medicaid patients.

State mental health department leaders say the move will save the agency thousands of dollars, but also comes at a time when the state faces a mental health crisis and a lack of trained professionals to help those in need.

The Oklahoma Department of Mental Health and Substance Abuse Services board voted at its meeting Friday to approve a moratorium on any new contracts to licensed professional counselors, social workers, marriage and family therapists or any other master's-level clinicians who work in private practice and want to provide services to SoonerCare patients.

The board also approved a rate change for the same group of providers.

The agency estimates the changes will save about $500,000, helping to balance its budget after not receiving its full appropriations request from the Legislature.

About five years ago, the Oklahoma Health Care Authority, which administers SoonerCare, the state's Medicaid program, changed its policy to allow master's-level clinicians to be reimbursed for care they provided in private practice, rather than at community mental health centers, substance abuse treatment facilities or other agencies.

State mental health deputy commissioner Carrie Slatton-Hodges said the health care authority originally changed the policy for two reasons; there weren't enough mental health providers in rural Oklahoma and the state lacked professionals to provide specialty mental health care.

But in the last five years, the policy change did little to relieve either problem, Slatton-Hodges said.

"As we've analyzed the data, what we've seen is that the vast majority of these are in Oklahoma City and Tulsa where we already have plenty of access, and they're not providing specialty care," Slatton-Hodges said. "So there really hasn't been an added boon to anybody for access."

Three years ago, authority over mental health services transferred to the Oklahoma Department of Mental Health and Substance Abuse Services, which started overseeing SoonerCare patients' mental health and substance abuse care.

If the Mental Health Department sees that more of these clinicians are applying to provide specialty care or wanting to work in rural areas, they would reassess the moratorium, doing so on an individual basis, Slatton-Hodges said.

Questioning effectiveness

Paul Davis, community engagement director at Mental Health Association Oklahoma, said mental health and substance abuse provider agencies have long been opposed to the private practice reimbursement policy, arguing that it gives clinicians no incentive to work at agencies, where they could serve more people.

Also, there's a concern that these clinicians graduate from college and go into private practice without the experience they need, he said.

Davis said he wasn't opposed to the move but that it brings up questions about what role individual practitioners play in providing services to SoonerCare members.

"It's a little bit of an aggressive step in my opinion for them to come out and do a moratorium like this," Davis said. "It's essentially them trying to shut the individual contracting down without going through the rules process, and granted, they're not going backward, but through attrition, you'll lose a lot of those contracts."

Lowering rates

The mental health agency's board also voted to approve a rate change for some providers.

Currently, master's level clinicians who work in private practice are paid more for services to SoonerCare patients than the same clinicians working in agencies. However, the board approved a change that equals out that rate.

"It will lower the rate that the individuals currently contracted are paid slightly, and those two changes together will yield us about $500,000," White said.

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