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State Hopes to Fix Health Program's Major Problems

Posted on: Friday, 29 July 2005, 18:00 CDT

A state health program that encountered criticism for waste, fraud and poor treatment of many of the 7,000 mentally ill people it serves is undergoing a major revamp, state officials said Tuesday.

The changes are designed to curb rising costs of the Mental Health Rehabilitation Service and avoid abuses that denied some recipients proper care, Department of Health and Hospitals Deputy Secretary Raymond Jetson said.

Effective Monday, Jetson said, DHH will:

Move to a fee for each service, replacing a lump-sum method in which providers received the same amount, regardless of the treatment an individual received.

Limit help to patients who are in serious need of intense mental- health rehabilitation. Others will be referred to their primary care physicians or mental health clinics.

Increase monitoring of the patient outcomes.

Screen mental-health providers to insure they are qualified.

The services are funded through Medicaid, the government's major health insurance program for the poor and uninsured. The program is for adults who have been diagnosed with severe cases of bipolar disorder or schizophrenia that resulted in a disability, or for children with a range of behavioral or emotional disorders. The cost of the state-federal program escalated from $10 million in 1998 to $58 million in 2004. It was projected to cost $67 million in the current budget year.

"It's an unbelievable level of growth," Jetson said.

The Legislature appropriated $43 million, counting on the changes to make a serious dent in costs.

The dramatic increase in costs, plus problems found by state and outside monitoring, prompted the changes, Jetson said.

A 2003 report by The Advocacy Center found many of the state's low-income mental-health patients were getting incompetent care from private companies that committed fraud. The report documented poorly trained employees and companies that billed Medicaid for services that weren't provided.

The report also concluded that state health officials were poorly monitoring the care providers.

Advocacy Center executive director Lois Simpson said the changes indicate the state is taking the problem seriously.

"At least it will provide them with real services. What we saw before was something on paper with people pretending to provide services," Simpson said.

"The people we are talking about really need some professional help, not just people taking them to a McDonald's."Yakima Black, executive director of the Mental Health Association in Louisiana, said the changes will give those with mental disorders "more of a chance to get quality care," which has been lacking from some providers.

Black said some providers routinely took groups of patients to movies and restaurants instead of giving them the intensive individual treatment they needed.

Black said there is some anxiety from clients and providers about the new regulations. "Some of that has to do with the fear of the unknown," she said.

Keys to the success of the program will be closer monitoring and moving from per-person fees to fees for services, Jetson said.

The state has been paying providers $1,300 a month for each patient, Jetson said. He said one patient might need $1,600 worth of services while another might need only $500, "but you paid $1,300 for every one of them."

"So this is a more-individualized approach to services," Jetson said.

Jetson said DHH will focus "on making certain this program provides appropriate services, community-based mental health services to people who have an intense period of need, develop a treatment plan that helps people recover and move back to their life."

State activity in the area will be a continuing priority of The Advocacy Center, a nonprofit group that advocates on behalf of those with disabilities and the elderly, Simpson said.

Source: Advocate; Baton Rouge, La.

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