The author is director of the Division of Medicaid and Long-Term Care for the Nebraska Department of Health and Human Services.
I read with interest a recent essay, “Prioritize behavioral health funding” (Jan. 24 Midlands Voices). The writer’s perspective is as a provider of behavioral health services who is also the president of an organization that includes other behavioral health providers. I believe his essay overlooked important facts.
I agree with the writer that good-quality behavioral health care is important for a number of reasons. For those unfamiliar with this term, behavioral health care includes mental health and substance abuse services.
Nebraska Medicaid benefits for mental health and substance abuse services are more comprehensive than most similar private insurance benefits in the state. To maintain the Medicaid program, we must do everything possible to manage costs effectively. Plans for moving to at-risk Medicaid managed care for behavioral health services will do this and will provide better care coordination for a broader range of clients.
The Nebraska Medicaid program is based on state and federal laws and regulations. It covers needy Nebraskans who meet certain requirements. They must meet financial criteria. The person must also be someone over 65, a person with a disability, a pregnant woman or a child under 19. Some parents of these children are also covered.
In a managed care model, the state Medicaid program contracts with a health insurance company to manage the care. The Nebraska Medicaid program has successfully moved to an at-risk managed care model for physical health and is now entering into at-risk managed care for behavioral health.
The managed care contractor is required to provide the same benefits in amount, duration and scope as are currently available under Medicaid. In addition, federal regulations allow a managed care contractor to provide value-added benefits and services otherwise not allowed to be covered by Medicaid. This is why moving to managed care provides better care coordination for a broader range of clients. All of these things will improve Medicaid-covered behavioral health services.
The essay’s writer suggested that the new payment rates for the managed care contractor are too low and not supported by Nebraska’s own Medicaid data. In fact, the payment rate structure was developed by an actuary with national expertise on Medicaid managed care case rates. The actuary used Nebraska Medicaid data for 2009, 2010 and 2011 and applied standard managed care assumptions. The rates follow requirements set forth in federal regulations and, upon finalization of the contract, will need to be approved by the federal Centers for Medicare and Medicaid Services (CMS).
The actuary also applied restrictions on rates set forth in Legislative Bill 1158, passed by the Legislature last year, which places stringent limits on any behavioral health managed care contract regarding the amount of administrative costs and profits allowed. The Nebraska limits are more restrictive than those allowed by CMS. As I warned in my testimony on LB 1158, the limits on profits and administrative expenses in that legislation could discourage some companies from bidding.
Nebraska Medicaid has received a bid from a national behavioral health managed care company with many successful managed care operations across the country. While it is disappointing that only one company bid for this contract, it is not unusual for states to receive only one bidder.
Lastly, the governor’s budget proposal includes a 2.25 percent increase in provider rates for fiscal year 2014 and another 2.25 percent increase for fiscal year 2015. This recommendation is significant in that it would increase state reimbursements to providers by over $93 million. That means the rates for providers of behavioral health managed care would also see these increases.
Let us not jeopardize the success of this effort to improve efficiency and delivery of behavioral health care in Nebraska by using scare tactics and overlooking important facts.