Advocates, legislators and state bureaucrats hope that regulatory changes that will increase Medicaid reimbursement rates for mental health services and cut red tape for doctors will help calm a growing mental health crisis in Arkansas.
For 18 months, a task force of mental health doctors, legislators, and Department of Human Services officials has worked on a report on how to modestly reform behavioral and mental health care in the state. The Arkansas Legislative Council on December 16 approved the report, which has been a guide for DHS rule changes and will serve as a roadmap for lawmakers in upcoming sessions. The state will increase Medicaid reimbursement rates to encourage more providers to accept Medicaid patients.
“I hope this is a big step in the right direction. That’s my hope,” said state Rep. DeAnn Vaught, who sponsored the legislation creating the task force. “Do I think it’s going to fix everything? No, because I think mental health is always on the go.”
Rates of depression and suicide among teens are rising, while jails and prisons are full of adults suffering from a wide range of problems, from increased drug addiction to untreated psychiatric problems, said Vaught, a Horatio Republican.
Those who suffer from behavioral health issues also need care, with fewer and fewer people in the field able to provide it. Department of Human Services officials have proposed changes to state regulations that would allow workers in similar fields to more easily fill mental health labor shortages. Since much of the emphasis is on home care, the department will change regulations to allow lay people in similar health care fields, supervised by physicians, to provide care.
Gavin Lesnick, a spokesman for the Department of Human Services, said the agency also finalized a list of rule changes that would reduce regulations for mental health care providers, known as manuals. The state’s Medicaid manuals are a set of regulations about how the state pays for services and what rules providers must follow.
Some mental health providers have said the current list of regulations is cumbersome, making it difficult to bill patients who are on the state’s Medicaid plan.
“The manuals that DHS used were old,” Vaught said.
The Licensed Independent Practitioner Certification manual, which is only required for health care providers who accept Medicaid, has 17 pages of rules that require doctors to be available 24/7 with a 15-minute response time, identifying any police or medical facility within a 50-mile radius, and passing an annual fire safety inspection.
Those regulations, which will be repealed starting January 1, apply only to mental health providers who treat clients on Arkansas Medicaid, leading some to accept only private insurance to avoid red tape.
“There are hundreds and hundreds of private practices in the state and I would say that most of them choose not to have a problem with Medicaid because they take responsibility for not following the rules because there are too many rules,” said Thomas Ritchie, a licensed medical professional counselor with practices in White and Lonoke counties.
For mental health professionals, much of the challenge is finding a way to provide more care with fewer doctors. Since the covid-19 pandemic and the resulting isolation, cases of mental illness have skyrocketed across the country, particularly with cases of depression and suicide.
Many mental health professionals said they have months-long waiting lists for outpatient treatment that have overwhelmed their practices and led to burnout.
“The burnout rate for therapists in the mental health world is high because we are chronically inundated with stories of trauma,” said Shawna Burns, a licensed mental health counselor at Harrison.
Burns said state Medicaid regulations that require freestanding clinics to be available 24/7 for emergencies with 15-minute response times on the phone and two-hour response times for face-to-face calls cara was difficult for smaller providers like her.
“They’ve reduced the number of regulations and barriers that are needed for providers to really access Medicaid recipients, and that’s a huge issue that’s also not talked about much because it really only applies to independent providers,” Ritchie said. “They removed a big hurdle in the way of the amount of intricate detail that we have to go into to have an office that can treat Medicaid recipients.”
The Department of Human Services said it will increase Medicaid reimbursement rates for many mental health services, including psychotherapy, which for many, but not all services, pays for 80% of what Medicare pays. The new rates will not match private insurance rates, but are intended to encourage more providers to accept patients who are covered through the state’s Medicaid plan.
“Just raising the rate was huge,” Burns said. “We need more providers to bill Arkansas Medicaid.”
The task force also recommended legislation in its report, which could be used as a guide for lawmakers in the next session. The report specifically calls on lawmakers to draft legislation to increase the number of psychological examiners, reimburse for childhood autism and maternal depression screenings, require depression and anxiety screenings to be covered by insurance, and review safe storage of firearms and chemical drugs.
The task force also stressed the need for more mental health screening in schools, as rates of depression and suicide have risen.
Vaught said the General Assembly is unlikely to approve all the recommendations in the next session, but the working group will meet again after the session ends.
“You can’t eat the whole elephant in one sitting,” Vaught said. “It will take several sessions for us to really work on these issues.”