http://journalstar.com/news/state-and-regional/govt-and-politics/article_647de0d8-e918-11de-95f6-001cc4c002e0.html
By JoANNE YOUNG / Lincoln Journal Star
The testifiers seemed oceans apart at times.
The progress Nebraska has made in getting help for kids with mental and behavioral health problems bogged down in opposing viewpoints.
A committee of senators addressed the problems head-on Monday with pointed questions to state Medicaid director Vivianne Chaumont and Deborah Happ, a vice president with Magellan Health Services, the state’s provider of mental health managed care.
The Children’s Behavioral Health Oversight Committee, which monitors how the state is implementing a bill (LB603) passed earlier this year to provide those services, also heard from parents who’ve had difficulty getting services through Medicaid and Magellan.
Angie Thiel showed the committee a photo of her son Alex, 13, who has been in residential care at Boys Town for 14 months after a struggle to get Magellan and Medicaid to approve the intensive care that doctors said he needs.
“This is the reason a parent fights so hard,” she said, as her emotions got the best of her.
He is doing well at Boys Town, she said, but she often has had to fight to maintain that treatment as the state frequently reviews his case.
“It’s very difficult to continue to battle every time,” Thiel told the committee.
She never wants to be forced to make him a state ward to get him the services he needs, as some other parents have.
“But it’s something parents like us face. It’s very real,” she said.
Carol Stitt, executive director of the state Foster Care Review Board, said 554 children entered foster care in 2008 because of mental health or behavioral health issues. Many had no services in place when their cases were reviewed.
Nebraska has a contract that grants or denies services based on medical necessity, she said. But these kids have behavioral, not medical issues.
“And when they deny services,” she said, “it’s a rare (caseworker) who tries to take on Magellan.”
It appears many children go through a process involving unnecessary, repeated failure in lower levels of care, which require more placement changes, before Magellan will approve treatment originally recommended by a professional, she said.
Medicaid director Chaumont said it is a myth that children have to repeatedly fail at lesser services first.
Medical necessity is a requirement of federal Medicaid law, she said. If the Nebraska program pays for services not medically necessary, it risks losing federal funds, she said.
“The goal … is to provide a framework in which clients receive the right service, at the right time, in the right amount, at the lowest level of care that meets the client’s clinical need,” she told senators.
Nebraska ranks ninth in the country in use of residential treatment for children and youths, a trend the state would like to reverse, she said. The state’s vision is a system that serves more children in their own homes.
Magellan vice president Happ said the managed care company would never say no to a service without saying yes to another level of service.
Lincoln Sen. Bill Avery questioned how Magellan could deny services and then contract with and pay doctors to judge the appeals of those denials.
“That’s how insurance companies work,” Chaumont said.
“That’s a good thing?” Avery responded. “That’s under debate.”
Senators also questioned treatment of providers by Magellan.
Sen. Annette Dubas of Fullerton said of the 65 Nebraska therapists who participated in a survey by the Association of Private Practice Therapists at the end of 2008, many said they were considering reducing the number of Medicaid/Magellan clients they had, or had already done so.
The reasons were paperwork requirements, lack of clarity on how to comply, risk of not getting paid for work with clients, time involved keeping up with system changes, interference with the client-therapist relationship and low pay.
Therapists have said they fear calling Magellan because of the way they are treated, Dubas said.
Happ said Magellan has submitted a plan to the state to improve communication and training. She has a “very high” standard for how the company treats people, she said, and tries to treat everyone with respect.
“Let’s be frank,” Chaumont said. “A lot of providers don’t like managed care. They want to be able to provide the care they think is necessary. … Whatever they do just gets paid for and nobody asks questions.”
Managed care saves money, she said. And that savings is put into mental health services that otherwise might not be covered.
“I think we are continually trying to make a better system for managed care clients,” she said.
