Not all in loop, but group-therapy caps pass

Motion at Legislative Council meeting left some confused about subject of vote

Sen. Terry Rice, R-Waldron
Sen. Terry Rice, R-Waldron

A legislative body on Friday gave final approval to a limit on a mental-health benefit for Medicaid recipients, but not everyone at the meeting knew what they were voting on.

The change approved by the Legislative Council will limit Medicaid reimbursement for group psychotherapy to one hour a day, instead of an hour and a half a day. The change also caps the total number of hourlong sessions to 25 per year per person although providers can apply for exceptions to that rule.

When the proposed rule came up Tuesday at a council subcommittee, providers said it would disrupt patient care and force treatment facilities to close. The rule was proposed because of the amount of money spent on the service.

On Friday, some lawmakers thought action on the change would be held for a future meeting. One of those who believed that was Rep. Chris Richey, D-Helena-West Helena.

"What happened was there was a group of us that had the understanding that there was going to be a motion made to submit back to Rules and Regs," he said in an interview, referring to the council's Administrative Rules and Regulations Subcommittee. "When the actual motion was read to review the committee report -- and something else had been delayed and was going to be heard at a later date -- we misunderstood."

The rule change originated from the rules and regulations subcommittee. That subcommittee's report to the council noted that the state Department of Human Services asked the council to hold action for a future meeting on a rule related to "behavioral health services." The Legislative Council reviews actions of state government in between sessions of the General Assembly.

However, action on the mental-health rule in question, which was called "Rehabilitative Services for Persons with Mental Illness (RSPMI) Update #1-16" on the report, was not held up, and lawmakers adopted the report in a voice vote.

Sen. Bill Sample, R-Hot Springs, a co-chairman of the council, said he knew that members were voting on the rule change, but he had heard complaints about the process and it had taken him a few hours to sort out what happened.

Sen. Terry Rice, R-Waldron, who made the motion to adopt the report, said he did so only because the subcommittee's co-chairmen were not at the meeting.

Sample had said early in the meeting that the council would return to the rules and regulations subcommittee report because a subcommittee co-chairman, Sen. David Sanders, R-Little Rock, was late.

Toward the end of the council meeting, Rice made the motion and said: "One rule -- DHS behavioral health -- would be rescheduled on a later agenda per the agency's request. All other rules were reviewed and approved. I move adoption."

Marty Garrity, director of the Bureau of Legislative Research, "gave me a copy of the prepared statement -- that they prepare for all the committees -- to read if [Sanders] didn't get there in time," Rice said in an interview.

"He did not get there in time and when I was called on to read it, I did so, and paused and went ahead and moved that. That's when discussion would normally come. There was not any and, lo, to my surprise."

Rice said if there's enough confusion, he would support an effort to expunge the vote at a future meeting.

Sample said it would take two-thirds of the Legislative Council to do so.

"That would be a monumental task," he said.

"There wasn't any attempt to go and mislead anybody," Sample said. "I went back and looked at the motion that Sen. Rice made and he read the motion off verbatim. I know that the providers had planned to object and call for a vote, but they didn't do it."

Medicaid Inspector General Elizabeth Smith proposed the rule change after AdvanceMed, a company with a federal contract to monitor Medicaid and Medicare spending in Arkansas and six other states, found that health care providers in Arkansas billed for group therapy services more often than did their counterparts in the other states.

From 2013-15, the state Medicaid program spent $147 million on group psychotherapy, more than the amount spent by the Medicaid programs in Alabama, Georgia, Louisiana, Mississippi, Tennessee and West Virginia combined.

Alabama, which had the highest total next to Arkansas, spent $8.3 million on group psychotherapy.

"When the federal contractor came to us, my first thought was that there was fraud, but then we realized that our policies were so broad that we were allowing more spending than the other states," Smith said in an interview Friday. "We're working on turning the tide for that."

Comparing Arkansas with Alabama, Georgia, Louisiana and Mississippi, AdvanceMed found that Arkansas was the only state with no annual limit on group psychotherapy sessions. Tennessee and West Virginia were not included in that comparison because information on annual limits in those states was not available.

If Arkansas previously had capped the therapy sessions at one hour, it would have saved $31.5 million in state and federal Medicaid spending from 2013-15, AdvanceMed found.

Limiting the therapy sessions to 25 per year, even without capping the session length, would have saved the state $70 million over the same period, the company found.

"The premise is that they would have therapy and they would graduate to something different," Smith said. "We don't believe this will negatively affect patient care. That's the last thing that we want to do."

Robin Raveendran, director of the Alliance for Health Improvement, which represents mental-health care providers, said in an interview Friday that providers will close because of the rule change.

He said he had planned testimony to that effect for the Legislative Council meeting.

He said the Alliance for Health Improvement had a plan to save the Medicaid program about $40 million.

"Testimony was supposed to take place that didn't take place," Raveendran said. "Everything was agreed to the best of my understanding and they were going to send it back to the subcommittee, but there was some misunderstanding."

Rep. Nate Bell, an independent from Mena, said he was on the fence about the rule change, but leaned slightly in favor of it.

"I don't know exactly what went down," he said of the Legislative Council's meeting.

"The Republicans haven't figured out how to be the majority party and the Democrats haven't figured out to how to function as the minority party. So, the consequence of that is that both of them occasionally mess up."

A Section on 09/24/2016

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