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story.lead_photo.caption The Arkansas Department of Human Services at Donaghey Plaza in Little Rock is shown in this April 28, 2019 file photo. ( Josh Snyder)

Citing reduced reimbursement from the state Medicaid program, two more providers serving Arkansas' mentally ill have closed or announced plans to do so.

Points of Light, a 44-bed assisted living facility in West Memphis, shut down Nov. 22, Arkansas Department of Human Services spokeswoman Marci Manley said.

Perspectives Behavioral Health Management, a Fort Smith company that had provided counseling and other services to about 2,500 patients, will close Friday, said Linda Short, one of the company's owners.

The closing is due to "DHS' massive cuts, and more cuts that are coming in the future," she said.

"We just can't make it," she said.

In a Nov. 7 letter to the Human Services Department, Rick Draper, an owner of Points of Light, described waiting up to eight weeks for a state contractor to perform assessments of new residents' care needs.

The state Medicaid program in 2018 began requiring recipients to have such assessments before it would reimburse facilities such as Points of Light for providing assistance with tasks such as dressing and bathing.

Draper, who declined to comment to the Arkansas Democrat-Gazette, is listed in federal records as chief executive of Life Strategies of Arkansas, which had provided mental health services to residents at Points of Light.

The closures come amid a shakeup in the state's mental health landscape after an overhaul of how the state Medicaid program pays for mental health services.

Little Rock Community Mental Health Center, which had been in operation for more than 50 years and had about 2,500 patients, shut down in September.

A month later, four of the state's 12 community mental health centers announced that they would merge, saying in part that it would create "a financially stronger and increasingly sustainable organization."

"Providers and beneficiaries have been in constant limbo for 3 years," Bess Ginty, chief executive of Kids for the Future, a Forrest City-based organization serving children with developmental disabilities or mental illness, said in a statement.

Her firm and Perspectives are among dozens of companies that had been certified as providers under the Rehabilitative Services for Persons with Mental Illness program, which ended in July 2018.

The replacement program, known as Outpatient Behavioral Health Services, lowered fees that had been paid to such organizations, increased them for independent counselors, and allowed those counselors to serve all Medicaid recipients instead of only those under age 21.

Around the same time, providers say, the state Medicaid program, which covers low-income people, began refusing to pay for individual or group therapy for recipients who are also on Medicare, the federal program that provides health benefits to the elderly and disabled.

Medicare will pay for individual or group therapy, but only when it's provided by certain professionals, including clinical psychologists and licensed clinical social workers.

The change "has been a problem for all behavioral health agencies in the state of Arkansas," said Rusti Holwick, chief executive for the Fort Smith-based Western Arkansas Guidance and Counseling Center, which is taking over much of Perspectives' caseload.

"Medicare providers are in demand, and it's really hard to cover all the bases for clients who need a Medicare provider," Holwick said.

Although the state hired managed care companies starting March 1 of this year to take over the health coverage of Medicaid recipients with significant mental illness, it required the companies to continue following the same payment rules for Medicaid recipients who are also on Medicare.

In an Oct. 17 email to a Human Services Department official, Perspectives' interim chief executive, Kerri Tucker, said her firm had just one licensed clinical social worker to serve patients living in residential care facilities in Clarksville, Paris, Mulberry, Greenwood and Barling.

The social worker "has agreed to provide services one day per week to the adult chronically ill population at one of the sites," Tucker said in the email.

"That leaves 43 individuals that we serve that are without a Medicare provider for professional therapy services," Tucker wrote.

She said the clients were being served "at a total loss" by licensed professional counselors, who are not eligible for Medicare reimbursement.

"From a business standpoint this is difficult to say the least," Tucker wrote.

Licensed professional counselors are required to have a master's degree in counseling and 3,000 hours of supervised experience.

Licensed clinical social workers must have a master's degree in social work and at least 4,000 hours of supervised experience.

Manley said that providers can bill the managed care companies for services, such as partial hospitalization and therapeutic communities, that aren't covered by Medicare.

Those services are meant for "high needs" patients and include counseling as part of a daily rate, she said.

Draper, the Points of Light owner, said in the Nov. 7 letter that he had been hoping the state would increase the reimbursement rate for services provided by facilities such as his on Jan. 1, when the state's minimum wage is set to increase from $9.25 per hour to $10 per hour.

"It now appears that if a rate increase is coming, it will not be implemented that quickly," Draper said in the letter. "Consequently, we no longer see a way forward."

Manley said state officials are "considering changing the rate, but there is no definite date for when that would occur" or what the new rate would be.

She said most facilities such as Points of Light that accept referrals from hospitals schedule the assessments to occur before the patient is discharged.

A Section on 12/09/2019

Print Headline: Medicaid changes hit mental health services in state; payment cuts cited as providers shut


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