On behalf of private providers, I would like to thank you for the opportunity to comment on the proposed changes to behavioral health services.  It should be noted, however, that up until today, no provider that I know of knew about these proposed changes or the opportunity to comment in the Town Hall format.  I encourage those that use this forum as a way of gathering input on proposed changes to be more pro-active in publicizing these opportunities.  Because providers are not notified of these opportunities, it appears as though nobody objects to the changes and that the agencies involved in making these changes have been transparent in their desire to gather input from stakeholders.  This is blatantly untrue.  As there have been very few comments and in networking throughout our area today there have been no providers who were aware of this posting, I also encourage that the timeframe for public comment for this particular Town Hall be extended.

There seems to be a general tightening of regulations and a general disregard for the provision of services to individuals who so desperately need assistance.  There seems to be little regard for businesses who are attempting to provide good services to the citizens of the commonwealth. 

Specifically, many of the changes affect services through the ability of providers to hire staff.  There is language in the proposals related to clinical experience that appears to state that the "Clinical Experience" of a QMHP can only be gained by working in the very programs in which their lack of experience disallows them from working.  Exactly how would someone gain experience in MHSS, ICT, PSR, etc. if they cannot be hired to work in those setting without the experience?  In addition, there is tightening of the qualifications in positions that require a licensed or licensed eligible individual.  The proposals state that a resident may only provide services if they are registered with the Board of Counseling with that specific site for licensure supervision.  The Board of Counseling sometimes runs 3 months or more behind in approving registrations.  What would a provider do with that employee while they wait for the Board to approve the individual?  In many parts of the state, there are an extremely limited number of licensed individuals and when providers are able to find licensed eligible, it takes time to register them. 

There is language in the proposals that seems to suggest the independent clinical assessments will be required in much broader fashion than was previously required, specifically for all age groups in MHSS.  Even if there is not a specific proposal for this at this time, there is a proposal that these types of assessments could be applied to any behavioral health service and that the only requirement is that DMAS give appropriate and timely notice to providers.  I am very concerned about what DMAS would deem appropriate and timely notice.  Also, the fact that CSB’s perform these assessments does not make them an “independent” clinical assessment, as the very services that these assessments recommend are provided by the CSB themselves.  In addition, many CSB’s only recommend their own services once the assessment is done and bar providers in certain services with assisting consumers to the assessment appointments stating that the provider has a financial interest in the client completing the assessment.  As a provider, we have seen case after case of delayed VICAP assessments due to this narrow vision on the part of CSB’s.  Clients who would otherwise complete the assessment with the support of a Crisis Stabilization worker, refuse to go back in the assessment for less intensive services due to severe anxiety and the CSB will then not complete the VICAP.  The thought that this could become the process for more behavioral health services is very alarming to consumers and providers alike.

Another concern is the wording that the criteria for services includes documented interventions related to previous mental health, social service, or judicial services.  This requirement added to the already burdensome documentation that is required for services, will once again make it much more difficult for consumers to receive services. 

My last comment relates to the language concerning violations to the marketing guidelines set forth by DMAS and also found in guidelines published by Magellan.  At this time providers are governed by a memo that states that the first violation of a marketing guideline will result in a $1,000 fine.  The second offense would result in a $2,000 fine and then the third offense would result in the provider losing their license.  These consequences have never been imposed on any providers in our area, even though we are aware of consistent violations to the current regulations.  Increasing the consequences will not matter if the consequences are not imposed when violations occur. 

Again, thank you for the opportunity to comment, I only wish that more stakeholders had been aware of this opportunity so that those gathering these opinions could have more input.