The proposed regulations state that an LMHP, LMHP- Supervisee, or LMHP- resident must complete, sign and date an ISP.  In many parts of the state, there is a significant shortage of LMHP's, making this a very difficult and costly regulation to adhere to, and in some cases, will make it impossible for providers to stay in business.  This will severely impact the access to care for individuals who need this service.  While there are more LMHP-Residents/Supervisees which would seem to increase provider's ability to fill these positions, LMHP-Residents/Supervisees will be unable to fill these positions because the hours they would spend writing ISP's will not count toward their licensure hours.  Recent regulation changes seem to imply that MHSS is a less intensive and less clinical service than was previously thought.  Supporting documentation for recent changes state that the service is skills based and can be done by QMHPP's.  If the service is less clinical, it should not be one of the only services that require an LMHP to write the ISP.

Proposed regulations state that Crisis Stabilization will require an authorization as opposed to a registration.  Currently, the timeframe on receiving an approval for other services is anywhere from 2-5 days. When a client is referred for crisis services, their symptoms are such that a 2-5 day wait before the start of services would be very detrimental to their mental health and possibly their safety.  This could also lead to clients needing access to more expensive levels of care such as emergency room visits and/or psychiatric hospitalization.  If providers are to start services prior to receiving the authorization, are they guaranteed payment for the hours spent serving the client if the authorization is eventually denied? 

Proposed regulations state that the ISP will set forth the number of hours and days a client will receive services.  In the course of treatment, a client's needs fluctuate a great deal depending on outside influences.  Will providers be paid for hours/days which are outside of the stated need on the ISP, and if they are paid, will these extra hours/days be considered for repayment during an audit?

In previous versions of these proposed regulations, there was language that proposed a change in the unit structure and in the reimbursement rate for MHSS.  We support the deletion of this language.  While providers would need time to adjust to a change in the unit structure due to the needed change in systems, electronic records, etc., that in itself is not an issue.  The issue with former proposed language is the change in reimbursement rate.  The proposed rate changes would have had a significant impact on providers and would not have been budget neutral.  Providers estimate that there would have been a 10-25% reduction in revenue based on the formerly proposed rates.  This amount of reduction would have made it difficult for many MHSS providers to stay in business and those that did would not be able to afford the quality assurance and supervisory positions necessary to ensure quality services.  We strongly support the deletion of this language from this version of the proposed regulations and hope that any further discussion of changes in reimbursement rate be discussed with input and supporting data from providers to make sure that any changes in rates do not significantly impact the access to this service for clients.

Proposed regulations propose adding Non-Residential Crisis Stabilization as a higher level of care in the consideration of MHSS eligibility criteria.  We strongly support the addition of this service as a higher level of care as the services that are provided in this service are the same as Residential services, they are just provided in a different setting.  There are many clients who refuse to consider inpatient/residential treatment based on their life circumstances.  One example of this would be those clients who are single parents with little/no extra supports.  If a client in this situation goes into a residential setting to receive services, there is nobody to care for their children and many times the children will then be taken away from the parent.  Non-residential CSS is able to work with the client that requires that higher level of care in the community, getting them the help they need and still maintaining their parental rights.  It is unfortunate that currently these individuals do not qualify for MHSS when they desperately need it and could benefit from the services. 

Thank you for the opportunity to comment on the proposed regulations.