Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
Amount, Duration, and Scope of Medical and Remedial Care and Services [12 VAC 30 ‑ 50]
Action Mental Health Skill-building Services
Stage Proposed
Comment Period Ended on 10/23/2015
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10/20/15  3:32 pm
Commenter: Owner in the Private Sector

EVERYONE MUST READ- Feedback on Proposed Changes


I recognize as a private provider and someone who has been in the mental health field for over 12 years that costs affect the nature of business in VA.

However, I believe that we have lost site of the true nature of our business and that is helping those with mental illness. We are out here in the trenches supporting those that have been left behind in almost every other aspect of their life. We are in a position where we can change the course of their direction and guide them to their ultimate destination and ultimate potential.

The more recent changes requiring hospitalization from adults with mental illness has made it nearly impossible to provide proactive assistance to individuals. All we can do is provide reactive assistance to these individuals after they have decompensated and are in crisis. Making not only our job 10 x’s harder but also making it even more difficult for the client to get back on their feet, when we could have just assisted with stabilization from the beginning with or without the hospitalization requirement.

The pattern for VA funding has been to make these regulations more and more stringent over the last few years.

What I find hard to believe is that instead of taking a hard look at private sector companies who abuse the privilege of billing for Medicaid funded services and stopping them, or demanding re payment, the decisions made by our government penalize all private providers!

There are horrible unethical private providers!!! There are also outstanding private providers out here doing things ethically and with purpose!!!

Shut down or penalize the providers who are fraudulently billing for services or not providing quality care. I used to worked for an agency that committed millions of dollars’ worth of fraud. I did everything I was supposed to when I discovered fraud within the company. I reported it to Licensure and the Medicaid Fraud Unit with a heavy heart. From there an investigation ensued for over 2 years, part of it under seal. The government then chose not to intervene, and passed the buck to my attorneys. There were not enough people within the company to back the story (hence why they call it a whistleblower suit, qui tam litigation, aka no one else knows because it’s only at the top).

It was explained that basically this wasn’t a case with a large company, more of a mom and pop, so therefore it just wasn’t worth their time anymore. After another almost year of attorney’s stepping into the governments’ shoes to continue to pursue qui tam litigation the case was all of a sudden dismissed sighting because the disclosure statement did not contain enough detail. This was after setting trial dates, and preparing to attend a trial date to compel the other company to produce evidence within a couple of weeks. While a very detailed disclosure statement was provided, the THOUSANDS of documents were not able to be presented at that point in litigation. Therefore, millions of dollars walked out the door. I used the system provided to me. I did what was ethically sound.

And for that I am repaid by now worrying that my now business will be greatly affected by rate cuts, qualification changes, and more upheaval to the delivery of Mental Health Skills Building Services.

In addition, let's have Licensure regulations and expectations that are the same across the board for ALL private providers. On paper it may appear that way, but each Licensure Specialist has their own requests and requirements and each private provider is at their beck and call in order to continue to receive a license in good standing.

It is inconceivable that the Community Service Boards can provide the needed services at the rate and frequencies needed by these mentally ill individuals. I have spoken to clients who have utilized CSB services and the response is always the same. The staff come once a week to check on them, they don’t know who their Case Manager is because they haven’t seen or heard from them in so long, the waiting list is over a month long, they are not accepting new patients for psychotropic medications, and on and on. They mean well, but it's just inconceivable to expect them to be able to manage it all.

A man called my company on the phone in crisis and I was able to verify his insurance, verify he met all the Medicaid criteria for services, and then send an Intake Specialist and Staff member out to the house to conduct the intake assessment, staying on the phone with him until they arrived. Then from there he was able to receive 1:1 direct care from a qualified staff member 3-4 times per week.

We are the ones who provide the reports to the CSB for their files and to count as their contact. We do all the ground work and keep these individuals afloat.

Virginia we have to do better!!!! Stop this madness!!! Please think about who you will effect before making more changes!! Address the real problems!!!

I also support the VACBP comments to the proposed Mental Health Skill Building Changes:

Regarding the proposed regulation which states that LMHP, LMHP- Supervisee, or LMHP- resident shall complete, sign and date an ISP:

In order for providers to have an LMHP/LMHP-like staff member to complete ISP’s, additional staff will need to be hired.

  • In many parts of the state, there is a severe shortage of licensed or licensed eligible individuals to fill these positions.  If this change is approved, MHSS providers will likely not be able to fill the needed number of positions, resulting in a reduction or elimination of the service. 
  • It is our experience as private providers that those licensed or licensed eligible staff who are available are not apt to take jobs such as these because they are paperwork intensive and their training causes a desire to work with people, not just fill out papers.  In addition, the work that would be required of these positions does not meet the requirement for hours toward licensure and as such does not make these jobs attractive to licensed eligible individuals, making it even more difficult to find staff to fill these roles.
  • If this change is adopted for this service, it may be the only service that does not permit QMHP-A or QMHP-E credentialed professionals to complete an ISP.

This approach to writing the ISP’s seems contrary to current trends.

  • The definition, scope of service and intent of MHSS has been modified to the point that regulatory bodies state that a QMHPP can provide the service, implying that the service is less intensive than others, yet it now requires and LMHP to write the ISP. 
  • To the extent these ISP’s could be written, they would be written by staff who have very little contact with the client.
  • Approving this change will reduce access to services that are needed by Virginians who suffer from serious mental illness.

Regarding the proposed regulation requiring an authorization for Crisis Intervention and Crisis Stabilization:

  • Currently, registration is required and can be done expeditiously. The timeframe for receiving an authorization for other services is anywhere from 2-5 days.  Considering that a client is in a crisis situation when they come into this service, it does not seem feasible to wait for an authorization to be approved to begin services.  An authorization requires a large amount of paperwork and this would further delay the beginning of actual services during a critical time.
  • If the intention is for providers to begin services without an authorization, are providers guaranteed payment if the authorization is eventually denied?
  • Delays in the beginning of the provision of these services could lead to clients seeking more expensive and intrusive higher levels of care.

Regarding the proposed regulation that Service Specific Provider Intakes (SSPI’s) shall be “repeated” for all individuals who have received at least six months of MHSS to determine the continued need for the service:

  • Does this mean that the SSPI must be re-done after six months? If so, this would be an unnecessary burden and distraction from delivering care for providers and consumers. We support appropriate review of the original SSPI.

Regarding the proposed regulation on the number of days per week and hours per week required to carry out the goals in the ISP:

  • Will providers be reimbursed if they provide services outside of these prescribed levels set forth in the ISP?  Client’s needs fluctuate greatly over the course of time and issues that arise may require additional hours/days of services.  Will these either be denied or reclaimed in an audit? 
  • Approving this proposed change diminishes a person-centered approach and the ability to meet a client’s specific needs as they arise.

Regarding the deletion of the change in the billing unit structure that was formerly mentioned in the proposed regulations:

  • This change would have resulted in a reduction in the quality and access to services and we wholeheartedly support the wise decision not to pursue it.
  • While the Department of Planning and Budget’s (DBP’s) Economic Impact Analysis states that the proposed changes to the billing unit and rate structure may be budget neutral, providers estimate a reimbursement reduction of 10-25% if this change were approved.  This would seriously impact the ability to continue to provide services as well as have the quality assurance and supervisory measures in place to make sure the services that are provided are of high quality.

Regarding the proposed change in which Non-Residential Crisis Stabilization may be used as a higher level of care in the consideration of MHSS eligibility criteria:

  • We support the addition of this service as a higher level of care, as the services provided in non-residential are the same as in residential CSS, they are just provided in a different setting.

Thank you for your consideration and I hope that you are able to support our desires for the mentally ill in VA. 

CommentID: 42245