Cynthia Persily, PhD, RN, FAAN
This week I had an opportunity to talk to some legislators at our Capital about the need for common sense changes in the regulation of mental health services. This is an important part of the legislative agenda for the WV Behavioral Healthcare Providers Association, and is important for us to be thinking about at the Highland Companies.
What do I mean by “common sense changes in regulation”? Well, here are a few examples:
- Behavioral health providers are licensed by a particular body of the state government. Part of the annual or biennial licensure is a “life safety” survey. This survey includes evaluating our facilities for fire safety. We completely understand why this is done, and appreciate the oversight because safety is our priority. However, we also undergo annual surveys by the State Fire Marshal. Again, we understand, and we appreciate the oversight. But, it’s two surveys of the same services and facility; both have a cost associated with them, and sometimes their recommendations conflict. We are just asking for some common sense compromise between two state agencies.
- Certain behavioral health services need to be billed in 15 minute service increments. For us, for some payers, this is true of our detox services. Instead of paying us for a day of service like we receive in our other services, we are required to bill in 15 minute increments, for every 15 minutes that we provide services. Think about the impact of this regulation on a program that is 24 hours a day, for 7 days. We need to have our staff document every minute of every service they provide—taking them away from patients who could be benefitting from their further intervention. We have to have extra clinical auditors who audit staff documentation to capture every fifteen minutes of service provided—driving up the cost of care. And, we need to then transcribe those 15 minute increments into a bill that is sent to the payer. I am sure that on the payer side, they also audit every 15 minutes of services provided, which has to increase their cost. We completely understand that these are the current rules. But, we think that there could be a better way to assure that patients get quality services, with reasonable billing practices that trustworthy providers like us can follow to assure that we are only billing for services provided. Common sense, right?
- Last year, a bill was passed in the legislature to place some limits on telehealth services. This was an important bill to protect our patients in our state from unscrupulous providers. However, there was an unintended consequence in a part of the bill that restricted the prescribing of Schedule II drugs (which includes opiates) via telehealth. Unfortunately, drugs for attention deficit disorder for children also fall into this category. And, over 500 rural kids who were receiving psychiatry services via telehealth and who need drugs for ADHD—good, quality services have been left out. We are working toward a common sense fix for that legislation.
At a time in our state when we are experiencing severe budget stressors, we need to use common sense to provide care, but also to do it in a cost efficient way. These small fixes would make huge differences for our patients and for our organizations. Stay tuned!