Many providers of mental health care warned the state. They stressed that officials were moving too fast to implement a sweeping redesign of the behavioral health system, first, with changes to billing rates and codes, and then shifting the operation from the Department of Medicaid to five managed-care companies. The worry has been that the rush would put treatment and services in jeopardy, patients and their families at risk as a result.
And that has been the unfortunate outcome of late.
Northeast Ohio Behavioral Health of Canton closed its doors three weeks ago. The organization served 400 to 600 patients, many children in foster care, dealing with abuse and trauma. Aultman Hospital shuttered its psychiatric unit. In July, the Crisis Intervention and Recovery Center stopped providing services. Other agencies and organizations have stepped up to fill the gaps. Yet the trend is plain, as more providers, in Akron and across the state, feel the financial pinch. Ohio faces fewer services available for mental illness and addiction.
That is a cruel twist given the stated purpose of the Behavioral Health Redesign. It rightly seeks true parity in coverage of mental illness and addiction, aiming for efficiencies, improved quality and expanded services. Stakeholders agree this is the direction to take. And state officials have tried to be reassuring as they insist the data are showing good progress.
The trouble is, those on the ground providing treatment and services tell a story of frustration and no small degree of anxiety. They've been on the mark since the state launched this effort, attempting to accomplish in six months what it first projected would take a year.
For providers, the immediate problem has been cash flow. The Department of Medicaid typically paid within two weeks and for roughly 95 percent of claims. With managed care companies, the payment window now is 30 days or longer. More, they are paying around 60 percent of claims. Thus, many providers with already fragile finances face shortfalls, some with accounts receivable two times or three times larger than a year ago.
A large part of the problem goes to the complexity in processing claims, the greater detail leading to more errors and rejections -- with the hurry having allowed less time for working through the predictable bugs. If providers are not closing their doors, they are weighing reduced services, with such items as group counseling, crisis intervention and nursing more vulnerable.
The state has helped by advancing $146 million to providers as a cushion. Yet those payments stopped at the end of October. The expectation has been that once the processing glitches are erased, providers would see a surge in payments owed. That has not happened, one calculation putting the system on pace to be 40 percent short of the cash it needs. Thus, it makes sense to revive and extend the advanced payments through January or even February,
That is especially so in view of the reminder from experts: The holiday months are the most challenging for those with mental illness and addiction, or hardly the time for reduced services.
The advances must be repaid by providers. So it follows, too, that the time for repayment should be extended until the system achieves financial stability.
Again, the concept of the Behavioral Health Redesign is sound. The problem is the implementation, not to mention understandable doubts about the practicality of some reimbursement rates. As it is, the process is working against the desired goal. Providers are at risk along with those who need their treatment and care.