Every now and then during therapeutic interventions a parent will get upset about how their child is or is not being treated by the child's counselor. Regardless of the reason of the grievance or who is at fault, a great number of parents will run this statement out there when they aren't satisfied with the action of the servicing agency: "I'mma call Medicaid!" Now whether or not they will actually do that is a crap shoot. But that statement has allegedly worked to the appeasement of the parent; concerned about what a counselor is telling their kid, but not concerned enough to read their report card. It is a fact however that Medicaid has shut down many agencies off of these calls. Not necessarily because the parents' accusation has been accurate, but because the Medicaid rep found other infractions of non-compliance when they got to the agencies' office. Sometimes they bring their road dawg (the Dept. of Behavioral Health and Developmental Services) with them. DBHDS may not, but when Medicaid comes they come for blood each time. So we as providers are all 'scared' of those two.
It is commendable that Medicaid has a division that funds mental health services because they recognize the need, to a degree. They actually make it possible for low income families to receive assistance for their emotional well being, and it can be said that these families need this the most. DBHDS works in conjunction with Medicaid by licensing agencies to be community programs. But I use that term conjunction loosely. The two organizations are often not in agreement with policies that are issued to providers. As a result, companies are constantly testing the limits of ethics and best practices attempting to stay in compliance with Medicaid or DBHDS or both. For example, we all know a child who does poorly in school can develop some behavior problems because he may be embarrassed or frustrated. Medicaid, however, will not reimburse agencies for educational assistance; so many companies instruct their counselors to not address educational issues. The lack of academic achievement hinders overall behavior, but Medicaid doesn't acknowledge it as a stimulus for poor adjustment. But some DBHDS licensing specialists will question about how an agency helps a child academically. Imagine telling that specialist, "Medicaid doesn't pay for it, so we don't do that."
I suggest that Medicaid and DBHDS do this: establish a complete document of policies that is easily accessible to providers and receipients. Since I have been in this industry the two have changed their policies four times. And many of these changes have not been congruent with each other. Confusion is a constant presence in our industry because there are two many gray areas. And all of this effects those who desperately need help. By the way...Medicaid, do something to make money, not take it from the people that do what you need to be done.
Now, for those who are familiar with the industry, I won't say take away KePro (prior authorization) because that should have been in place from the start. But I will ask that they take the RNs out of the decision process. I mean nurses? Really?
In closing of this topic, people, we are helping kids. Let's move like it.
Peace
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