a division of The American Association for Marriage and Family Therapy

Proposed SoonerCare Changes

Posted by on Jan 18, 2016 in Blog | 4 comments

changeThe Proposal: “The proposed revisions revoke all coverage and reimbursement guidelines for this specific provider type, as ODMHSAS is requesting that independently contracted providers in private practice no longer be reimbursed for SoonerCare services.”

ODMHSAS Rationale: “The proposed rule is expected to result in a savings to ODMHSAS… (at) an estimated annual reduction of $9,707,264 in SoonerCare reimbursement to contracted providers.”

(But), “SoonerCare members currently receiving services from an affected provider will still have access to the same services through a SoonerCare contracted outpatient behavioral health agency if they wish to continue services and meet medical necessity criteria.”

The Reality: There are only two ways for OHCA to save money; they can reduce the reimbursement rate or they can curtail the services available.  This proposal does neither.  It simply moves therapy from one location to another.  The same consumers will have the same amount of services available to them and OHCA will pay out the same amount of money. This is the best case scenario.

The worst case is there will be fewer providers.  Not all independent providers will go to work for an agency.  The result for consumers will be longer wait times for initial sessions and time between sessions will increase.  Consumers will give up and drop out. Savings will occur but only because the people who need the services the most will simply stop seeking help. This appears to be what ODMHSAS is counting on.

In other words, rather than making difficult decisions regarding reimbursement and availability of services, ODMHSAS is proposing to save money by subjecting SoonerCare recipients to a Darwinian exercise where the people with the most emotional and financial resources persevere and the most vulnerable ones fall by the way side.

Additionally, ODMHSAS is making the argument that independent providers were only added to increase the number of providers in rural areas. This, ODMHSAS states, has not occurred.  The majority of independent providers are in metro areas.  Of course, the independent providers that are in rural areas will no longer be able to see SoonerCare clients, either. Rural Oklahoma gets hurt, not helped.

Finally, ODMHSAS claims that this proposal will not harm small businesses because providers that were small business owners can now become agency employees.  Not ODMHSAS employees, but employees of private agencies that contract with OHCA.  Forcing someone to close their business and go to work for a competitor is, OKAMFT believes, the definition of harm.

The Unintended Consequences: When people give up because the system is counting on them giving up, they don’t suddenly become healthier.  They get worse.  This will result in trips to hospital emergency rooms.  Costs will go up, not down.  And they will go up quickly since ER visits and hospitalization are much more expensive than outpatient therapy.

Rural Oklahoma will lose providers.

Mental health care in Oklahoma will soon have a bi-modal distribution: middle and upper-class consumers will seek help from experienced, licensed professionals and the poor will be seen by not-yet-licensed candidates desperate for a job and willing to work cheap for agencies.  Our most inexperienced providers will be working with our most vulnerable population.  That is bad for consumers and it is bad for the profession.

The Next Steps: ODMHSAS and OHCA need to make reasoned and thoughtful decisions about available care and reimbursement.  This proposed policy change will not save the state any money. At best it will move money from one sector of the market to another.  At worst the unintended consequences will cost the state more.

This is a bi-partisan issue: conservatives should be concerned about the fiscal ramifications of this plan as well as the harm to small businesses.  Progressives should care that the poor will not have the same degree of choice about their own health care as wealthier Oklahomans.  Everyone should be alarmed that the agency charged with looking out for the mental health of our state wants to put in place a plan where the objective is for people in need to simply give up.

First, we need all OKAMFT members to leave a comment on the OHCA’s web site.  It will remain open until February 10, 2016.

Second, we need to attend the MAC meeting this Thursday and the OHCA’s board meeting on February 11, 2016.  You won’t be able to say anything, but a strong presence will be helpful.

Finally, if the OHCA approves this measure it will then be sent to the legislature.  At that point we will ask all of our members to begin contacting their legislators.

4 Comments

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  1. Dale R. Doty, Ph.D.

    I propose that instead of discriminating against the private sector providers that we instead make cuts to agencies according to the percentage of their budget devoted to administrative overhead. Reward the sector of providers that devote the highest portion of their overhead to direct client services.

    Does anyone believe that the agency sector has the highest qualified providers rendering direct client services? What do Oklahoma citizens deserve?

    • Omar197910@gmail.com

      How are we going to handle this now, there was a split vote. Are we going to protest, are we going to speak with our political representatives, what next. I believe we must take action now and not wait for the final vote in February. My name is Omar Chatman my e-mal is omar197910@gmail.com

      I am ready to do whatever I have to do to advocate for the rights of my clients…

  2. Janet Cooper

    I agree with all the points made by the OKAMFT. I am an LCSW and I have two concerns that I would like to emphasize. One is, access to quality services of the most vulnerable populations in rural Oklahoma and the benefits to these populations from a licensed practitioner. Licensed professionals typically have more knowledge and experience, and have had the practice time to develop more efficient and effective therapeutic skills. With a “best practices” approach, in many cases, can prevent recidivism and ultimately save ODMHSAS and OHCA money. My second concern is the hard work, dedication and investment that goes into obtaining a license and the quality of care that that produces should be reimbursable and recognized by the state as valued and respected. There’s little incentive for individuals interested in the mental health field to further their education and obtain licensure to work for an agency; that doesn’t seem to make much sense, and the proposed changes don’t seem to encourage individuals down the road to individual private practice.

  3. Della Dean

    How will this effect case managers?

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