AUGUSTA, Maine - The LePage administration wants to cut Medicaid reimbursement rates for community mental health services. The rationale is to streamline rates and bring them in line with other New England states.But community mental health providers say the cuts are too drastic and would drive those who need complex mental health care away from specialists to overburdened, ill-equipped primary care physicians. The issue was before a legislative committee in Augusta today.
Individuals with mental illness often need medication, and that medication needs to be managed. It's a billable service. But when Department of Health and Human Services Commissioner Mary Mayhew looks at how much that service costs in a mental health clinic as compared to a private practice, she's struck by the vast difference.
In a mental health clinic, adult medication management costs almost $56 per 15 minutes. In a private practice, says Mayhew, "providing an identical medication management service under Section 90 receives $24.14 for 15 minutes."
In other words, about half. The only difference, Mayhew says, is the setting where the service is provided. And she told the Legislature's Appropriations Committee the payments should be the same - at the lower private practice rate.
But Dr. Marc Kaplan, medical director of mental services provider Sweetser, says where a patient receives medication management does matter. "It's a specialty service - specialty health care service, just like cardiology, nephrology, or any of those things."
Kaplan says reducing reimbursements will cause some mental health providers to stop or limit that treatment. And that will drive patients to primary care physicians, which, he says, are the doctors who send them to mental health specialists in the first place.
"Sweetser's got six outpatient sites. We have waiting lists all the time. Our primary source of referral is primary care practices," Kaplan says. "So primary care practices will become overwhelmed. "
Several lawmakers on the Appropriations Committee expressed similar concerns. Democratic Rep. Peggy Rotundo asked Commissioner Mayhew whether some patients would lose access to care as a result of the cuts. "I'm focused on the impact of the people served and just want to make sure that their needs continue to be met," Rotundo said.
Commissioner Mayhew assured lawmakers she's confident the current level of services will be maintained. But Simonne Maline of the Consumer Council System of Maine says there's already a shortage of psychiatrists in Maine.
"Many of my peers tell me - actually we just had a forum the other day in Sanford, and somebody said they have a two-month wait to get into a very robust agency that has a medication management program," Maline said.
The Appropriations Committee is also considering a proposed cut to outpatient mental health services that assess and create treatment plans for individuals with mental health and substance abuse issues. Commissioner Mayhew says it's another area where Maine needs to control spending.
"When compared to other New England states, Maine is an outlier in reimbursement for mental health services," Mayhew said.
For example, Mayhew says, individual therapy with a psychologist in Maine costs $88 an hour, while in Massachusetts, it's $74 an hour. She wants to reduce Maine's reimbursement rates by 10 percent.
But Democratic Rep. Linda Sanborn questioned whether providers could absorb that seemingly small cut. Last year she submitted a bill to help community-based providers struggling to keep their doors open. "So I know that a 10 percent cut is really significant," she said, "and I believe strongly some providers will go under if we make that kind of a cut."
Sweetser CEO Deborah Taylor says these outpatient services are tied to medication management. And the proposed cuts are too radical. "In some part, I don't reject the thought we might be able to become more efficient and ratchet down that distance between rates," Taylor said, "but to think the provider community can sustain a 56 percent cut all in one moment is really impossible to believe."
The LePage administration says it's committed to mental health services and points to its increased investment in the Riverview psychiatric hospital as part of this budget. But critics say that only touches a small portion of the population, and adequately-funded community-based care is the first line of defense to prevent the need for such hospitalization.
