Therapists who provide group sessions for mental health and substance abuse clients have complained since last summer about rate cuts that the state has implemented. Formerly paid close to $60 per client for 90-minute sessions, therapists saw the rate drop to $40 per client on July 1 and then to $21.50 on January 1.
The Shumlin administration says the rate changes are necessary to bring the state into compliance with its federal contract with the Centers for Medicaid and Medicare Services. Officials noted, too, that the state had been paying more for group therapy than most other states.
The administration expects to save $1.8 million in Medicaid costs with the rate change, one of the few reductions in a Medicaid budget that has grown significantly this past year.
But Margaret Joyal, director of outpatient services at Washington County Mental Health Services, told the House Human Services Services Committee that the rate cut could force her agency to reduce the number of group therapy sessions it offers. It would likely double the waiting list for counseling. She predicted many clients would end up receiving more expensive individual therapy — but only after lengthy waits.
"Other agencies are just closing down their groups," Joyal said.
"Group therapy remains one of the most effective, cost efficient, access-promoting modalities available today," Rick Barnett, a therapist and legislative liaison for the Vermont Psychological Association, told lawmakers in written testimony. He attached anonymous comments from other therapists who argued the rate cut was a step backward in the state's efforts to address drinking and drug problems and strengthen its mental health network.
Representatives of the Department of Vermont Health Services, which oversees Medicaid, told the Human Services Committee they would monitor whether access to group therapy diminishes following the rate change. Ashley Berliner, health care policy director at DVHA, said that if they document a lack of access in three to six months, the state could ask federal Medicaid regulators to allow an exception for a higher rate.
Members of the House Human Services Committee peppered administration officials Thursday with questions about the rate change. The panel struggled to understand the explanation for the error. One fact surprised lawmakers. "Our committee was very concerned they [DVHS] knew about it [the incorrect rate] for seven years and didn't solve it," said Chair Ann Pugh (D-South Burlington).
Despite concerns, Pugh said the committee concluded that it couldn't recommend that the House Appropriations Committee reject the rate cut and forego the $1.8 million in savings that is part of the administration's mid-year budget adjustment proposal.
The budget-writing committee will make its decision about the rate cut next week, but Appropriations Chair Mitzi Johnson (D-South Hero) said the panel had few options. It could put group therapy reimbursement under the jurisdiction of the Department of Mental Health. "But then that changes the entire rate structure," Johnson said. And it would require finding more money. Johnson said, "I'm not sure we could free up that money."