Nevada Medicaid has launched a full out assault against the behavioral health provider community through its efforts to increase the service authorization paperwork requirements and even more insidiously by its efforts at recoupment of funds already paid for services delivered by providers.
On December 20, 2017 Nevada Medicaid published web announcement 1484 which notified Nevada contracted psychologists of rate changes for all of calendar year 2017 and included notice of recoupment for the decrease in fees.
On June 21, 2018 Nevada Medicaid posted web announcement 1622 notifying all behavioral health providers of a recoupment effort for psychotherapy and neurotherapy overpayments between June 26, 2016 and June 25, 2018. Nevada Medicaid is identifying the “overpayments” as those services not under prior authorization during this two year period. However, Nevada Medicaid failed in its duty to warn providers of being out of compliance with contract requirements during this period and continued to pay for services being rendered thereby creating a de facto approval of the services being delivered.
Efforts by the Nevada Psychological Association and this writer, Kristopher Komarek of Family Wellness Center, to contact Nevada Medicaid in writing and through press announcements have so far led to no response from Nevada Medicaid to concerns about the significant negative impact of the recoupments on the financial stability and well-being of the Nevada behavioral health community and by extension the clients we serve.
Furthermore, at the June 29, 2018 public workshop by Nevada Medicaid announcing its intention to increase the requirements of behavioral health providers to complete prior authorizations before even beginning services to new patients, Nevada Medicaid appeared to be responsive to concerns raised by the provider community to this new requirement. However, it has come to this writer’s attention that the “responsiveness” to providers’ concerns about the new prior authorization policy is simply to allow providers to deliver three (3) services before the new prior authorization is required in order to continue services. As this provider indicated in public testimony during the June 29th public workshop, these requirements are regressive, provide no benefit to either the provider community or to the public we serve and in fact increase provider costs and likely delay or deny services by creating more barriers to services.
These actions by Nevada Medicaid cannot be allowed to stand. Therefore, this effort to bring the provider community together is aimed squarely at increasing the voice, representation and power of providers against the actions of Nevada Medicaid that threaten our literal financial survival. We need to improve the relationship between providers and Nevada Medicaid, and to ensure that the communities and clients we serve receive the services they need and deserve.
I hope you will join me.