Title XXV Committee Reviews new Payment Model Proposal

By Tom Lacock
Wyoming Medical Society

CHEYENNE – The Wyoming Legislature’s Joint Subcommittee To Review Title 25 Issues met in Cheyenne on Tuesday with a new payment model for Community Mental Health and Substance Abuse Centers highlighting the debate.

Stefan Johansson, Administrator of the Wyoming Department of Health’s Policy, Research, and Evaluation Division presented the changes and says the new payment model would help the Department of Health to gain better data through one centralized data system for Title 25 and substance abuse.

“We haven’t gotten recommendations perfect, but we feel this is a good compromise for where payment reform groups are currently,” Johansson says. “This type of managed care system can be achieved but it is a longer term goal that requires good data collection…. We think reduced cost in Title 25 systems is major goals by connecting dots between mental health and hospitalization system.”

Phase I of the model, a managed care system, would involve a capped fee-for-service model with tiered bonus payments to Community Mental Health Centers who are able to avoid hospitalizations, help clients gain employment or housing. The program is available to clients who are designated as high-risk Title 25 individuals.

Committee member Sen. Ray Peterson (R-Cowley) said his concern with the changes is that counseling centers in smaller communities might be left in the cold. He urged caution as the Department of Health changes to the new payment system.

“If we go this route too soon, I can see some of the small counseling providers in our smaller rural counties who don’t have a stabilization crisis center or in-patient beds and they receive less money lose staff to the point of closure. The big get bigger and the small disappear.”

Peterson also sits on the Joint Labor, Health and Human Services Committee, which met last week in Lovell. He says he heard the same concerns last week as he did this week.

“What we have heard last week and today is we don’t like the current system, but we don’t want to change it,” Peterson says. “ I am concerned that there is no real consensus for how to move forward.”

WAMHSAC – an association of community mental health and substance abuse treatment centers across Wyoming – and its Executive Director Erin Johnson took exception to proposed legislation which would aid the implementation of Phase I, pointing out its members had not had enough input into the conversation to support changes in the law. Part of that had to do, she said, with its member institutions attempting to mitigate $12 million in cuts it absorbed this summer while not turning any clients away.

Committee Co-Chair Rep. Mary Throne (D-Cheyenne) asked how long Phase I would last and Johansson said it could stand on its own for between two and five years to find trends in the data and make sure the state is ready for the proposed phase two, which would address more targeted populations.

The committee will meet again on Oct. 17.

Notes from the meeting

DA’s Seek A Place For Aggressive Patients:  Jodi Darrough, Assistant Fremont County Attorney, testified at the meeting as well looking for facilities who would be willing to take aggressive patients. Sharon Pendlebury of Cheyenne Regional’s Behavioral Health Department says her facility does take aggressive patients. Shae Ward, of Wyoming Behavioral Institute, added that they do take aggressive patients on a case-by-case basis.

Darrough also says one of her fellow County Attorney Association members was interested in seeing if a law could be passed to force providers who receive Medicaid payments to see Title 25 patients and require facilities to bill the Medicaid rate.

Discussion on cuts to mental health continued to be discussed as Wyoming Hospital Association Director Eric Boley mentioned Southwest Counseling in Sweetwater County has been asked to treat patients from surrounding counties who cannot get into Wyoming Behavioral Institute in Casper or the State Hospital in Evanston. He added cuts in Southwest Wyoming have led to High Country moving its facilities from Kemmerer to Afton, resulting in longer wait times to see potential Title 25 patients.

“The counties do not have the infrastructure to keep these patients from being a revolving door and coming back to them after they are released,” Boley said. “We need a statewide approach to infrastructure.”