Lawmakers and regulators want to do the right thing, but a lack of understanding of complex reimbursement processes makes it difficult BY JANE M. PORTER
The Centers for Medicare and Medicaid Services (CMS) will soon release proposed regulations for Medicaid's Rehabilitation Option which, in CMS's own words, will clarify rehabilitation services by "clearly defining allowable services that may be claimed as rehabilitation services, which are optional Medicaid services typically offered to individuals with special needs or disabilities to help improve their health and quality of life." A full comment period is expected, and behavioral health agencies and associations, such as the United States Psychiatric Rehabilitation Association (USPRA), will have the opportunity to weigh in and help shape the final regulations.
As a newcomer to the mental health field after many years working on Capitol Hill, it has been personally enlightening to see how money flows through states to service providers once it has been appropriated by Congress. As a former staffer on the full House Appropriations Committee for nearly six years, I'm well versed in how federal agencies receive their funding, but I have enjoyed learning the block grant and matching systems available to states and how each is applied. I must confess that it is more complex than I had imagined as a Hill staffer. I suspect this complexity is what makes it difficult for Congress to ensure sufficient funding of effective programs. And even amidst all the media sensationalism about corruption and unethical behavior, the vast majority of members of Congress are good, honest people with high levels of integrity. They, like me, simply lack a solid understanding of how the mental health system works.
And not just elected officials get a bad wrap. CMS is often painted as an evil empire chat makes callous decisions about the services individuals can or cannot receive. However, after a twoday road trip with eight CMS staff members directly responsible for oversight of the rehab option, I can assure you that their intentions are good. On February 8 and 22, we visited six model psychiatric rehabilitation programs across Maryland, Virginia, and the District of Columbia, including an Assertive Community Treatment team, clubhouse, day program, peer-operated drop-in center, residential program, and a supported employment program. All are excellent examples of how rehabilitation services delivered in a community setting lead to recovery for individuals with severe mental illnesses.
I commend CMS for its staff's efforts to learn, and in some cases experience, the principles of psychiatric rehabilitation. And while the regulations for rehabilitation services have been drafted, CMS expects, but more importantly welcomes, feedback during the comment period from organizations such as USPRA, rehabilitation providers, and individuals affected by the proposed regulations. …