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Mental Health Reform

The new mental health reform that is putting a formerly state run Medicaid program to be run by regional Managed Care Organizations (MCO)is causing providers and consumers undo stress and is decreasing the quality of care and the access to services. Mental Health providers who are now currently credentialed with Medicaid will now have to apply for an all new credentialing process with each individual MCO in order to serve consumers from the areas. If providers see consumers who are registered in one county, but are living in another county (living with grandparent, group home, etc.), if the provider is not credentialed with that MCO, they can not serve the client. As a provider trying to go through this process, it is beyond frustrating and providers are questioning whether or not it is worth it to see Medicaid consumers. Now, instead of billing to one place, providers may be billing to all the MCOs. In addition, there is no reciprocity between MCOs and the paperwork is different for all the MCOs with no uniformity. The new waiver also allows Medicaid to close their networks meanging that unless their "yearly" needs assessment reveals that they need new providers, they will not allow new providers in the network. For group practices, if one provider leaves the group, the group will not be allowed to replace the provider to serve the consumer's needs unless the MCO decides in their "yearly" review that more providers are needed. As our office has been trying to make contact with various MCOs across the state to attempt to be in compliance, we have only had one MCO even return our call and have not gotten through to any of the provider relations departments of the MCOs. Many of the internet sites that we are referred to are "under construction" and the information is not available. When we called Southeastern Center, the receptionist who answered the phone acted like she didn't even know what we were talking about. I urge providers and consumers to educate yourselves about this new reorganization and take action.


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