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Maine implements
managed care program
(April 2008
Issue)
By Ami Albernaz
Eighteen years after a consent decree laid out the basic requirements
for Maine's mental health care system, fulfilling these requirements
given a squeezed budget continues to dominate the state's healthcare
priorities.
As reported in the New England Psychologist in November 2006 and
January 2007, the matter of whether the state's mental health services
meet the standards set forth in the decree has come before court
several times since it was issued in 1990. The decree, which followed
complaints about the quality of treatment at the former Augusta
Mental Health Institute, called for the development of individual
treatment plans and the establishing of a comprehensive system of
community-based care, among other changes.
Now, the state is deemed to be 80 percent in compliance, says
Maine Department of Health and Human Services Commissioner Brenda
Harvey. Resources have recently been bolstered in areas including
vocational services, housing and "warm lines" (peer support telephone
hotlines) that had been rated inadequate by the court master.
Harvey calls the increased compliance "a real positive step," while
adding the challenge will be to sustain the gains within a tightly
constrained budget. "The question will be, can Maine sustain these
given the current fiscal climate?" she says.
To contain costs and assure a base level of services, Maine implemented
a managed care program for behavioral health services in December.
Though the state has a large number of individual not-for-profit
providers compared to other states, "it's difficult to assure that
they provide coordinated, sufficient care to individuals," Harvey
says. The goal of managed care is to stop people from "falling between
the cracks."
APS Healthcare, the Silver Spring, Maryland company that is running
Maine's managed care program, is now conducting a utilization review
for the state. "We're basically putting our toes into the water
this year," Harvey says. "When we have data telling us if people
are in too-high cost service or insufficient-cost service, we'll
be able to adjust accordingly." While it is too early to gauge how
managed care is working, she says a preliminary report looks promising.
Some psychologists, meanwhile, are concerned about managed care's
impact on reimbursement rates and ultimately, on the clients they
serve. A computer problem that started in 2005 has delayed payment,
sometimes by months, to psychologists treating people on MaineCare,
Maine's Medicaid system. Though managed care is a separate issue,
many psychologists fear that "more administrative hoops" will further
bog down the system, says Sheila Comerford, executive director of
the Maine Psychological Association (MePA).
"Reimbursement rates were always low, but now that there's a managed
care system, they're saying, 'I'm done,'" she says. A survey the
association sent to psychologists late last year indicated that
60 percent of respondents who see MaineCare clients would no longer
do so. "I think the ramifications for service will be severely
compromised," Comerford says.
She adds, however, that she is optimistic a solution can be reached.
She has asked the head of APS in Maine to attend MePA's next Policy
Council meeting and says he is willing to help psychologists "make
the managed-care process as painless as possible."
"We're taking a wait-and-see approach," Comerford says.
Meanwhile, a proposal that would increase reimbursements for psychologists
is before legislature, Harvey says.
Also new in Maine are revised licensing regulations issued by the
State Board of Examiners of Psychologists. Among the areas significantly
changed are continuing education requirements, which now call for
three hours in ethics and 20 hours "in the licensee's current areas
of practice or anticipated areas of future practice." Another new
requirement is that non-accredited academic programs include at
least two years of full-time residency at the educational institution
with face-to-face instruction.
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