Download NAMI NV Response to Medicaid MCO Expansion

NAMI Nevada is a state-level affiliate of the nation’s largest grassroots mental health
organization dedicated to building better lives for the millions of Americans affected by
mental illness. NAMI Nevada provides education and support to hundreds of Nevada
families dealing with mental illness. We also advocate for individuals and families of
those who have a mental illness to improve services, supports and education.
NAMI Nevada is extremely grateful to the Legislature and Governor Sandoval for
expanding the Medicaid program to cover many more individuals in need of services.
However, we are concerned with the availability of mental health services in Nevada.
Little usable information on access to Medicaid mental health services is available to the
public. We only know through the experiences of individuals and families struggling to
find services as well as the stories from providers who face barriers getting credentialed,
getting services approved or getting paid. These challenges frequently result in
individuals with illness ending up in emergency departments, on the street, in jail or dead.
NAMI Nevada is not opposed to Medicaid managed care. However, we have several
specific concerns we would like addressed before the State moves forward with a
Medicaid managed care expansion to the aged, blind and disabled, or rural
communities.
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NAMI Nevada would like assurance from the State that the requirements of the
Mental Health Parity and Addictions Equity Act are being met by the Nevada
Medicaid program, including fee-for-service and Medicaid managed care plans.
It is vital that the State demonstrate its programs are compliant with existing
federal laws and regulations before moving very vulnerable populations into
Medicaid managed care.
NAMI Nevada would like assurances from the State that essential medical and
behavioral health services are currently being provided to Nevadans enrolled in
Medicaid. This can be demonstrated through the public release of state health
care data available before and after the Medicaid expansion in January 2014.
NAMI Nevada believes this information needs to be publicly reviewed and
considered before moving the aged, blind and disabled into Medicaid managed
care. As a part of any evaluation of access, the State should also determine the
accuracy of providers claiming to take new Medicaid patients, and look at
different models for managing care beyond capitated contracts with private
insurance companies, such as either contracting out the performance of case
management/care coordination services or using “medical homes” to perform
these functions. NAMI Nevada would be glad to assist the State in the
development of these reports.
NAMI Nevada ● % Community Health Alliance, 680 S. Rock Blvd. ● Reno, NV 89502
(775) 336-3090 ● e-mail: [email protected]
Web site: www.naminevada.org
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NAMI Nevada also requests an open, community-based process be used to assess
the current status of mental health services in Medicaid, but also that the
requirements of existing federal laws are being met. This should be done before
any plans to expand Medicaid managed care. Medicaid consultants should
conduct in-depth focus group meetings in key locations with consumers and
providers of mental health services as well as informed advocates regarding the
desirability of adding the aged and disabled into Medicaid managed care, and to
discuss best practices if that is done. NAMI Nevada would like to be a part of any
planning initiatives developed by the State on a go-forward basis.
We have some specific recommendations as well as model legislation we could provide
to give more information as decisions are made to expand Medicaid managed care:
o Use of community providers - ensuring Managed Care Organizations
partner/contract with qualified community providers helps assure more access to
care, limited disruption to individuals already treating with community providers,
and more choice for individuals seeking treatment.
o Drug formularies and preferred drug lists – The State of Nevada Pharmacy and
Therapeutic Committee has decided that atypical antipsychotic injectable
medications will be exempt from the Preferred Drug List, allowing physicians to
have a full range of medications to treat their patients. The managed care RFP
should require easier access to drugs without use of step therapy.
o Use of integrated behavioral health and primary care - This is a SAMHSA, HRSA
and CMS evidence-based approach to quality care, and should be included in the
RFP to require Medicaid managed care plans to work seamlessly with qualified
integrated care practices. This is defined in Nevada statute as a Patient-Centered
Medical Home.
o Parity - The Medicaid RFP should require parity in areas such as prior
authorization requirements as well as transparency in the criteria used to approve
mental health services.
o Crisis Services – the Medicaid RFP should require vendors to establish 24/7 crisis
phone numbers with a crisis stabilization unit to provide emergency service for
those in mental health crisis.
o The State should consider making participation in Medicaid managed care
voluntary rather than mandatory for new, vulnerable populations as well as those
who live in rural communities.
We look forward to working with legislative committees as well as the executive
agencies involved in providing and funding mental health services in Nevada.