ANNAPOLIS – Richard Bearman has heard some wild things before, but the state denying mental health services to a substance-abuser on parole after serving a 22-year sentence for child rape was just outrageous.
Providers statewide said a series of cost-containment measures by the Mental Hygiene Administration, including reduced service authorizations and new reimbursement rates, has limited the ability of community mental health providers to help populations in need.
“If they don’t want this person looked after, who do they want?” asked Bearman, director of the Go-Getters program in Salisbury that provides psychiatric rehabilitation services for children and adults.
Those decisions are made by Maryland Health Partners, which contracts with the state to assess need for services and provides payment in the public mental health system, which serves Medicaid-eligible and uninsured citizens.
New authorization criteria, part of the administration’s attempt to offset a potential $31 million deficit, kept the company from allowing Go-Getters to serve the parolee, who had just been released to a shelter by Peninsula Regional Medical Center.
The Department of Health and Mental Hygiene, which oversees MHA, plans to rely on community services to help prevent the need for hospitalization, said Health Secretary Nelson Sabatini. Crownsville Hospital Center, a state-run psychiatric facility, will close in July and $5 million in savings from the closure is targeted to community services.
A spike in the use of psychiatric rehabilitation services for children accounts for a large portion of the 79 percent increase in Medicaid expenditures in Maryland between 1998 and 2003, according to department figures.
The number of children in the public mental health system receiving these services, which include behavior modification and social skills training, increased by 552 percent between 1998 and 2003.
At Crossroads Community on the Eastern Shore, the number of children served has decreased from 150 in July 2003 to 66 as of January 2004. Adults served also decreased, though not as dramatically.
“We’re down to 60 kids and fading fast,” said Lou Van Hollen, director of Arch Way Station in Cumberland.
Community mental health services also are losing staff through the cost-containment measures.
Some providers, including Go-Getters, have reduced staff by 50 percent or more in programs that serve patients with chronic mental illness, including schizophrenia, bipolar disorder and severe depression.
A change in case rates for children and dependent adults forced Arch Way Station to eliminate one of its two mobile units providing rehabilitation service to people in their homes.
Van Hollen said the program often can’t get authorization until a client is on the verge of hospitalization, and the extreme restrictions are the result of trying to fix a five-year problem overnight.
“The way they’ve done this is infuriating,” Van Hollen said. “The craziness of this whole process has demeaned and beaten us down.”
On Feb. 1, the Department of Health and Mental Hygiene switched to a system where providers receive a monthly rate per patient regardless of the number of services provided to that patient, rather than a fee per service rendered.
Thus a patient who needs daily therapy sessions brings the same amount of funding to a provider as a patient who receives only the minimum number of sessions a month.
“To see them three times a month is a joke,” Bearman said. Go-Getters is not turning anybody away because in rural areas like his, access to other treatment options almost doesn’t exist.
“In Allegany County, there’s not a lot of options,” Van Hollen said. “There’s not a lot of other places to point a kid to.”
Providers are frustrated by the cuts, but they are trying to work with the department to avoid a managed-care scenario.
In 1996, Maryland’s public mental health system was restructured to contract with managed care organizations, but certain community services are administered by the department.
Now, Sabatini is talking about returning those services to managed care if the administration continues to run a deficit, but legislators and providers are trying to stop him because it might make care even harder to get and of poorer quality.
Delegate John Hurson, D-Montgomery, and Sen. Thomas Middleton, D-Charles, introduced bills preventing the department from contracting specialty mental health to a managed-care company, but less-restrictive amendments have been proposed in the past few weeks.
“As bad as this situation might be, it might get worse being put under managed care,” said John Plaskon, director of Crossroads Community. “I think Sabatini is listening . . . you just like to feel more secure about where you’re going.”