Federal officials found fault with the way Kansas had screened people for admission to psychiatric hospitals, but left the door open for the state to divert patients if it reforms its screening procedure.
Gov. Sam Brownback vetoed a section in Senate Bill 161 that would have reinstated a requirement that Medicaid recipients be screened before admitting them for inpatient psychiatric treatment. Brownback said he supports the screenings, but the Centers for Medicare and Medicaid Services have threatened to reduce state funding for health programs by up to $1.8 million because of the requirement.
The issue is parity. Under federal law, insurers, including Medicaid programs, can’t put restrictions on mental health and substance abuse benefits that don’t exist for comparable medical or surgical benefits. A CMS official, who declined to be identified, said it appears to be a violation to require a person to be screened before he or she can be admitted for inpatient psychiatric care, but not to require a similar screening for a person being admitted for a physical condition.
CMS didn’t rule out requiring mental health screenings, but the state would need to have other, unspecified “criteria” that would ease concerns about parity, the official said. Both CMS and Brownback’s office said they are discussing ways that the state could conduct some form of screening without violating parity.
“Other states use a prescreening process to make recommendations regarding admission, but more often whether to divert to community services,” the CMS official said. “Our understanding is that Kansas proposed to use this process to make a decision regarding admission to an inpatient facility, and payment for that admission. There was no such requirement on the medical/surgical side for any inpatient admissions.”
Angela de Rocha, a spokeswoman for the Kansas Department for Aging and Disability Services, said CMS considers the screening for Medicaid recipients a form of prior authorization. KDADS changed its screening policy in October 2015 so that screenings wouldn’t be required before a person covered by Medicaid could be admitted for inpatient mental health treatment in a private or community hospital, she said.
“Kansas received anecdotal feedback that the screens, in some instances, were creating unnecessary delays in access to treatment for hospitals with psychiatric units,” she said.
Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas, said he was disappointed in Brownback's decision to veto restoring the screenings, and hopes Kansas will make the case that its screenings are an appropriate way to place people who need mental health treatment in the least restrictive setting possible.
"We would argue the screening process has been diversionary," he said. "It seems like this is something that can be fixed."
The current procedure is for medical staff at the hospital to determine if the person needs to be hospitalized, de Rocha said. The three managed care organizations that administer KanCare still could determine that a hospital stay wasn’t necessary and decide whether to pay fully for the care, she said.
Kessler said he has heard some concerns that private inpatient beds have been filling up, because the people present at the screenings aren't also aware of what community resources are available. In some cases, that leads to people being admitted to state hospitals, because local inpatient facilities don't have space, he said.
Kansas’ community mental health centers still screen people before they are admitted to the state psychiatric hospitals at Osawatomie and Larned. Those hospitals only accept people who are determined to be a danger to themselves or others. That appears not to create a parity issue because no equivalent concept exists when it comes to physical conditions: People who don’t manage their diabetes may be putting their health in danger, but the state can’t force them to stay in a hospital until their blood sugar is under control.
Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC
