Minnesotans in mental health crises are confined to hospital emergency rooms with nowhere else to turn. Treatment centers are bleeding staff complaining of low pay and burnout. Children remain on waiting lists for treatment for months.
National systems are increasingly unable to meet demanding demands. Those working in mental and behavioral health and addiction services repeatedly point to common themes at the heart of the problem. That is, the reimbursement rate from the state is not sufficient to cover the costs of its operations.
A long-awaited state study released Wednesday reveals how far rates have diverged and suggests a plan to better match the numbers with reality.
“If we cannot pay for care, our system, and more importantly, our children and families, are doomed to lack care in the midst of a crisis and risk causing the greatest harm.” “We will continue to develop and promote our business,” said Executive Director Kirsten Andersson. He is an advocate for therapeutic services for children with the AspireMN organization.
But there is no price tag yet for the sweeping changes outlined by the Department of Human Services on Wednesday, although staff said they were working on an estimate. It remains to be seen how much state leaders are willing and able to spend, given the potential state budget deficit.
“We're going to do everything we can to raise rates,” said Rep. Mohamud Noor, D-Minneapolis, who heads the House Human Services and Financing Committee. But he cautioned: “We don't want to disappoint anyone. We do not have the budgetary capacity to implement the rate hikes reflected in this study, but we will continue to work together.”
Kristi Glaum of the Minnesota Department of Human Services said the state's mental and behavioral health reimbursement rates are set arbitrarily. She said these were not based on legitimate costs and were not commensurate with the cost of providing the services.
“This is clearly a huge issue for the sustainability of the behavioral health system,” Grohm said, noting that the fees for some services are “almost completely unsustainable.”
Medicare, on the other hand, uses complex equations to set prices for different types of services. This equation takes into account factors such as the provider's level of education, location, and the type of equipment needed to provide specific care.
DHS's Diogo Reis said states should adopt the Medicare system and follow an annual rate update approach. Reiss said Minnesota's system paid about 74% of what Medicaid paid for services last year.
However, there are some services that are not covered by Medicare's pricing methodology, and for those, state officials recommended a market-based pricing approach, indexed to inflation.
Fees for residential substance use disorder treatment providers are particularly low, Grohm suggested, and should be a starting point when lawmakers consider available state funds and how to spend them.
Providers who provide residential services for addicts and provide low-intensity services, meaning at least five hours of skilled treatment services per week, will receive a per diem of $79.84. The study recommends almost tripling it to $216.90.
Brandon George, vice president of Ascension Recovery Services, said other states have also increased their rates. The costs will be high, but if people don't get the treatment services they need early and end up in the emergency room or jail, failure to change rates will result in even higher bills in the future. He warned lawmakers that he would.
At Children's Minnesota, the number of emergency room visits for mental health issues went from about 1,700 in 2018 to about 3,300 last year, said Jessica Brisbois, acute mental health manager at Children's Minnesota. It is said that the number has increased. In the first 10 months of last year, about 200 children spent a total of 1,500 days locked in hospitals because there were no treatment centers available, she said.
“Children are forced to wait months for treatment and too often use the emergency room as a last resort,” Brisbois said. “I know that many of these crises could be avoided if these children had access to outpatient mental health services.”
