A new bill in the Nebraska Legislature aims to make it harder for state-hired insurance companies to aggressively audit therapists providing mental health help to low-income Nebraskans.

That bill and a related one, both introduced by State Sen. John Frederickson, Democrat from Omaha, followed a Flatwater Free Press investigation into the audits, which sometimes resulted in the insurance companies demanding tens of thousands of dollars back. Several therapists told FFP that the audits had prompted them to drop Medicaid patients.

“We want to ensure there’s very clear rules of engagement,” said Fredrickson, who before joining the Legislature was a mental health provider. So “that there’s no mystery around what it means to accept Medicaid.”

Medicaid is cheap or free health insurance for Nebraskans who make less than $17,131 a year as a single filer. Families of four making less than $35,245 qualify for Medicaid.

States and the federal government share the cost. Nebraska is paying three companies $4.25 billion over the next six years to manage its Medicaid services.

Currently mental health providers can get between $75 and $129 for 30 minutes of therapy. Rates vary depending on licensure — doctors make more than counselors — as well the kind of service provided.

A goal of LB380 is to make sure the companies that administer Medicaid pay the same rates set by the state, said Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations. Right now that’s not required in the companies’ contracts, she said.

Nebraska already has some of the highest reimbursement rates for mental health providers in the country according to a 2022 study. The rates have been one solution to addressing serious mental health worker shortages, particularly in rural Nebraska.

The bill would also call for a definition of “network adequacy.”

Plainly, that means having enough providers to meet patients’ needs, but Dubas said it’s unclear how that’s determined and what happens if the companies aren’t maintaining that standard.

Right now it’s hard to know how many providers even offer Medicaid services. The state releases annual reports, which shows a steep decline in mental health providers across the state since 2016. But those figures include double-counted providers, the state told Flatwater Free Press last fall. The state provided unduplicated figures which shows the number of providers is growing.

Dubas said providers are also worried about onerous compliance requirements that could lead to more providers dropping Medicaid.

Providers in Omaha told the Flatwater Free Press in November they were planning to leave Medicaid over the aggressive audits, which the providers alleged didn’t follow state law or best industry practices. Some had already left.

Other mental health providers began organizing through a Facebook page, sharing their experiences as well as how much the companies ordered them to pay back. They’ve now counted $768,247.73 companies tried to recoup through 34 audits.

Last fall DHHS spokesperson Jeff Powell said the medicaid companies’ audit processes were consistent with state and federal policy. The audits are important to protecting taxpayer money, he said.

Fredrickson said he hopes LB381 will make provider fraud easier to spot, by separating those cases from others involving clerical or documentation errors.

The proposed fixes for audits include requiring companies to explain why they’re auditing providers, banning “arbitrary” treatment limits and limiting auditors to collecting only one year’s worth of material unless it’s a fraud investigation. The bill would also limit what documents an auditor can request and bar auditors from trying to collect money for rendered services they already approved.

State law already says investigators can’t request more than 200 pages of case notes and other materials from providers. But that law doesn’t apply to the Medicaid companies, Powell told Flatwater last fall.

Many providers interviewed by Flatwater were also confused about their audit results which identified clerical mistakes but resulted in demands to repay tens of thousands of dollars. When they tried asking questions, providers said they got lost in the labyrinthian systems that separate them from the giant companies that pay them.

The confusion and fear is driving providers from Medicaid, advocates said.

Other states have already reigned in companies like UnitedHealthcare, which has faced scrutiny for using an algorithm to limit therapy expenses. UnitedHealthcare, the largest healthcare company in the world, is one of three parties managing Nebraska’s Medicaid services.

This story was originally published by Flatwater Free Press, an independent, nonprofit newsroom focused on investigations and feature stories in Nebraska that matter. Read the article at: https://flatwaterfreepress.org/new-bills-aim-to-aid-mental-health-provid...