Medicaid Rolls Back Mental Health Policy Change

A change to Medicaid’s mental health policy has caused a scare in Nevada.

In the past, patients could see a therapist up to 26 times per year before they would need approval from the state. But a new rule limits those visits to five.

“We were doing that because we were seeing some very significant increase in the spending and the number of sessions per person that we were being billed for,” Cody Phinney, deputy administrator, of Nevada Medicaid told KNPR's State of Nevada.

However, when the state agency presented the proposal, it received a lot of pushback from providers and people on Medicaid who use the services.

Under the proposed rule change, after five visits a provider would have to request a prior authorization to see the patient for more sessions. Providers said that was extra paperwork that took time away from treating patients.

“The biggest help was the community came forward with alternative solutions that help us reach our budget goal, help us address our concerns about the increases and don’t necessitate the five-session rule,” Phinney said.

Some of the alternative solutions including improved certification for specific types of therapies, which will improve the quality and availability of care. 

Another change is around medication training and support. Phinney said that was one of the areas that providers thought didn't have to put in the mental health care bucket but could be supervised by other providers.

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During a hearing set for October, Phinney expects the new rules to be rolled back and the old rules to be re-implemented.


Cody Phinney, deputy administrator, Nevada Medicaid

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