Medicaid payment for juvenile therapies advanced

Lawmakers gave first-round approval March 24 to a bill that would authorize Medicaid reimbursement for therapies used to assist troubled Nebraska youth.

LB500, sponsored by Omaha Sen. Sara Howard, would direct the state Department of Health and Human Services (DHHS) to submit an application by July 1, 2015, to the Centers for Medicare and Medicaid Services for a state plan amendment to provide payment for multisystemic therapy (MST) and functional family therapy (FFT) for youth who are eligible for both Medicaid and the Children’s Health Insurance Program.

A Health and Human Services Committee amendment, adopted 26-0, removed youth who are on probation from the bill’s provisions. Lincoln Sen. Kathy Campbell, chairperson of the committee, said the change would ensure that the bill meets federal requirements.

Howard said the bill is an attempt to clarify that the state already is obligated to provide MST and FFT if the services can be accessed. She said the therapies involve the entire family of a troubled youth and have proven effective in reducing juvenile recidivism and out-of-home placements.

The problem, Howard said, is that the current billing process is so burdensome that the cost to bill for the therapies often is greater than the reimbursement that providers receive. As a result, she said, there is no incentive for providers to offer them.

“This bill is about a service that we already cover,” Howard said. “We’re trying to clarify the Medicaid state plan so that our managed care provider feels comfortable billing [for] it.”

Sen. Merv Riepe of Ralston said lawmakers should give the new administration time to examine problems with DHHS and the state’s Medicaid program before asking for a state plan amendment. He also expressed concern that the bill would constitute an expansion of Medicaid.

“DHHS is a broken system,” he said. “I want to be part of helping them be successful.”

Seward Sen. Mark Kolterman supported the bill, calling it a way to begin reforming the state’s Medicaid system. Currently, funding for MST and FFT for qualified juveniles is paid with general fund dollars, he said, while Medicaid is the more appropriate source.

“I’m not a supporter of Medicaid expansion,” Kolterman said, “but I didn’t look at this as Medicaid expansion as I approached the issue.”

Campbell agreed, saying the state should access available federal dollars to offset the cost of services that are proven effective. Medicaid funds are, in part, tax dollars that Nebraskans have paid into the system, she said.

“The emphasis here is that we have a great opportunity to help youth … stay in their home instead of being in an out-of-home placement,” Campbell said. “And we have a chance to rebuild families.”

The bill advanced to select file on a vote of 28-1.