Burns and Associates, the Maine Department of Health and Human Services’ rate setting consultant, has made an initial proposal of very substantial rate cuts for children’s mental health services. If these rate cuts were to be enacted, some children’s services would be sharply curtailed, while others would be eliminated. Given the profound effect the proposed rate cuts would have on children’s mental health treatment system, the Legislature must insist on overseeing and approving the final rates.
An example: Multisystemic Therapy, or MST, and Functional Family Therapy, or FFT, are two evidenced-based in-home treatment programs that have multiple studies documenting their effectiveness in enabling aggressive youth to stabilize, live successfully in their families and avoid being incarcerated or sent to residential treatment programs. Some MST therapists receive special training to treat youth at risk of becoming sexual offenders. MST and FFT are part of a larger program called Home and Community Based Treatment, or HCT, in which a licensed therapist works in the child and family’s home in order to help our most challenged and challenging youth.
The number of youth in residential treatment in Maine decreased from 565 in 2009 to 297 in 2012, while the average number of youth detained at our Youth Development Centers (Long Creek and Mountain View) decreased from an average of 55.5 in 2006 to 34.8 in 2011. These decreases in out of home placement would not, in my opinion, have been possible without the widespread availability of MST, FFT and HCT. These statistical improvements represent many, many Maine youth who have been able to live successfully with their families and in communities instead of being removed from both.
Burns and DHHS, though, are currently proposing to cut HCT clinician reimbursement by 13.6 percent; there is already a statewide waiting list of 150 youth, and such a large cut is sure to greatly reduce availability and substantially increase that waitlist. MST and FFT rates are proposed to be cut by 16.6 percent to 33.8 percent; such a cut would almost certainly destroy these evidence-based treatment programs. Maine would return to relying on residential treatment and incarceration to treat its youth who are prone to aggression. And we would be without the most effective treatment available to prevent youth sexual offending.
A second example: The Burns/DHHS initial rate cut proposal cuts psychiatric medication management by 11.9 percent and nurse practitioner medication management by 47.8 percent. Primary care practitioners can treat uncomplicated ADHD, anxiety and depression; they do not consider themselves competent, though, to treat youth with more complicated problems. These rate cuts would greatly reduce the access of Maine youth and families to specialty psychiatric care.
Burns and Associates collected information from providers in calculating their initial rates; provider agencies have stated, however, that Burns then did not use that information in proposing initial rates. Burns has a process for providers to respond to the initial rate proposals; there is no guarantee, however, of what Burns will do with that input. The current rate cut proposals would result in the largest reorganization of children’s mental health services in many years; when changes of this magnitude are proposed, the Legislature needs to be a full partner to the executive branch. The Legislature needs to pass legislation this session to ensure that it can oversee any rate change proposal.
Lindsey Tweed, MD, MPH, is president of the Maine Council of Child and Adolescent Psychiatry.