Nevada Pauses Medicaid Mental Health Provider Enrollments

Nevada Medicaid officials have announced that they are putting a temporary hold on the enrollment of some mental health providers while they consider new certification requirements.

The enrollment pause will begin on December 1, 2018 and will last for 6 months. During that period, no new qualified behavioral aides or qualified mental health associates may be enrolled in Nevada Medicaid.

You can read the notice from the Nevada Division of Health Care Financing and Policy her

Provider Qualification and Overbilling Issues To Be Addressed

One of the concerns voiced by state mental health groups is that some providers enrolled as either a qualified behavioral aide or mental health associate were performing services without the proper qualification.

Qualified mental health associates must hold a bachelor’s degree. However, qualified behavioral aides can practice with a high school diploma. Neither type of provider is licensed in Nevada. After the provider’s application is approved by Nevada Medicaid and a background check is passed, the provider works while supervised by a clinician but with no state check-in until the 5-year reenrollment period approaches.

 Another concern is potentially improper billing codes used by both types of providers, including medication training and support and crisis intervention. In the 2018 fiscal year, the state Department of Health and Human Services (DHHS) has investigated $73 million in paid claims for fraud in the behavioral health arena.

 The state office can call for a prior authorization requirement on certain services but has few other tools to fight improper payments. This past summer, the office attempted to strengthen prior authorization rules for psychotherapy and neurotherapy, but the decision was reversed after a backlash from both patients and providers.

 DHHS admits that both quality of services and oversight of providers must be improved after reviewing data and discussing the issues with the community. Lack of oversight can create avenues for poor or inappropriate care to these vulnerable patients.

 How the 6-Month Moratorium Will Work

Beginning December 1, providers can re-enroll if they have current registrations with the state. Qualified behavioral aides and qualified mental health associates may continue to work while the state crafts the regulations. Part of the new rules will dictate how existing providers will be grandfathered in in order to comply with the new requirements.

 The state assures providers that it will work on a case-by-case basis to evaluate an enrollment for an unmet need, if necessary.

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