Mental Health Reimbursements & Policies

Tue, 17 Feb 2015 22:47:07 GMT

As a part of the current LeadingAge Leadership Academy, my project team is looking into the gaps in providing mental health services to our Residents. Could you help us by sharing any particular concerns or questions about mental health reimbursements or policies? What or where do you see we need to focus on and address? Thanks, Dale

Dale Melton

Salemtowne

Fri, 20 Feb 2015 14:00:41 GMT

We definitely have identified a need for psychiatric services at our facility. We started first in the health center. We had several residents in need of counseling for depression and life situations. There was also a need to address behavioral issues in a regulatory compliant manner. As we know N.C. has been under scrutiny to decrease anti psychotic dand psychotrophic drugs. Another need was to continue psychiatric services after the resident returned to independent living. We have contracted with NCEPS (North Carolina Elderly Psychiatric Services). We have regular visits from a nurse practitioner and psychiatrist. We do not at this time have separate policies for these services. A staff member or professional can recommend services and the attending physician refers them for services.

Fri, 20 Feb 2015 15:16:10 GMT

Concerns:

· Mental Health is typically only reimbursed at 50% level by most insurers or not covered at all.
· Elders with mental health is growing rapidly and training for caregivers is not keeping up.
· Need more mental health trained professionals in the industry
· Adequate supply of Affordable Housing for mental health
· Need for more increased “awareness” of the issues and possible paths to treatment

Fri, 20 Feb 2015 20:08:21 GMT

Good afternoon, in my 25 plus years doing this mental health services for the elderly have been very hard to secure, especially in more crisis situation typically a hospital inpatient ward will never help , their attitude seems to be that they are already in an safe institutionalized environment and also “who is this sweet little old lady going to hurt” Sadly enough I have actually over the years had to involuntarily commit residents (police cars and handcuffs)! This is a big need.

Fri, 20 Feb 2015 20:09:15 GMT

Let’s face it, the residents and families who cause us some of our greater challenges often have mental health issues that are near if not fully pathological. They are also the ones least likely to recognize the state of their mental health and their need for mental health resources. As a rule these causers of strife within our organizations are significantly strife torn individuals and families who lack the capacity to accept that the pain affecting them arises from within rather than from outside of themselves. That’s more than a gap, it’s a chasm. Whether a talented group focusing on the way to break through this denial and blame based approach to life can come up with a viable approach I don’t know. If one can, they’d deserve the Peace Prize.

We use professional counseling resources only on a limited basis and primarily in licensed areas where our ability to make referrals is greater. We have a contract service provider who bills residents directly for the service. The primary care physician for most of our residents prescribes medication for residents who exhibit depression or other forms of anxiety based/compulsive behavior. All the above feels a bit like a sideline compared to the amount emotional pain some residents and families experience. Those capable of voicing their own need and of accepting referral are usually helped.

Tue, 24 Feb 2015 16:33:40 GMT

Our setup here is having outside contractors provide services. They will in turn bill Medicare directly. Have always had problems with consistency and quality of service but have not found the slam dunk yet. Is seems that the vendor focus is on volume which makes it hard to get focused attention on a particular case of a presence if the volume isn’t there…

Tue, 24 Feb 2015 17:11:22 GMT

This is a difficult area of service provision especially for the most frail and those economically disadvantaged. We currently utilize NCEPS for Skilled and Assisted Living residents. This service is ok but not as thorough as was the case when we were able to retain a Psychiatrist and Mental Health Nurse Practitioner from a local mental health provider group. Due to reimbursement issues we had to change to the larger group several years ago since the previous providers stopped proving the service.

The ability to access services for those with financial means in our independent living areas is better but since services are fragmented, residents are often confused about how to obtain services. For residents in independent living that are community Medicaid and others that have limited ability to pay, the ability to access services is becoming more difficult due to State Mental Health Managed care groups. The ability to access services is limited by the lack of competition and reimbursement. I am not encouraged that this situation will improve any time soon since this has been a growing problem for over 25 years in this State.