On October 31st, The Mississippi Division of Medicaid (DOM) issued a public notice of proposed state plan amendments to Mississippi Youth Programs Around the Clock (MYPAC) coverage and reimbursement.
According to the Division of Medicaid, “MYPAC is a home and community-based Medicaid program for children and youth with Serious Emotional Disturbance (SED), that follows the High Fidelity Wraparound process. MYPAC provides various services as an alternative to traditional Psychiatric Residential Treatment Facilities (PRTF). Wraparound is an all-inclusive planning process that is youth-guided and family-driven.”
We have not reviewed the proposed changes in depth. It appears that Medicaid removed group therapy as a covered service and defined community support services in more detail:
“Community Support Services defined as specific, measurable, and individualized that focus on the mental health needs of the beneficiary while attempting to restore beneficiary’s ability to succeed in the community. These include: 1) Identification of strengths which aid the beneficiary in their recovery and the barriers that will challenge the development of skills necessary for independent functioning in the community. 2) Individual therapeutic interventions that directly increase the restoration of skills needed to accomplish the goals set forth in the Individual Service Plan. 3) Monitoring and evaluating the effectiveness of interventions that focus on restoring, retraining and reorienting, as evidenced by symptom reduction and program toward goals. 4) Psychoeducation regarding the identification and self-management of the prescribed medication regimen and communication with the prescribing provider. 5) Direct interventions in de-escalating situations to prevent crisis. 6) Relapse prevention. 7) Facilitation of the Individual Service Plan or Recovery Support Plan which includes the active involvement of the beneficiary and the people identified as important in the beneficiary’s life.”
Medicaid updated the rates based on “actuarial analysis of historical utilization, payment and cost data for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) eligible beneficiaries served in the community that meet the Psychiatric Residential Treatment Facility (PRTF) level of care and the expected utilization of services.”
In looking at Medicaid’s Community Mental Health Fee Schedule, it appears on line 55 that the first hour of MYPAC services, such as a therapist, community support specialist or peer support visit, are billed at $251/hour for the first hour and then billed in fifteen-minute increments after that. These same services are billed at hourly rates of $87 – 127 (therapy), $64.24 (community support) and $33.80 (peer support) outside of MYPAC.
If you wish to give public comments to Medicaid on any of these changes, you can submit them to the Division of Medicaid, Office of the Governor, Office of Policy, Walter Sillers Building, Suite 1000, 550 High Street, Jackson, Mississippi 39201, or DOMPolicy@medicaid.ms.gov
Given we just read this state plan amendment today, we do not know yet if Families as Allies will submit public comments on this proposed state plan amendment. If we do, our comments are likely to focus on whether families gave input into the changes in how terms were defined (“Do they think those are the activities that would most help their children live in the community?”) and how rates were determined (“Did families give input and recommendations for the rate study? Do families believe they are getting good value for the services offered? How do families think funds should be spent to most help their children?”).
We strive to make all of our public comments consistent with our mission, vision, core values and beliefs, as well as the nationally accepted definition of family-driven practice:
Family-driven means families have the primary role in decisions regarding their children and the policies and procedures governing the well-being of all children in their community, state, tribe, territory and nation. The role for families includes, but is not limited to:
- Identifying their strengths, challenges, desired outcomes/goals, and the steps needed to achieve those outcomes/goals;
- Designing, implementing, monitoring, and evaluating services, supports, programs, and systems;
- Choosing supports, services, and providers who are culturally and linguistically responsive and aware;
- Partnering in decision-making at all levels.