Colorado mental health providers say they’ve been ‘blindsided’ again

Colorado mental health counselors in private practice say they have once again been surprised by new rules that will make it harder to treat the state’s most vulnerable patients: those with Medicaid insurance.

The latest friction between behavioral health professionals and the Colorado Department of Health Care Policy and Funding involves the supervision of postgraduate counselors working toward their state license.

The department — which approved policy drafted by regional agencies that handle payments to mental health clinics — says the new rules are necessary to ensure Medicaid patients receive quality care. But private practice counselors say the rules could mean the loss of dozens of workers and potentially hundreds of mental health appointments.

They are also frustrated because they said they didn’t know the new rules were coming.

The policy, which was announced earlier this month, places stricter requirements on the use of interns who are still working towards their graduate degrees and therapists who have graduated but have not yet received their bachelor’s degree, a process that takes two to four years after graduation. These pre-licensed counselors can see patients, but must have a licensed counselor sign their diagnoses and progress notes from each counseling session.

Under the new rules, only advisers who have been licensed for at least two years can approve the work of pre-licensed advisers. The rules also state that any counselor sanctioned by the State Licensing Division, Department of Regulatory Agencies, must wait two years after their sanctions expire before supervising pre-licensed counselors.

Colorado is divided into seven regions operated by agencies under contract with the state’s Medicaid division. Behavioral health providers who wish to take patients on Medicaid must first register with the State Department and then with regional agencies. (Colorado Department of Health Care Policy and Financing)

Private practice counselors see both rules as overbroad, which will mean fewer appointments for patients on the government’s insurance program for the needy, Medicaid. About 30 of them attended a virtual meeting this week with the Medicaid division, which is housed within the Department of Health Care Policy and Financing.

“We think this is going too far,” said Andrew Rose, psychotherapist and director of Boulder Emotional Wellness, in an interview. “If DORA has decided that you can practice safely, that should be enough.”

But Cristen Bates, the state’s acting Medicaid director, said the policy is intended to expand the workforce — creating standardized rules so counselors who are still seeking their license have a clear path to acquiring experience and become licensed counsellors. The problem is that regional agencies that mediate between clinics and the state’s Medicaid department have had inconsistent rules because they allowed pre-licensed counselors to practice under supervision. The new policy, which also applies to community mental health centers, was created by those agencies to apply to counselors statewide.

“We need to ensure that our members receive high quality care,” Bates said. “We were happy to see very clear rules about when it is and isn’t appropriate.”

Where the department erred, Bates said, was in not telling behavioral health professionals about policy changes or showing them a project before the implementation date.

“The deployment was where we ran into some difficulties,” she said.

Regional agencies are now considering possible changes to the policy and have said they will not deny claims or penalize clinics that do not follow the new rules. After the outcry from providers, regional agencies backtracked on the July 1 implementation date. One of them, Colorado Access, said in an email to The Sun that the policy change was not effective and that “any changes to our current program will include additional information and notice.”

The discord is the latest in a long list of frustrations among mental health professionals who say they want to provide therapy to people on Medicaid but are tired of dealing with cumbersome rules, redundant paperwork and even threats of revocation of payments. It comes as Colorado faces an unprecedented need for services, in part due to isolation and stress from the coronavirus pandemic.

Rose said he typically signs 100 to 200 notes a week for his team of pre-terminated staff at Boulder Emotional Wellness. The clinic employs 38 pre-licensed counselors and plans to increase that number to 42 next month.

The rule changes will make that a challenge, as it’s already difficult to find licensed counselors willing to take on the responsibility of supervising pre-licensed therapists, he said.

Rose and others said they discovered the policy in a July 5 newsletter from one of the regional agencies that also set out other policies that went into effect July 1.

“The biggest concern here is really who sets the policy and who has a say in that process?” he said. “It’s quite difficult at the moment to keep suppliers. We just need relief from this. We need to be included in decisions about who we can hire.

The need for mental health counseling is so high right now that appointments with licensed counselors are “filled in a hot second,” said Dr. Lisa Griffiths, director of the Center for Valued Living in Aurora. Many clients rely on appointments with pre-licensed counselors under the supervision of licensed counsellors.

One of Griffiths’ seven supervisors has a doctorate but has not been licensed for two years, meaning she can no longer supervise other advisers under the new rules.

Mental health providers have been meeting regularly with the Medicaid department to smooth their relationship after a series of issues including rate cuts and treatment issues that led to a regional agency trying to claw back money from clinics that had already been paid to see Medicaid clients. .

Over the past few months, providers and the department have collaborated on new policies for marriage therapists and the treatment of patients with gender dysphoria. The latest policy changes, however, came out of nowhere, Griffiths said.

“Providers felt caught off guard,” she said.

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