UPDATE: The state will not move forward with a controversial Medicaid policy proposal that would have limited mental health patients to just five sessions before getting prior authorization.

The state sat down in focus groups to hear out patients and providers first-hand. Protocol now will go back to the original policy. In psychotherapy, that means 18 sessions allotted for adults per year. Patients under the age 18 will get 26. 

In neurotherapy, the number of sessions is determined case-by-case. For either service, prior authorization is only required for additional appointments past those allotted. 

For state protocol purposes, the official rescinding of that policy goes into effect October 25th.

Original Story:

After backlash from dozens of mental health providers, their patients and other concerned citizens, the Nevada Department of Health and Human Services made changes to a controversial medicaid policy proposal. It originally specified a wait time before a patient could be treated. 

KTVN was the only news station at that first meeting back in June, and Tuesday, our team was there again as opponents protested and the department presented their revisions. 

The amended policy allowed patients three visits before requiring prior authorization. At the start of the meeting Tuesday, the state changed it once again. Now, patients are allowed five sessions before prior authorization is required. 

Critics say they do feel like they're being heard.  Genevieve Ramos with Serenity Mental Health in Carson City says, "They are at least attempting to hear the concerns of the community." However, many say they still have work to do. Heather Flowers, Neurotherapy Clinician says, "That's still falling very short but I'm very pleased that they are willing to now listen to the providers."

Currently, patients are alotted a limited number of sessions for certain mental health services. They would need prior authorization going forward for any additional visits; something providers say is often a difficult medicaid process. Ramos adds, "Once we do get [prior authorization requests] submitted, some get approved, some get denied and there doesn't seem to be a reason why." 

With the lines of communication now open, some hope that caps on mental health sessions are eliminated in the future.  All parties involved say they look forward to more discussion. 

There is a six-week delay until the policy is effective to allow for more feedback and possible revisions.

The policy is effective October 1, 2018. 

Original Story:

A policy change proposal that could affect Medicaid's behavioral health patients drew plenty of public opposition at a workshop on Friday.  The policy would require prior authorization for Neurotherapy and Psychotherapy Medicaid patients to demonstrate medical necessity before they receive treatment.

The Department of Health and Human Services and the Division of Health Care Financing and Policy held a workshop to hear feedback from the public about their proposal. The department says they are now revising this policy proposal, after hearing those concerns. 

Officials said this policy would help both the most vulnerable patients as well as the administrative staff; but opponents strongly disagreed. 

Elizabeth Neighbors, the Statewide Forensic Program Director explained, "The intent is to improve services and to get the Medicaid dollars delivered to the populations that really need the care."

Patients would need to be assessed and evaluated, either in-person or via telemedicine, before a clinical team approved them to receive treatment.  State officials said this evaluation is important to see exactly which treatment plan works best. Neighbors says, "So that all of the services delivered are evidence-based services."

Opponents, however, said this would discourage those in already vulnerable positions, from seeking help. Kristopher Komarek, a Licensed Clinical Social Worker with the Family Wellness Center in Carson City explained, "Most of the clients we see come from extremely dysfunctional and chaotic backgrounds," he continued, "You just simply added a whole other burden that stands in their way."

Through the policy, the patient's status would last about 3 months, before prior authorization is required again. The prior authorization takes around 5 days to be approved. Some suggested that waiting period could result in issues like patients possibly harming themselves. 

The division reassured the public that the policy change would not affect those in immediate need. Shannon Sprout, Deputy Administrator for the Division of Health Care Financing and Policy says, "A crisis situation does not require that prior authorization."

Providers like the CEO of Northern Nevada Hopes noted administrative strain on an already understaffed industry, as well as the spike in need for mental health services. 

Officials tell KTVN the policy is currently being amended to address those public concerns. Initially, a public hearing where a decision would be made on the policy change, was set for late July--that hearing will now likely be pushed back.  

If you'd like to give your input about this policy, you can contact them here