Reverse 2019 Medicaid Billing Changes Negatively Impacting Social Workers and Clients

Reverse 2019 Medicaid Billing Changes Negatively Impacting Social Workers and Clients

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Mark Harrison started this petition to Alabama Medicaid

Alabama Medicaid has moved to severely limit social workers in their billing of mental health services, limiting the ability to provide mental health services in the State of Alabama. This petition represents an attempt to change this policy. 

Background: In January of 2019, Alabama Medicaid released policy changes in the 34th chapter of the provider manual which pertains to mental health services. Within this chapter are certain policies that greatly impact social workers providing services in the behavioral health realm. The changes have resulted in a policy stating that social workers (Licensed Master Social Workers, Licensed Independent Social Workers, and/or Private Independent Practitioners) can bill Medicaid for mental health services only in cases where referrals are sent by a Medicaid-enrolled psychologist hrough an AMP (Alabama Medicaid psychologist) referral form. This differs from those holding a licensed professional counselor (LPC) license, who are able to accept referrals from primary care physicians through an EDSPT (Early and Periodic Screening, Diagnostic, and Treatment) form. This creates an unfair disadvantage to social workers, who provide the same types of therapeutic mental health services as LPCs, frequently though the same agencies and providers. 

Additionally, social workers can no longer bill Alabama Medicaid for psychiatric diagnostic evaluations (code 90791). This effectively removes the ability of social workers, regardless of licensing level, to bill for behavioral health diagnosis. This can now only be billed by LPCs. 

Also, group therapy can now only be billed to Alabama Medicaid by clinical psychologists licensed in the State of Alabama, limiting the ability of both social workers and professional counselors to file for Medicaid reimbursement. 

These changes also limit Medicaid recipients from receiving behavioral health services, as the number of Medicaid providers is instantly reduced. This imposes unreasonable restrictions on providers of mental health services in Alabama, especially in rural areas, where access to such services is already severely limited.

Alabama Statistics:

There is only one mental health provider for every 1,260 people in Alabama, placing Alabama 50th out of 50 states; 51 out of 51 if the District of Columbia is also included (Mental Health America, 2018). 

Alabama has a higher prevalence of mental illness and lower access to mental health care than other states in the nation (Mental Health America, 2018).

In fiscal year 2016, a monthly average of 1,043,551 Alabamians were eligible for Medicaid out of the total population of 4,863,300 (Alabama Medicaid, 2016).

Access to care (Mental Health America, 2018): 

382,000 adults had a mental illness in Alabama in 2018 and did not receive treatment. 

24,000 youths had a mental illness in Alabama in 2018 and did not receive treatment. 

136,000 adults with a mental illness in Alabama in 2018 were uninsured.

17,000 youth in Alabama in 2018 had private insurance that did not cover services for mental or emotional problems. 

Policy recommendation: This Alabama Medicaid policy should be changed to include social workers (LMSW, LICSW, PIP) as providers to receive referrals from primary care physicians, be able to bill code 90791, and be able to bill for group therapy interventions. 









 

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