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Restricting eligibility for support services that keep people out of institutions is the wrong response.
Sunday, April 14, 2013
There are bad actors lurking among the businesses that provide care to individuals with mental illnesses through the Medicaid program.
Those bad actors take advantage of taxpayers who foot the bill, as well as the men and women who need support services so they can live in their community with some level of independence.
The Virginia Department of Medical Assistance Services is proposing new regulations to reduce abuses. While the goal is good, the suggested cure threatens to unfairly punish the people who depend on those services and would likely cost taxpayers even more in the long run.
State Medicaid officials want to restrict eligibility to individuals who have previously needed intensive or inpatient care.
In doing so, the state would likely cut off assistance to men and women who are thriving now but, if abandoned, could end up in a hospital psychiatric ward or a state institution. Or worse, they could join thousands of other people with mental illnesses in Virginia’s homeless shelters and jail cells.
If the state wishes to clarify eligibility, it should take care to include individuals who are at risk of hospitalization, not just those with a history of inpatient treatment.
But the most effective way to clamp down on abuses such as poor quality care, overbilling and inappropriate charges is to focus on the culprits, not their clients.
State officials can more strictly define what counts as a support service, a broadly defined term that covers help with living skills such as personal hygiene, safety, food preparation and nutrition, basic finances and monitoring of medications. Taxpayers should pay only for therapeutic, recovery-oriented services.
Poorly defined companion care and socialization activities are areas ripe for abuse.
Finally, the state should better vet providers by replacing the current licensing process with a request for proposals and a thorough evaluation of companies that respond. Those approved should be subject to regular audits.
The goal of support services is to keep people out of hospitals and institutions. Any changes to the rules should enhance that goal, not abandon it.
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