The state’s method for paying those who provide mental health care to the poor is inconsistent, inequitable and “no longer appropriate,” an independent auditor told lawmakers Monday.
The state department of Health Care Policy and Financing acknowledged problems with the system for reimbursing Medicaid contractors.
However, officials said, any changes would require new legislation – and a substantial amount of money.
Auditor Margaret Dickinson told the committee that the cost of contract care at the 17 Community Mental Health Centers varies wildly.
For example, 20 to 30 minutes of individual psychotherapy costs the state as little as $35.93 at one center, but the same treatment costs $157.69 at another center.
Because the rates are based on information that is 10 years old, “it is likely that the current fee schedule does not reflect current costs of care,” Dickinson told the committee.
State reimbursement amounts are calculated with a complicated formula, set by law, based on cost information from past years.
The department estimated that overhauling the system would require an initial investment of about $350,000, said HCPF executive director Steve Tool.
Money for those changes is not included in the department’s budget request for the coming year because the budget was due before the audit was completed, Tool said.
The performance audit, by Mercer Government Human Services Consulting, was presented to the Legislative Audit Committee Monday.
Despite the roadblocks of cost and legislative action, State Auditor Sally Symanski urged the health-care policy department to implement the suggested changes.
“This is an area where the state has struggled for years,” Symanski said.
Staff writer Karen Augé can be reached at 303-954-1733 or kauge@denverpost.com.
