LITTLE ROCK — A legislative panel on Friday rejected an effort to reverse a previous vote to limit group therapy benefits for Medicaid recipients.
The state Legislative Council held a special called meeting to consider expunging a Sept. 23 vote that approved an emergency rule for the state Department of Human Services. The rule, effective Saturday, lowers the cap on Medicaid reimbursements for group therapy from 1½ hours per day to one hour per day and sets an annual cap, which has not existed before, of 25 one-hour sessions.
Thirteen members voted to expunge, falling short of the needed two-thirds majority, or 22 votes.
Members who requested the special meeting said they had not understood what they were voting on when they approved the rule a week earlier.
Earlier in September, the House and Senate public health committees signaled their disapproval of the rule by declining to review it. On Sept. 20, the Administrative Rules and Regulations Subcommittee of the Legislative Council approved the rule, and on Sept. 23 the council approved a report from that committee without discussion.
Sen. Joyce Elliott, D-Little Rock, said some council members who had concerns about the rule were led to believe it was being sent back to the Rules and Regulations Subcommittee.
“We need to work together, and we cannot do that in the best interest of the public if we don’t keep our word to each other,” she said.
Rep. Chris Richey, D-West Helena, said he believed it was a misunderstanding, not a “conspiracy,” that led to the council’s approval of the report from Rules and Regulations last week.
“When the report was read and there was included in the report, ‘a behavioral health rule will be heard at a later date,’ (for) me and the other people who understood that there had been this agreement to send it back, that confirmed our expectation of what was going to happen,” he said after Friday’s meeting.
In fact, it was a different rule that was to be heard at a later date.
“I just think it was one of those deals where circumstances came together and created the misunderstanding,” Richey said.
Before the vote on expungement was taken, Sen. John Cooper, R-Jonesboro, moved for the council to hear testimony.
“A lot of what has transpired, I think, up to this point has been due to some lack of information and confusion about information that’s been delivered,” he said
Rep. Kim Hammer, R-Benton, spoke against the motion, saying, “I feel that this subject has been well discussed and it’s time to move on.”
Ruth Allison Dover, CEO of Jonesboro-based Mid-South Health Systems, said after the meeting that if she had been allowed to testify, she would have warned the council that the rule could make Arkansas vulnerable to lawsuits.
“We will be violating our constitutional responsibility to take care of … the group who have committed a crime but have been acquitted by reason of their mental illness,” she said.
Dover said Mid-South has been helping the state meet that responsibility by providing round-the-clock care, but the state has never provided a daily rate for that care, as surrounding states do, so Mid-South has been relying on the group therapy reimbursements.
“Basically what the state has done is taken away our biggest tool to care and treat this population,” she said.
Bradley Phillips, who lobbies for the County Judges Association of Arkansas, said that if people who were acquitted of crimes because of mental illness are shifted to the state hospital, the state’s costs to care for them will increase.
Jail overcrowding also would increase because more people with mental illnesses who are awaiting trial would have to be housed in county jails, he said.
Medicaid Inspector General Elizabeth Smith has said she proposed the rule after AdvanceMed, a Virginia-based company that monitors Medicaid spending in several states for the federal government, found that Arkansas’ spending on group therapy significantly exceeded that of surrounding states.
Smith has said the caps are estimated to save $8.2 million in state dollars and $18.9 million in federal dollars this fiscal year and $10.9 million in state dollars and $25.2 million in federal dollars in the next fiscal year.