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OK SPA 22-0032 Rate Increases for Outpatient Behavioral Health Agency Services, Residential Level of Care Substance Use Disorder Services, and Independently Contracted Psychologists

The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) proposes to increase rates for select services that are currently reimbursed less through SoonerCare than through ODMHSAS state funds or that have not seen increases in recent years. Services receiving rate increases include: individual and family therapy, individual Assertive Community Treatment, individual and group community recovery support, group psychosocial rehabilitation/illness management and recovery, and screening and referral. Proposed rate increases range from 7.5% to 100% and a new rate for complex screening and referral is being proposed. The new proposed rate for complex screening and referral is $75.00 per event.

Additionally, the ODMHSAS proposes to increase rates for residential level of care substance use disorder services. ODMHSAS proposes to increase the current reimbursement rates based on analysis of other states' rates for similar services; the increases align with proposed rates for these services when reimbursed through ODMHSAS state funds. Services include: halfway house services for adults and adolescents; residential treatment services for adults, adolescents, and adults with co-occurring disorders; intensive residential treatment services for adults and adolescents; and medically supervised withdrawal management services for adults and adolescents. Proposed rate increases range from 12.5% to 65%.

Further, the ODMHSAS proposes to increase rates for independently-contracted psychologists. ODMHSAS proposes to increase the current reimbursement rates that fall below 80% of the CY 2021 Medicare Physician Fee Schedule to equal 80% of the CY 2021 Medicare Physician Fee Schedule rates. Services include: individual and family therapy, assessment, interpretation of results of evaluations, and interactive complexity add-on. Through this proposal, the State also seeks to clarify its current reimbursement policy within the Oklahoma Medicaid State Plan for behavioral health licensure candidates. Payment will only be made for behavioral health licensure candidates practicing within an agency setting.

Please view the draft SPA pages here: OK SPA 22-0032 and submit feedback via the comment box below. 

30-day Tribal Consultation Period: May 26, 2022 – June 25, 2022

Tribal Consultation: June 8, 2022

Public Comment Period: June 9, 2022 – June 24, 2022

Proposed Effective Date: July 1, 2022   


Comments

Crystal Hoffman Faulkenberry:

I am a clinician supporting the increase.

OHCA Response:

Thank you for your support of these rate changes.


Molly Sanders:

Mental health professionals deserve more. Please take into consideration how valuable this work is and how much it serves our communities.

OHCA Response:

ODMHSAS strives to provide rate increases as funds are available. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Bryan K Thomas:

I know of several practitioners who struggle while putting their time and energy into caring and supporting others. Raising the rate would be lifechanging for so many people and would increase the drive and motivation of so many practitioners who feel the wear of our position.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Lacey B:

I believe this is absolutely necessary! Those that work in mental health are under tremendous amounts of stress and pressure on a daily basis. We are highly educated experts in our field and the Soonercare rate doesn't reflect that. We hold ourselves to the same HIPAA regulations and standards as all other medical professions, and many of us write our own notes and manage our own schedules. Most of us don't have office staff scheduling our appointments or doing our intakes. Not to mention that our livelihoods are dependant on clients coming for their sessions since their isn't a reimbursement rate for "no-shows".  Other insurances are paying upwards of $150 (or more) per hour and pay out more for family sessions beyond that. Those of us that have chosen to support clients in Oklahoma who have very little resources are doing so at the cost to our own livelihoods. This makes the rates of private practice (with private insurance) much more appealing. However, we then miss out on serving those in the community that need it the most and create an institutional situation where those in need, once again, don't have access to resources because the qualified professionals have chosen to pursue higher paying avenues. This, or course, leads to a perpetuation of the current mental health crises.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Dixi Randall:

Much needed.

OHCA Response:

Thank you for your support of these rate changes.


Kendra Morgan:

There has been an influx of people in need of treatment. As a result, Oklahomas mental health providers are doing their very best to  provide effective care to help Oklahomans manage various  mental health issues and substance-abuse difficulties. Because of the pandemic, inflation and other financial challenges,  to match the level of care they are receiving to the compensation clinicians receive  is fair and justified.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Bethany:

As a new clinician working less than one year, I am pleased to hear that this proposal is being considered. There is a lot of work I end up doing to arrange my schedule and communicate with clients via text messaging (because that is how many prefer to be contacted) that I am unable to bill. There's been a huge learning curve for me as well and a lot of time spent figuring things out that is also unbillable. A rate increase would help to compensate for all of the pre-session and post-session work that I do to ensure I am providing high quality services and care to each of my clients. Thank you for considering this!! With gratitude- Bethany, LMSW; MSW u/s

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Ashley:

The cost of living has increased so much with no increase in rate in many years.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Kelsey Hukill:

In favor of increases due to economic purposes.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Avis Taylor MS, LPC:

Yes please!! Long overdue.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Teresa Huggins:

Thank God. We lose money every month due to Oklahoma rates. Please increase our rates. We continue to do this work and would like to be breaking even at least!!! This is loooooooong over due!  I will be so thankful if it happens.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Josiah Stogsdill, M.S., LPC:

As an LPC I know that there are many service providers in general that are doing what they love to heal other people and are really doing what they can to survive on financially. Thank you for this consideration, a rate increase is a much needed and much appreciated decision! Thank you very much!

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Sojourner Harper:

This is much needed. I shouldn’t have to struggle financially to serve my clients and keep them mentally healthy.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


LaTasha Littleton-Guthrie:

I think the rate increase will be beneficial due to inflation and cost of living rising.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Allison Mason:

I fully support and endorse increases.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Amy Dwerlkotte:

If ever there were a time to increase for profit company rates it is now. Us mental health therapist and staff have had a tremendous hard couple of years but have none the less been here to work our passion of helping others. Please do make this increase for all to be treated equal.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Morgan Cutter:

An increase would help providers who see predominantly Medicaid clients make up for increasing prices in todays economy and encourage providers to continue to meet with them instead of moving away from taking Medicaid.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Leah Hutchings:

As a therapist, I fully and wholeheartedly support a rate increase for SoonerCare mental health services. Individual, family and group therapy is essential to the mental health needs of our OK residents. Therapists and practitioners working with this population deserve to earn a better working rate and one that is more comparable to private insurance. Thank you.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Tyler Cawyer, LPCC:

This proposed rate increase would be an important step towards further incentivizing providers to work with clients insured through Soonercare. Current rates do not, and have not kept pace with the absurd inflation we're all enjoying across the state. Clients and patients insured through Soonercare deserve the highest level of care, though it is no secret that many providers choose not to take their insurance due in large part to the lower reimbursement rate. This is unfair both to clients in need, and to the providers who wish to work with them, though struggle to afford the significant loss in revenue which comes with serving Soonercare clients. Oklahomans deserve better! 

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Megan Ingwersen:

Would love to see an increase and show Oklahoma that mental health is important. Thanks!!!

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Brittney Zickefoose:

There is a significant need in Oklahoma for mental health services for all ages. I know many providers who do not accept Medicaid because of the significantly lower pay rate compared to other payer sources. Increasing rates would ultimately improve the number of providers and hopefully increase accessibility for individuals and families to receive services.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Caroline Long:

A rate increase is much needed!!

OHCA Response:

Thank you for your support of these rate changes. 


Sherry Bray:

It is no secret how important that help is needed for assisting individuals with Mental Health problems they are trying to deal with.  Please help us maintain our therapists by aiding their reimbursement for the many services they offer these clients.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Stephanie:

Yes, please increase rates for Outpatient Behavioral Health Agency Services, Residential Level of Care Substance Use Disorder Services, and Independently Contracted Psychologists! These fields provide much needed services. This increase will also help these fields to make more money that they deserve. Yes, yes, yes to increases!

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Alyssa Danker:

I support the proposal for an increase in pay rate. Following the rise of inflation, it is becoming more challenging to pay for expenses. We are already dealing with a mental health provider shortage and should compensate appropriately for those who do stay in the field.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


B Thomas:

I entered a previous comment but I wanted to add that the proposal would be beneficial to help with inflation as well. Community therapists need to be concerned with rapidly rising gas prices to get to various clients as well as utilizing personal funds for resources. With the rising need for mental health services in the country, let alone the state of Oklahoma, it would be a massive help and boost in morale for people who have dedicated our lives to serving people.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Linda Carol Massey:

Rates in Oklahoma should be comparable to surrounding states and comparable to insurance companies.  Oklahoma needs mental health awareness and services now more than ever before.  OHCA has done an excellent job thus far, and they are always willing to help the providers in the state to understand policy.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Christopher Graham:

Mental health services have not diminished over the last 2 years. The need for proficient and competent professionals is harder than ever to find in this field. We cannot address the mental health crisis in our communities if we cannot first address the staffing crisis. Please increase outpatient rates to encourage the growth of this field. Mental illness and chronic disease will not decrease if we cannot provide meaningful and evidence-based services. Good treatment costs good money. Increase rates.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Brook Jamali:

We are currently in a mental health crisis as a state... the shortage of therapist is causing a huge impact on the mental health community and getting clients adequate services. If we can't pay therapists what they are worth we will continue to have more and more burnout and eventually there will be hardly any therapists left to see and treat the lower income communities. I highly encourage and support to increase rates for sooner care providers. 

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Laura:

A rate increase would be of benefit to patients as well as providers in that more providers would be willing to contract for services that are in tremendous need for some of our most vulnerable folks.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Tina Gibson:

I feel a rate increase is timely and necessary to be able to provide services for our rural community. Practitioners leave rural areas to seek better opportunities in other states or cities. A rare increase will provide not only access to services but a better quality of care. 

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


David Peters:

As the Executive Director of a private agency I strongly encourage these increases to occur as soon as possible. It has been an unfair market for ODMSAS programs to receive higher funding that private agencies who often have staff way more qualified and better trained. It is time for this difference to end. Thanks and let's get this passed.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Lynda Harrison:

Rate increases are sorely needed. Especially considering inflation and the growing mental health problems in the community.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Cassandra Cummins:

Thank You!! Much needed!!  Hopefully this will attract more providers!!

OHCA Response:

Thank you for your support of these rate changes.


Stephanie Quick:

I am in agreement and glad to see a proposed funding increase for mental health services.  It is long overdue in my opinion.

OHCA Response:

Thank you for your support of these rate changes. 


Cherese F Riggs:

Our state supporting increase for behavioral health providers is a step in  the right direction for our communities.  Now more than ever people are seeking qualified personnel and Oklahoma is losing these people to surrounding states due to the lack of compensation compared to those states.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Joe James:

This rate increase will be welcomed and is greatly needed, however, please strongly consider reaching 100% of the Federal Medicare Rate (rather than 80%). 

OHCA Response:

Thank you for your support of these rate changes. ODMHSAS strives to provide rate increases as funds are available. For independent psychologists, we chose a rate floor of 80% Medicare as a way to select services for increases. Other services are already paid higher than 80% Medicare.


Leslie Keenan:

It is VITAL provider reimbursement is increased. Medicaid members deserve access to quality mental health providers. Without an increase in reimbursement, we will continue to lose quality providers to private practices creating further disparity in access to healthcare for our Medicaid members. These individuals deserve access to quality healthcare. A rate increase is a terrific first step. Please consider increasing rates to the full 100% of the Federal Medicare Rate.

OHCA Response:

Thank you for your support of these rate changes. ODMHSAS strives to provide rate increases as funds are available. For independent psychologists, we chose a rate floor of 80% Medicare as a way to select services for increases. Other services are already paid higher than 80% Medicare.


Amanda Johnston:

This is desperately needed! Mental health providers have been under paid by Medicaid for decades, and as a result, amazingly talented providers are moving to private practice where they can make more money. Therefore, the Medicaid population is underserved. This increase would begin to, but not completely, remedy the problem. 

OHCA Response:

Thank you for your support of these rate changes. ODMHSAS strives to provide rate increases as funds are available. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans. 


Kathryn J:

This proposed rate increase is of vital importance to the health care of Oklahomans. Please consider increasing the rates to 100% of the Medicare Physician Fee Schedule rather than 80%. We need to support mental health providers now more than ever. In the psychologist section, it would also be best to replace "Clinical psychologist" with "Health Service Psychologist."

OHCA Response:

ODMHSAS strives to provide rate increases as funds are available. For independent psychologists, we chose a rate floor of 80% Medicare as a way to select services for increases. Other services are already paid higher than 80% Medicare. "Clinical psychologist" is the term that is consistent with other parts of the Oklahoma Medicaid State Plan.


Kim Baker:

More and more providers have stopped accepting Sooner Care, not because they don't want to serve that population, but because they can't survive with the current reimbursement rates.  We need to do better in supporting, in particular, our adoptive families who struggle to find the help they desperately need.

OHCA Response:

ODMHSAS strives to provide rate increases as funds are available. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Byron Brannon:

Mental Health Professionals deserve an increase due to their knowledge/skills WE have worked to achieve and continue to develop.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Kendra Lincoln:

I am in the position now of needing to choose whether or not to continue working at my agency or move to full time private practice becasue I can't continue to support my family as costs rise and pay does not. I would love to continue serving the families I work with now.  There are many therapists who would love to provide excellent services to Soonercare recipients, but cannot afford to continue to do so without detriment to their own livelihood.  Raising compensation to a level that competes with private insurance would allow Oklahomans receiving Soonercare better access to care.  Thanks for your consideration. 

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Jamie Sawyer:

Mental Health must be a priority in Oklahoma!

OHCA Response:

The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Linda Price:

To say that COVID rocked the world would be an understatement of colossal magnitude! With that has come such an increase in demand for mental health services that agencies are struggling to keep up. On top of that, the Great Resignation hit this industry just as hard as any other, with devastating consequences for everyone.  The remaining mental health providers need your help to keep their doors open for the people they serve.  As an adoptive and foster mom, I can tell you from experience that it is getting harder and harder to find qualified, committed therapists so your child is not going through a revolving door of burned-out therapists, new therapists who can’t afford to stay, or be on a waitlist for 6-10 months. Mental health services are vital for these kiddos because the wounds caused by trauma can be lifelong. This increase would help so many people, so please, strongly consider 100% rate increase.

OHCA Response: 

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Ashleigh DeLarzelere:

Much needed. The strain on the mental health system over the last two years is extraordinary. Therapists deserve more pay for their time. 

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Lisa Criswell:

I support the increase for providers. The staff is providing invaluable on site resources  to children. These providers are educated with the skills to help develop and address behavior health. They are an asset to the community and should be compensated for their work. Looking forward to seeing the community grow from the help these providers bring.

OHCA Response:

Thank you for your support of these rate changes. The State acknowledges the importance of the services that behavioral health providers furnish to Oklahomans.


Amy Fischer:

Very worthy option.  Please increase reimbursement rates.  Thank you.

OHCA Response:

Thank you for your support of these rate changes. 


James:

I support the increase.

OHCA Response:

Thank you for your support of these rate changes. 


Marla Marcum:

Periodic increases are necessary to keep potential interest in the field.  As an agency owner, I struggle to find clinicians interested in billing Medicaid, because they can't make a decent living.

OHCA Response:

Thank you for your support of these rate changes. ODMHSAS strives to provide rate increases as funds are available. 


Crystal Stimac:

People Inc. supports the increase.  The increase of inflation and costs going up, makes the rate increase needed.

OHCA Response:

Thank you for your support of these rate changes. 


Dr. Ward:

Why not 100% of the Medicare Rate? Should we now add Medicaid recipients to our busy caseloads because it would only be a 20%+ loss relative to a Medicare/Commercial patient?

OHCA Response:

ODMHSAS strives to provide rate increases as funds are available. For independent psychologists, we chose a rate floor of 80% Medicare as a way to select services for increases. Other services are already paid higher than 80% Medicare.


Cathy Blackburn:

A rate increase is desperately needed to increase the ability to provide quality services. Will the dollar amounts allowed at each prior-authorization level be increased as well? If not, a rate increase could actually mean less services for the persons served.

OHCA Response:

ODMHSAS data shows that current prior authorization amounts are sufficient, and we do not anticipate that these increases will result in providers exceeding their prior authorization amounts. However, we appreciate you bringing this to our attention so we can continue to monitor to ensure amounts remain sufficient.


Last Modified on Jun 29, 2022