Changes to staff/client ratio, reimbursement rates for certain care proposed

TRENTON – The Department of Human Services is proposing changes to reimbursement rates and staff-to-patient ratios for certain types of psychiatric care.

For what it calls “psychiatric adult acute partial hospital and partial hospital services” and “independent clinic services’’ the state wants to change the ratio of staff to clients from 1 to 12 to 1 to 15.

In addition, reimbursements under the Medicaid/NJ FamilyCare program would drop for partial care services from $15.40 per hour to $14.55 per hour, and reimbursements for such hospital services would drop from $35 to $33.08.

These partial care services are for people with severe mental illness, are designed to help them avoid hospitalizations and relapses, and instead live in communities and have access to counseling, case management and other services.

But, according to the department, ongoing fund cutbacks for community mental health programs and to the providers of Medicaid/NJ FamilyCare require cuts in the reimbursement rates, cuts in program costs, and revised staff to patient ratios.

The department states that these changes are necessary “in order to ensure that consumers can receive needed services in the most efficient and effective manner possible.’’

There will be consequences, however.

The department acknowledges there may be fewer staff positions as a result, but stated in its proposal, “it is often the duty of government agencies to balance competing interests in implementing public policy.”

The state reported that in fiscal year 2010, total department expenditures (state and federal monies) for partial care services were approximately $80.4 million.

It estimates that gross annual savings from these changes will be approximately $4.44 million for partial care and $885,000 for partial hospital expenditures.

In its proposal, the department states that it “believes that providers should experience no net negative economic impact as a result of the amendments because resulting reduced staffing costs will balance out reduced reimbursement rates.’’

The department reported that in fiscal year 2010, 6,266 patients received partial hospital services from 36 hospital providers in the Medicaid/NJ FamilyCare program.

And it also reported that for the same fiscal year, 6,538 patients received partial care services from 29 providers in Medicaid/NJ FamilyCare.

Department spokeswoman Nicole Brossoie said no official would be available today for further comment, but she stated that “this was an FY ’11 budget initiative.”

“This adjustment, and the contract cost reduction, better reflect the provision of less intensive mental health services in these settings.

“Providers’ costs will decrease commensurate with the reduced staffing requirements and therefore will not be adversely impacted.’’

Industry representatives are following the developments.

“Whenever there is a reduction in reimbursement to providers, there is natural cause for concern,” said Mary Ditri, director of professional practice for the N.J. Hospital Association.

“We’re still evaluating whether the impact of the reimbursement cut will be offset by the change in staff-to-consumer ratios.

“The bigger issue, and what needs to remain the focus, is the ultimate impact this will have on access to care for individuals in need of services. Community resources are woefully limited already and hospitals act as the safety net for this vulnerable population.”

Changes to staff/client ratio, reimbursement rates for certain care proposed