Thank you for the opportunity to comment on the most recent version of possible regulation changes for MHSS. 

This version of regulation changes has some very positive improvements included such as adding folks with certain credentials back into the regulations as being able to provide MHSS, such as QMHP-E's, which we had been told was an oversight.  The addition of counting non-residential crisis stabilization as a higher level of care for eligibility criteria is also a positive change.

The concerning portion of this version of changes is the cap on the number of units MHSS can be provided in a day.  While I certainly agree that serving clients for 3 units (more than 5 hours) a day should not be necessary on a frequent basis, there are some very real and legitimate times in which  spending that much time with a client is not only necessary, but to do otherwise could be neglectful and/or limit the client's access to care.  A new client who comes into services frequently comes in with nothing.  No housing, no resources, no medications, etc.  It is imperative during that first week to see to the needs of that client so that their risk of hospitalization and other higher forms of care are decreased.  It would be very difficult in this situation to limit the services given to the client just based on regulation as opposed to the client's need.  This is especially true in rural areas where resources are spread out across a large geographical area.  In rural areas, clients are forced to go long distances just to get their basic needs met and to see service providers, including psychiatric care.  Limiting the client's access and not basing the services on the client's needs is not person-centered and, depending on the client's need, could be considered neglectful.  This will either force clinicians to provide services for free or the client's needs will not be met.  This type of choice will encourage less ethical individuals to engage in fraudulant activities.  For those providers who choose to continue to see the client, providing the services for free, it will significantly impact their revenue as they will continue to pay staff, but receive no reimbursement for the additional hours. 

Another instance would be when a client is having difficulty with heightened symptoms and the clinician is able to talk the client into going to the hospital for evaluation with them.  The waiting times for these evaluations can be extremely long and can quickly add up to more than a 5 hour visit with the client.

In the new regulations, DMAS has lifted the cap of 8 hours per day for Crisis Stabilization and Magellan has stated that appointments longer than 8 hours will face more auditing and/or scrutiny.  This is the standard that should apply to MHSS as well.  Those clients that are consistently seen for 3 units a day should be examined to make sure there is appropriate supporting documentation to justify the more lengthy provision of services.  
Another option would be to audit more closely those providers who consistently provide services for longer than 3 units a day for many of their clients. 

It would appear that this change in regulation is in response to providers who are not good stewards of the service.  A change like this would only limit a client's access to care and make it difficult to meet their needs.