Arkansas DHS mulls caps in therapies for developmental disabilities

A proposed cap by the Department of Human Services on therapies for Arkansans with intellectual and developmental disabilities drew opponents to a public meeting Wednesday, but a spokesperson for DHS says the process for changing the rule is only in the beginning stages.

DHS is proposing establishing a threshold of 90 minutes per week for developmental and intellectual disability clients for each of speech, occupational and physical therapies – a total of 270 minutes, or 4.5 hours.

Brandi Hinkle, DHS spokesperson, said the proposal was developed with help from clinicians and by studying what exists in other states. Hinkle said if a client needs additional 15-minute units, his or her doctor would have to file for prior authorization under the proposal.

Hinkle said the proposed rule change is part of an overall assessment of DHS programs. Legislators recently approved a cap on group psychotherapy sessions, which previously allowed up to 10 children or 12 adults to participate at once for 90 minutes per day, with no limits to how many times the sessions could occur per week or year. She said prior authorization processes exist in other Medicaid programs.

Sen. Jim Hendren, R-Gravette, who chairs a task force on Medicaid reform, said policymakers are looking for savings in a Medicaid program that is growing year by year. Moreover, the state begins paying 5% of the cost of the private option in 2017. The private option is the program that uses federal Medicaid dollars to purchase private insurance for lower-income Arkansans.

“I think we have to do a better job of making people understand that the purpose of reform is not because we don’t want people in need to have services,” he said. “It’s because we do want them to have services, and if we allow this program to run out of money or get to the point where we have to start making hard choices about cutting programs in other areas, I think we’ve failed in our responsibility.”

Arkansas’ Medicaid program had an operating budget of $6.337 billion in fiscal year 2015, with $4.827 billion of that coming from the federal government. The Division of Developmental Disability Services cost $350 million that year. Medicaid represented 23% of the state’s overall budget of $27.6 billion and 18% of the $5 billion budget funded by general revenues in 2015.

Medicaid’s costs have grown significantly in recent years. According to the Arkansas Medicaid Program Overview for fiscal year 2015, Medicaid’s cost, not including administration, was $3.299 billion in 2007, with an average annual cost of $4,440 per beneficiary. In 2016, the cost was expected to be $7.317 billion, with an average cost of $7,250 beneficiary. And that figure estimated that 250,717 Arkansans would receive benefits through the private option. Instead, 265,608 were enrolled in August in the program, with another 28,638 deemed eligible and in the process of being included in the system.

Hinkle said the process of changing the therapy threshold to 90 minutes began with a public comment period that began Sept. 14 and ends Oct. 14. Ultimately, rule changes must be approved by the Legislature.

Hinkle guessed that about 100 people attended a public meeting Wednesday. Among them was Lainey Moore Morrow, the mother of a 3-year-old with Down syndrome and the founder of the group Medicaid Saves Lives. She began the group in April in response to opposition from some lawmakers to expanding Medicaid through the private option.

Morrow said her daughter, Lila, receives 180 minutes a week of each of the three services, which she said allow her to go to day treatment school and have access to resources and therapists. She said she is thankful for Medicaid.

“It has been just essential for our family and for her,” she said. “I think that she’s thriving because of this therapy. I mean, she would be light years behind where she is now without these therapists.”

She said that, “Ideally, we would not want any cuts. We like it the way it is as it is.”

Morrow met Thursday with Melissa Stone, director of Developmental Disabilities Services. She believes DHS is working in good faith and that the public meeting went well.

“I felt heard,” she said. “I’m thankful that we’re allowed to make comments.”