JLARC Report. On the Implementation of STEP-VA Issued

June 24, 2019

JLARC (Joint Legislative Audit and Review Commission) is the “gold standard” of oversight for the Virginia General Assembly; in 2018 the staff was tasked with a review of the initial phases of STEP-VA.  The Report evaluated implementation as of May 2019.  The focus of the report is derived from the original goal that STEP-VA is intended to achieve consistent access to quality behavioral health services statewide. JLARC Commission Draft on the Implementation of STEP-VA STEP-VA intends to increase the number of required services from two (Case Management and Emergency Services) to eleven services and to accomplished this by July 1, 2021.  Clearly some “steps” are more complex than others, but all require funding to achieve and the workforce to implement. The well known descriptor of the 40 CSBs has long been – “If you know one CSB, you know one CSB!” With that foundation of significant differences among the 40 CSBs, the challenge of implementation is to clearly understand both the capacity and the needs in each area, set standards and develop measurable outcomes, adequately fund the increased expectations and set implementation target dates which are, in fact, achievable!  Not a simple task, and a significant point made by the Report is that the entire process has lacked the leadership necessary at DBHDS to achieve the goal. It is also apparent that the funding has not been adequate to meet the targets, though the total through FY20 is $60M in ongoing funding.  The greatest impact that any implementation may have on the private sector is the increased demand for clinical staff and the increasing competition for the limited workforce available. It may, however, present some opportunities for collaboration, especially in the provision of follow-up services within the desired timeframe.   The rate increase described in the Medicaid Bulletin of June 19th was overdue but we think our work over the last two Session contributed to its accomplishment! “Psychiatric Services Rate Increase” In accordance with Item 303.DDDD of the 2019 Acts of Assembly, DMAS increased practitioner rates for psychiatric services to reflect 100% of the 2018 Medicare rates. DMAS created a separate service category for psychiatric services, adjusted rates to reflect changes in relative value units (RVUs) in a budget neutral exercise and increased rates 21%. As a result of the adjustment for changes in RVUs, the actual increase by procedure code varies and reflects 100% of the 2018 Medicare rates. Rates for new services were also increased. This increase affects all providers of these services. In accordance with 12VAC 30-80-30(3), physicians are paid 100% of the Medicaid rate, psychologists are paid 90% of the Medicaid rate and other authorized practitioners are paid 75% of the psychologist rate.” NOTE: For specific rates you will have to search by CPT Code; the new rates are currently posted on the DMAS Website.