Notes from CCUSA Behavioral Health Conference Call

1. Program Structure:
a. Counseling center with insurance billing (private and Medicaid) or
self pay on a sliding fee basis determined by income and family size.
b. Parish based
i. Parish pays a yearly amount (billed quarterly, ie. $4,000/year)
for CC presence at the parish location. The clients are given a
25% less charge for services if they are from that parish.
Counselor (MSW or MA in counseling, under supervision, must
be on track to attain license, supervision covered by agency in
order to create loyalty to organization so they will stay on after
they get licensed as LCSW or LPC). The parish is required to
provide a private office with a phone and locked file cabinet
(COA Standard). The counselor is to offer quarterly education
sessions open to the parish. This is a good service but also a
way to promote the program. The parish places a little
advertisement in the bulliten each week.
ii. Agency pays reduced rent to parishes for office space and
provide services to parishioners and others.
c. In home services- counselors provide therapy in clients homes
d. Services to Catholic grade schools- charge the school a flat fee for a
certain number of days/hours per week for the school year. Provide
counseling services for students during school hours as part of
contract. If parents/families need services outside the school
day/year then they are charged on regular sliding fee scale.
2. Use of Interns/Practicum students and unlicensed clinicians
a. Second year or advanced placement social work masters students
provide therapeutic services on an increasing level of autonomy as
school year progresses. Have interns research best practice methods.
b. Have students see clients with regular supervision on site. Work with
local universities to assure quality students.
3. Insurance/Medicaid
a. The Affordable Care Act has effected our clientele both positively in
that folks have insurance and negatively in that the deductibles are
extremely high. Many of the clients that have previously been seen by
our agencies that did not have insurance could be billed at a sliding
fee rate so that it could be affordable. Numerous clients have
deductibles as high as 5,000 and it may take them the entire year to
reach this amount. Clients previously charged the reduced rate are
now being charged the maximum rate of as high as $125 per session
so that the insurance can be billed when the deductible is met.
Therefore, clients are put on payment plans. If the rates fluctuate then
agencies can be penalized, even having to pay the entire amount back
to the insurance companies. These are creating difficulties for our
clients who have traditionally been on the sliding scale. The
regulations of being on panels for some insurances such as Blue Cross
have become unrealistic financially due to the requirements such as
having a psychiatrist on staff. These difficulties are still unfolding and
will need to be monitored. Some of our states have taken the Medicaid
expansion and some have not which effects the co-pay and access to
services.
4. Promotion of Program
a. This is a tough area for all of our programs. Suggestions such as
weekly bulletin announcements, advertising in the Catholic
newspapers, posters in churches, free educational sessions in parishes
or community centers to tell about our services, free radio shows,
PSAs and articles on the impact clients have had from counseling in
catholic and mainstream newspapers.
b. This is an area where many people have lots of ideas and further
thoughts but also lots more questions.
5. E.A.P.
a. This is an area that some of our agencies have gotten into especially in
a contract with local county agencies to provide DUI counseling and
assessments.
b. Some agencies provide EAP services to the diocesan employees. This
is an area that could use some promotion among the employees that
work for the diocese so that they know that the service is available to
them. In some cases an employee can call the EAP number and go see
the counselor and then the diocese receives a bill without a name
attached so that the confidentiality is honored.
6. Telephone counseling
a. Not much interest in this. It seems that some insurance agencies have
advised against it due to risk management issues.
b. There are some agencies that have been able to manage this utilizing
1-800 numbers and setting appointments. This can be helpful for folks
in rural areas that do not have access to mental health counseling in
their areas.
7. Court Referrals
a. Some agencies contract or simply receive referrals from county
entities for domestic violence, county custody evaluations, and anger
management classes. One agency mentioned offering supervised
visitation for non-custodial parents with extra funding source being
therapeutic supervised visits. These can be referrals from the court.
b. Some agencies mentioned working with the DA office on victim
advocacy this can be a stream of income. In these cases the
perpetrator pays for services and the funding goes into a victim
compensation pool of funds.
8. Integrated Health
a. This is a trend among national advocates. One agency mentioned that
in Washington state there is a bill to research best practice among
integrating A and D counseling, mental health and primary health
care.

Hopefully this caught some of the concepts and will trigger some ideas for you all.