pillsToday the Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services is releasing conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program.

This means there are finally rules that  “focus on the care provided to the client, establish requirements for staff and provider operations, and encourage clients to participate in their care plan and treatment.”

We’re talking about protecting not only the 48 million seniors covered by Medicare but also 8 million other, younger disabled adults who are covered by Medicare. That’s 56 million Americans – more than the populations of California and Florida combined.

In 2012, 100 certified community health centers around the country billed medicare for partial hospitalization services.

There are 184 pages of rules and they are going to make some folks unhappy. There will now be rules for the qualifications of personnel working in CMHCs; client rights; admission, evaluation, comprehensive assessment and discharge or transfer of client; the treatment team and plan and coordination of services; quality assessment and performance improvement; and governance and administration.

Why do we need these rules? Because of complaints of physical abuse, fragmented care and that some CMHCs have stopped providing services once their center has been certified. Many centers have never had an on-site visit from the Centers for Medicare & Medicaid Services after they are certified and if a problem was found, the government is limited in kicking the CMHC out of the Medicare program.

We also need the rules because of the findings of and August 2012 Inspector General’s report entitled Questionable Billing by Community Mental Health Centers. The report found that in 2010 about half of the CMHCs met or exceeded what is considered high billing for at least one questionable billing characteristics.

Additionally, two-thirds of those with questionable billing were located in eight metropolitan areas. Finally, 90 percent of the CMHCs with questionable billing were located in States that do not require CMHCs to be licensed or certified.

Among the 203 comments submitted by the public in response to the proposed rule were complaints that anyone with money, yet no knowledge of psychiatric care can open and operate a CMHC.

These commenters asked for minimum professional standards at centers where the administrator has a financial interest in the CMHC. In response, other existing regulations were changed and now require “two or more persons to serve on the governing body, one of whom must possess the knowledge and experience as mental health clinician.”

The administrator can still sit on the board but “if the administrator has no psychiatric health background, either one of the CMHC’s clinicians or another qualified professional should be appointed to serve as of member of the governing body.

Rules don’t come cheap and this is where we may hear some complaints. It is estimated that it will $30,000 for a CMHC to implement the new rule the first year and $22,000 annually after that.

Now, let’s see if the rules work and are worth the price.

Man with too many meds image available from Shutterstock.