The problem:
A psychologist was asked to provide the state’s Medicaid provider with raw scores without any interpretation of the scores. The provider was concerned about this practice as “Releasing raw test data, without any interpretation, the potential use of assessment tools by unqualified persons, and the fact that Psychologists are required to retain responsibility for the appropriate application, interpretation, and use of assessment instruments as well as the need to ensure that explanations of results are provided by the psychologist, AND that there is a possible breach in test security. Before I return to my professional organization, the Maine Psychological Association (MEPA), I thought I would ask if you have heard about this practice, which seems relatively new. Would you be able to help with this as it is a systems issue and you know about systems better than the Association. Frankly, outside of the above ethical breach, I am even more concerned about adding one more barrier (as well as unnecessary fiscal and emotional (on the part of the individual and their caregivers) expense for duplication of work) to individuals getting the services they need.”
Action:
Through existing positive working relationships, MDDC was able to contact upper management at DHHS and MaineCare to bring attention to this issue and resolve quickly.
Results:
A misinterpretation of MaineCare rules was identified and was being implemented by the recently contracted prior authorization agency. DHHS leadership formally corrected the practice. We estimate that over 6,000 children could have been impacted by the practice if it was not corrected.
Unique role of the Council:
MDDC is well-positioned to address systemic issues quickly, given our reputation and role as a trusted systemic contact.