Why Dialectical Behavioral Therapy?

Dialectical Behavior Therapy (DBT) is an evidence-based therapy that is effective for a wide range of disorders and problems, most of which are associated with difficulties regulating emotions and associated cognitive and behavioral patterns. DBT requires more up-front service/cost than other mainstream treatments but saves up to 50% in treatment costs by the end of one year and has been shown to be more effective. DBT saves lives and enhances quality of life.

What Are The Barriers To DBT?

Private insurers in Missouri do not have sustainable rates of pay for DBT service delivery. While private insurance typically covers the cost of individual therapy, the two-hour group skills training and on demand coaching are only partly covered or not covered at all. Medicaid does cover both individual therapy and two hours of group skills, but the clinician’s two-hour consultation meeting and 24/7 coaching calls are not covered. Medicaid also reimburses at a below market rate. These factors have led to a shortage of qualified DBT clinicians in Missouri and most providers are “cash pay”.

Missouri also does not have a requirement for clinician certification, despite the existence of a state and national certification program. Anyone can represent themselves as a DBT provider, regardless of the level of training received. Research has shown that DBT is most effective when delivered with fidelity. Missouri needs to establish:

1. certification procedures to ensure that providers of these services are qualified
2. treatment protocols including required service components and criteria foradmission, continued treatment, and discharge

How To Overcome Barriers

Require Medicaid to increase rates (via a modifier) for the Individual and Group Skills Training components of DBT such that ancillary costs of comprehensive treatment (weekly consultation team and coaching calls) are also covered.

Explore possibility of requiring coverage of all components of DBT by commercial insurance companies. This could be accomplished by having enhanced reimbursement rates for one hour of individual therapy and two hours of group therapy. The enhanced rate (accomplished via a modifier) will account for the extra time required for 24/7 coaching calls and the weekly two-hour team consultation meeting.

Establish certification procedures and treatment protocols to ensure that clinicians implement DBT protocols with fidelity.