Jodi Smith of Coeur d'Alene, a PSR provider, said Idaho is the first state in the nation to require new certification credentials for providers of psycho-social rehabilitation services, a requirement that's now pending. Yet the state is considering eliminating those services as part of $25 million in Medicaid cuts next year. "Providers in Idaho are actively working to obtain the necessary requirements for their certification," Smith said, which she said will also improve the quality of care. "It seems ironic that a state that ... so strongly ... requires practitioners to obtain a certification in their area of work, is considering eliminating the very ... services it seeks to improve." Smith said in her work, she can report 90 percent success in avoiding psychiatric hospitalization for her patients. The average cost per patient per day for PSR services is $32.14, she said, while the hospitalization cost exceeds $500.