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Health care payments continue to evolve and shift away from fee‐for‐service payment systems that typically reward volume and move to value‐based payment (VBP) models that incentivize high‐quality, cost‐effective care. While this is happening more for physical health services, there's more uncertainty about the role of behavioral health. A new white paper aims to tackle that question with information about existing models that have been implemented along with recommendations for federal and state policymakers. [ABSTRACT FROM AUTHOR]

The year ended on a high note for the mental health field with the release of the Consolidated Appropriations Act of 2023 (also known as the "Omnibus"). The omnibus appropriations funding package, which passed Dec. 23, 2022 by the House of Representatives and earlier in the week by the U.S. Senate, contains key mental health provisions, including significant increases for the Community Mental Health Services Block Grant and for Certified Community Behavioral Health Clinics (CCBHCs). [ABSTRACT FROM AUTHOR]

Medicaid payment rates for psychiatric services continue to lag behind comparable Medicare reimbursement in most states, with wide variation in rates across the country, a newly published study reported. While low payment rates are thought to contribute to a shortage of psychiatrists treating low‐income patients, the study's researchers suggest that simply increasing reimbursement rates might not be enough to shore up the workforce. [ABSTRACT FROM AUTHOR]

A survey of Medicaid enrollees with serious mental illness (SMI) in a state with significant experience in integrating behavioral health and medical care is pointing out many shortcomings in managed care's response to these individuals' complex needs. [ABSTRACT FROM AUTHOR]

Many Medicaid‐eligible children are not receiving recommended timely follow‐up care in the community after a mental health‐related visit to a hospital emergency department, a newly published study suggests. The study's numbers paint an especially disappointing picture for Black children, likely reflecting a number of conditions ranging from a lack of diversity in the behavioral health workforce to limited access to school‐based services. [ABSTRACT FROM AUTHOR]

The article discusses the Treat First model of care program led by the New Mexico Behavioral Health Services Division for clinical practice improvement. Topics discussed include reactions of medical service provider on proposed cuts in Medicaid payment rates and fragmented service system, assessment related to patient's paper work and views of program coordinator Betty A. Downes on the same.

North Dakota officials continue to make adjustments to the state's Medicaid behavioral health program, first implemented in a state plan amendment last February. The most recent changes to North Dakota's Medicaid 1915(i) state plan amendment include an eligibility score adjustment that should expand access to home‐ and community‐based services for a broader range of individuals with mental health needs. [ABSTRACT FROM AUTHOR]

States are overcoming a variety of structural and financial barriers to make inroads in meeting the mental health needs of persons with intellectual and developmental disabilities, a new report suggests. No one model has emerged as the ideal approach, though in all cases there has been a need to improve coordination of effort across multiple organizational silos. [ABSTRACT FROM AUTHOR]

The article reports that Kentucky officials are proposing to redesign the state's Medicaid program to address a $675 million shortfall in fiscal 2006. The redesign process includes improved coordination of mental health and substance abuse services and physical health services, to address the current fiscal crisis affecting the program. Faced with a $675 million budget shortfall in fiscal 2006, officials are planning to submit a Medicaid waiver proposal outlining their vision for a transformed Medicaid program to the U.S. Centers for Medicare and Medicaid Services officials on September 7, 2005. INSET: Kentucky Medicaid officials point to integrated care delivery..

Reports that New Jersey is seeking input on a document outlining state officials' ideas for managed mental health services under Medicaid. Areas in which the document is different from other states, including consumer choice, partnerships, medical necessity and outcomes.

Access to physicians in all health care categories poses a problem for Medicaid beneficiaries, but a research letter published this month highlights the disproportionate challenge in identifying psychiatric services for this population. [ABSTRACT FROM AUTHOR]

This article presents news related to mental health services. According to a congressional investigation recently made public, the government pays for prescription Medicaid. Thera-Tech LLC, acknowledging the unique business needs of private mental health practices, has launched a new industry-specific web site to help independent practitioners market and manage their practices online. Value Options was awarded an eHealthcare Leadership Award at the Eighth Annual Healthcare Internet Conference.

The article focuses how mental health advocates are building a momentum urging consumers and families to speak up against the U.S. Congress who is taking legislative action on repealing the U.S. Affordable Care Act (ACA) by letting them know how important the reform is for them.

The article discusses the highlights of the 29th annual Rosalynn Carter Symposium on Mental Health Law that was held on November 7-8, 2013 in Atlanta, Georgia. According to the author, the symposium attracted about 200 mental health professionals, providers, consumers, and field leaders to address important components for the field in working for consumers with mental health issues and service delivery.

The article discusses a report released by the Institute of Medicine (IOM) that compares national trends in the number of children with mental disorders under 18 to trends in the Supplemental Security Income (SSI) childhood disability population. Topics cited include an increase in the number of children who receive SSI from the Social Security Administration and the need for better data about diagnoses and comorbidities to inform improvement to the SSI program for children. INSET: Quality diagnosis essential in identifying children for....

The article discusses the study led by University of Southern California professor Darius Lakdawalla that examines the requirements for prior authorization in mental health. It mentions the applicability of the antipsychotic medications in Medicaid programs. The anticipated repercussions if mental health is inappropriately managed in the healthcare system are also emphasized.

The article discusses the highlights of the U.S. Energy and Commerce Subcommittee on Oversight and Investigations' hearing to examine the shortage of beds for inpatient psychiatric care on March 26, 2014. Topics discussed include the advocacy groups' submission of comments that seek the repeal of the Medicaid Institution for Mental Disease (IMD) exclusion and examination of the effects of bed shortage to consumers with serious mental illness, hospital care and communities.

Washington State Settlement Set to Overhaul Medicaid MH Services for Youth Smoking Rates Declining in General but Not for People with Mental Illness Kansas Officials, Providers Discussing Psychiatrist Shortages Readers: Service Access, Integration Key Challenges for 2014 Proposed Rules Issued to Strengthen Federal Background Check State News Coming up [ABSTRACT FROM AUTHOR]

The article discusses the experience of Toledo, Ohio-based Zepf Center in its participation in Ohio's Medicaid health homes initiative. It explains that the program involves the integration of behavioral health and primary care services and requires understanding of patients' other medical records including body mass index, blood pressure and cholesterol level.

The article focuses on the issue of Medicaid expansion in Missouri. Joseph Parks, medical director, Missouri Department of Mental Health, revealed that under the Affordable Care Act (ACA) federal disproportionate share hospital (DSH) payments will gradually decrease to a 50 percent cut. Impacts of non-expansion of medicaid include reduction or elimination of psychiatric services and outpatient mental health system will focus more on crisis services.

The article focuses on medicaid expansion proposed by North Carolina health and human services officials. It will enhance quality of care and service access as well as enable local management entities (LMEs) to make alliance with community stakeholders, consumers and providers, that is to combine services into a single model. According to the Director of North Carolina Division of Mental Health Steve Jordan, the LMEs will be operational by January 1, 2013. It will improve service delivery.

The article reports on the proposed Medicaid system in Missouri which received some attention from national advocacy groups for its implementation. According to the article, the legislative bill will move forward, however without a plan for beneficiary wellness incentives that had worried advocates for individuals with serious mental illness and other disabilities.

The article reports on the concern of mental health advocates to the pending legislative decision regarding budget reconciliation. The mental health advocates are pushing for the potential changes to Medicaid including a higher cost-sharing requirements for critical services like prescriptions, physician services and inpatient care. Advocates assert that cuts to Medicaid in the House would dismiss the safety net for millions of beneficiaries who mainly rely on the program.

Reports that the industry group Pharmaceutical Research and Manufacturers of America filed a lawsuit against the Medicaid program of Michigan in July 2002.

The article talks about social media campaign of Treatment Advocacy Center (TAC) and the National Association of Psychiatric Health Systems. Topics include aim of the social medial campaign such as Institutions for Mental Diseases (IMD) exclusion; impact of IMD exclusion on preventing people with serious mental illness from receiving hospital care; and letter of the Centers for Medicare and Medicaid Services regarding its willingness to improve access to substance use disorder care.

Reports that Washington Community Mental Health Council representatives held a meeting with United States Health Care Financing Administration (HCFA) officials to air concerns about the functioning and structure of the state's mental health carve-out. HCFA's review of the state's application for the renewal of its Medicare waiver; Problems in the program; Other concerns cited by advocates. INSET: Origin of Washington RSNs.

The article reports on the risk associated with the elimination of the Medicaid expansion as per the mental health and consumer advocates in Arkansas . Topics discussed include expansion of the U.S. Affordable Care Act, in Arkansas; views of Kim Arnold, executive director of the National Alliance on Mental Illness Arkansas, on Medicaid expansion; and views of Marquita Little, health policy director for Arkansas Advocates for Children and Families, on relationships with patients.

The article reports on the positive results of the implementation of Oklahoma Medical Risk Management (MRM) program. It mentions that the program was developed by several organizations including the Oklahoma Health Care Authority, Oklahoma Department of Mental Health and Substance Abuse Services and Care Management Technologies. It cites that the mental health Medicaid program aims to manage care coordination for children who have mental health and physical health conditions.

The article reports on the concern raised by mental health advocates in Indiana regarding the proposed changes of the Medicaid Rehabilitation Option (MRO) program. It states that the changes might have an impact on clubhouses including the Carriage House in Fort Wayne. According to a report from the Division of Mental Health and Addiction (DMHA), the recent audit for the MRO program has initiated concern about the misuse of the program to finance non-Medicaid reimbursable activities.

The article offers information on a step-by-step guide to be released by the National Governors Association (NGA) for states seeking to design and implement statewide transformation of Medicaid programs using the authority of either state plan amendments or Section 1115 waivers.

The article provides updates related to medical care in the U.S. The Bazelon Center for Mental Health Law urges advocates to participate in the public comment period regarding the final regulations on the case management services under Medicaid by the Centers for Medicare and Medicaid Services (CMS). The Food and Drug Administration is necessitating drug makers to incorporate a comprehensive suicidal risk factor assessment in its clinical trials.

The article reports on the increasing role of Medicaid agencies in funding, managing and monitoring public health services in the U.S. The result of the survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that Medicaid agencies are the primary payer of mental health services in the nation. It is suggested that collaboration between Medicaid and mental health agencies will help stabilize the state of financing mental health services.

Focuses on the reactions of mental health providers on the expansion of Medicaid coverage to uninsured individual in the United States. Impact of waiver on the flexibility of Medicaid planning; Plans on expediting the federal waiver process; Redefinition of Medicaid benefits.

Reports that managed behavioral health care firm American Psych Systems is using its electronic authorization system called CareConnection for its operations in Georgia's Medicaid program. Provision of a permanent electronic record in addressing the needs of mental patients; Efficiencies derived from the program.

Reports on the plans of the United States House Budget Committee to cut federal spending for Medicaid and Medicare. Impact on providers of behavioral health care; Possibility of structural changes to Medicaid and Medicare; Possible reduction of mental health services.

The article reports on the multi-million dollar campaign aimed at beefing up and reauthorizing the State Children's Health Insurance Program (SCHIP). SCHIP is a joint state and federal effort that subsidizes health coverage for children from families that earn too much to qualify for Medicaid but not enough to afford their own private coverage. Health Care for Kids has launched a bipartisan and direct mail campaign to convince a divided Congress to approve the bill.