Accessing Medicaid Funds for School-Based Mental Health Services
Over the past several decades, our national public education system has seen a shift in responsibility for meeting student needs. Beyond education, schools are providing an increasing scope of mental and behavioral health services. While less than 20% of school-aged youth needing mental health services actually receive them, the majority of those that do receive mental health services receive them through the schools.1
Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy Changes and Clarifications Related to Home Health
This final rule revises the Medicaid home health service definition consistent with section 6407 of the Patient Protection and Affordable Care Act of 2010 (the Affordable Care Act) and section 504 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to add requirements that, for home health services, physicians document, and, for certain medical equipment, physicians or certain authorized non-physician practitioners (NPP) document the occurrence of a face-to-face encounter (including through the use of telehealth) with the Medicaid eligible beneficiary within reasonable timeframes.
Medicaid Coverage of Social Interventions: A Road Map for States
Extensive research demonstrates the impact of social factors—such as income, access to food and housing, and employment status—on the health and health outcomes of Americans, particularly lower-income populations. These findings are not lost on federal and state officials who seek to provide Medicaid beneficiaries with quality, cost-effective care. In developing strategies to address both the medical and social determinants of health, states face several challenges, including, primarily, how to provide a revenue stream to cover the cost of the social services. After all, Medicaid is first and foremost a health insurance program. Nonetheless, under some circumstances, Medicaid is available to cover the costs of social service interventions linked to the health of Medicaid enrollees.
Integrating Behavioral Health into Medicaid Managed Care: Design and Implementation Lessons from State Innovators
Medicaid enrollees with behavioral health needs have a high prevalence of chronic conditions and are often
frequent users of physical and behavioral health services. This brief, made possible by Kaiser Permanente
Community Benefit, provides insights from Medicaid officials and health plan representatives in five states
— Arizona, Florida, Kansas, New York and Texas — that are pursuing innovative approaches to integrate
behavioral health services within a comprehensive managed care arrangement.
Across the country, state and local officials are increasingly focused on improving health outcomes for people living with mental illness or substance use disorders. This brief analyzes national data on behavioral health and reviews published research focused on how Medicaid expansion under the Affordable Care Act advances the goal of improving treatment for people with behavioral health needs.
The Centers for Medicare & Medicaid Services (CMS) CMS has released the final 2016 Medicaid Managed Care Rate Development Guide for states to use in development of any Medicaid managed care rates with rating periods starting on or after January 1, 2016. This follows the release of the draft Guide in June of 2015 where CMS collected public input. Although the final Guide has remained largely the same from its draft version, this Guide includes revisions based on the input collected which includes but is not limited to 1) changes around the administrative load development, 2) clarity on defining the types of managed care plans, 3) when a legally mandated change should be incorporated into the rates, and 4) clarification on the types of supporting documentation expected. States and their actuaries should follow this guide in development of their actuarial certifications in order to streamline the review process. CMS will use this Guide as well as the regulations found at 42 CFR 438.6 as the basis for the review of 2016 actuarial certifications. Click here
The Medicaid Home and Community-Based Services Settings Rules: What You Should Know
In January 2014, the Centers for Medicare & Medicaid Services (CMS) announced new rules that will potentially have a far-reaching and positive impact on the nature of residential and day service settings funded through Medicaid as part of Home and Community Based Services (HCBS). The final settings rules took into account thousands of public comments reflecting a wide range of perspectives that were gathered over five years. Click here