Expanding Access to Virtual Behavioral Care: Navigating State and Federal Regulations

2024 could prove pivotal for virtual behavioral health as the federal government considers making COVID-era telehealth flexibilities permanent.  Federal and state regulations can heavily influence the availability of behavioral telehealth appointments. For behavioral health providers who provide care to Medicaid beneficiaries, or who prescribe controlled substances for conditions like substance use disorders (SUDs), regulations can […]

Congress Tries Again to Increase Medicaid Spending for Behavioral Health

Federal lawmakers are taking another stab at increasing funding for behavioral health expenditures in the Medicaid program. A version of the Medicaid Bump Act was introduced in the U.S. Senate and Congress on March 12. The bill would create financial incentives for states to elevate spending on behavioral health beyond levels in 2019. Specifically, it […]

Dispelling Medicaid Myths and Removing Barriers for Value-Based Behavioral Health Care

State Medicaid programs and their managed care organization (MCO) partners are amenable to value-based care contracting. However, misconceptions remain as the industry navigates the early stages of value-based care adoption. This openness allows companies to come to the table with new or different approaches to contracting, opening the door to escaping the fee-for-service paradigm. “The […]

PE Wary of Serious Mental Illness Investment, But Venture Capital May Be Ready to Pounce

While private equity investors continue to look for new opportunities in behavioral health, there is one area that is still relatively uncharted: serious mental illness (SMI) care. Caring for the SMI population can be very challenging and requires a multipronged approach, as well as a robust patient engagement plan. Due to these challenges, SMI care […]

Behavioral Health Key to Elevance’s At-Risk Strategy

Behavioral health is at the heart of Elevance’s (NYSE:ELV) plans to increase its at-risk offerings. Specifically, Elevance plans to focus on rolling out its Medicaid behavioral health offering focused on serious mental illness care. “We have new offerings that are whole health full-risk opportunities, like assuming full-risk in oncology, as well as in Medicaid with […]

CMS Launches ‘Revolutionary’ New Behavioral Health, Primary Care Integration Model

The Centers for Medicare & Medicaid Services (CMS) is working to improve access to behavioral health with a new initiative designed to integrate behavioral health with physical health. The newly launched program, called the Innovation in Behavioral Health (IBH) Model, will connect adults with mental health conditions or substance use disorders (SUDs) to physical, behavioral […]

CMS Approves ‘Groundbreaking’ Behavioral Health Integration Waiver for New York

The Centers for Medicare and Medicaid Services (CMS) has approved a $7.5 billion waiver for New York, allowing the state to integrate primary, behavioral health, and health-related social services over the next three years. One of the main goals of the waiver is to help boost population health and equity outcomes for high-risk Medicaid enrollees, […]

Integrated Managed Care Organizations Fail to Outperform Carve-Outs in Behavioral Health Access

Access to and utilization of services was not better at integrated managed care organizations – Medicaid plans that do not carve out behavioral health services – compared to other models. That’s according to a new study published in JAMA, which analyzed claims-based measures of utilization, health-related outcomes, rates of arrests, employment and homelessness. Historically, Medicaid […]

Mental Health Now Top Comorbidity for Highmark Members

Highmark Wholecare reports that over a third of its members have been diagnosed with at least one mental health condition. That’s according to a recent analysis of over 420,000 Highmark Wholecare members, which found that mental health disorders have become the most common health condition among its members, surpassing common conditions like diabetes, hypertension, tobacco […]