The Centers for Medicare & Medicaid Services has prioritized equitable behavioral health care access, proposing a new rule to cap behavioral health costs for Medicare Advantage members. The proposed rule, scheduled to be published on Dec. 10, would require that Medicare Advantage in-network cost-sharing for mental health and substance use disorder (SUD) care not exceed […]
Category: Compliance
The entanglement of politics and regulation requires behavioral health providers to bolster advocacy efforts more than ever. At the state and federal level, the industry faces a potent mix of increased scrutiny on health care dealmaking — especially the involvement of private equity investment — and historic public underinvestment. These forces pose potential threats to […]
Digital mental health startup Cerebral has reached a nonprosecution agreement with the U.S. Attorney’s Office for the Eastern District of New York. The agreement resolves the investigation of Cerebral’s policies and practices for controlled substance prescribing, specifically stimulants for ADHD. The company now faces fines totaling $6.57 million, according to a copy of the nonprosecution […]
Bad news at Acadia Healthcare (Nasdaq: ACHC) has translated into a real financial impact. The behavioral health behemoth experienced lower patient volume growth than expected in October, which company leadership attributed to bad press in its Q3 earnings call. Acadia expects the negative impact to be temporary, according to Heather Dixon, Acadia’s chief financial officer. […]
A Florida federal court ruling issued last month could lead to a “massive sea change” in what lawsuits can be brought against behavioral health companies. That is the interpretation of Gregory Jones, a principal at the law firm Polsinelli’s Los Angeles office, who represents health care companies, including in False Claims Act (FCA) cases. FCA […]
One of California’s largest opioid treatment providers (OTP) is taking advantage of a landmark change in federal rules. Pinnacle Treatment Centers announced Monday that they will begin prescribing opioid use disorder (OUD) patients methadone via audio-visual telehealth sessions in the state of California. “Expanding access to methadone by allowing patients to initiate treatment via telehealth […]
The Drug Enforcement Administration (DEA) will extend its telehealth flexibilities past the end of the year. Health care providers that have linked telehealth and controlled substance prescribing have been staring down a regulatory cliff following inaction by Congress on the issue. Twice already, the DEA has extended COVID-era regulation that provided wide flexibility when it […]
Behavioral health care giant Acadia Healthcare (Nasdaq: ACHC) will pay $19.85 million to the U.S. and several states’ governments to resolve allegations that it knowingly billed for medically unnecessary behavioral health services and endangered patients. The U.S. Department of Justice (DOJ) alleged that Acadia falsely billed Medicare, Medicaid and TRICARE for inpatient behavioral health services […]
New research shows that the number of prescriptions written for stimulants and antidepressants is on the rise. Prescriptions for stimulants increased by 37.5% from 2019 to 2022, according to a new study published in JAMA Network Open. The number of antidepressant prescriptions also increased, jumping up by 21%. An increased share of stimulant and antidepressant […]
Opioid treatment programs (OTPs) are the door to evidence-based medication for patients with opioid use disorder (OUD). Current regulations may not be strong enough to keep these facilities in compliance with requirements that prevent overpayment for services and ensure that patients receive the most appropriate treatment. An audit conducted by the Department of Health and […]
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