CMS Lacks Oversight of State Compliance with Mental Health Parity Rules for Medicaid Managed Care Plans

The Centers for Medicare and Medicaid have fallen short in ensuring several states comply with Medicaid managed care mental health and substance use disorder parity requirements. That’s according to a new audit by the Office of Inspector General (OIG), which evaluated eight states with Medicaid managed care contracts. Four of the states in the review, […]

Senators Aim to End ‘Fraudulent’ Ghost Networks with Behavioral Health Bill

Inaccurate provider directories, known as “ghost networks,” can land patients with shocking bills and cause providers to miss out on potential patients. Ghost networks have increasingly come under fire by policymakers aiming to hold health plans accountable and protect patients.  A new bill, introduced last week by U.S. Senators Tina Smith (D-Minnesota) and Ron Wyden […]

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 […]

Biden Highlights Fentanyl, Mental Health Workforce Challenges in SOTU

President Joe Biden’s State of the Union Address Thursday night almost completely left out behavioral health and policies related to the industry. This is something of a departure for the country’s 46th president. In his first State of the Union in 2022, Biden laid out what he called a unity agenda. It included several behavioral […]

SAMHSA’s New OTP Rule Cements Greater Flexibility for Methadone Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) has finalized an overhaul of opioid treatment programs (OTPs) that enshrines many flexibilities first implemented during the crisis response to the COVID pandemic. The final rule represents the first significant change to OTP regulations in over 20 years. In brief, the final rule intends to enable […]

US Senators Move to Eliminate In-Person Rule for Behavioral Health Telehealth Services

Lawmakers have reintroduced a bipartisan bill to make behavioral health delivered by telehealth more available to those on Medicare into Congress. Four sponsors have reintroduced the Telemental Health Care Access Act. The legislation would eliminate the in-person exam mandate to receive mental health services via telehealth. It undoes 2020 legislation that expanded telehealth access for […]

Behavioral Health Providers Face New Compliance Burdens With No Surprises Act

A law meant to protect patients from spurious hospital practices may create headaches for the behavioral health industry. The No Surprises Act adds additional administrative burdens to provider organizations to take on without a corresponding funding measures. The law, in part, requires health care organizations to provide good faith estimates to patients who choose to […]

Court Sets New Parity Standard; United Behavioral Appeals to Supreme Court

The fight for behavioral health parity has momentum heading into 2024 following three major decisions at the appellate level. And the battle may extend to the U.S. Supreme Court following an appeal by United Behavioral Health. Three cases in this slice of the appeals court address how health plans governed by the Employee Retirement Income […]

How Biden’s Anti-Competitive Merger Plan Could Impact Behavioral Health

The federal government could begin scrutinizing private equity-owned behavioral health practices. The Biden-Harris administration announced new initiatives to thwart anti-competitive mergers and practices that could increase health care costs for patients. Private equity firms, health insurers and health systems will be subject to additional surveillance to foster competition in the behavioral health sector.  Although still […]