Nearly Every State Bypassing IMD Exclusion in Some Way

The IMD exclusion is as old is the Medicaid program itself — and so are the complaints against it. Oftentimes, those complaints come from the behavioral health providers affected by the rule. But, nationwide, loopholes in the federal exclusion are helping providers get paid to provide services they otherwise wouldn’t be reimbursed for.  In fact, […]

‘Rehab Mogul’ Pleads No Contest in $175M Billing Scheme; Outpatient Mental Health Provider Settles False Claims Suit

The one-time owner of more than a dozen Los Angeles-area substance abuse treatment centers has been indicted on charges he operated a massive $175 million billing scheme. Robert Bathum, who has called himself the “Rehab Mogul,” pleaded no contest Monday in Los Angeles County Superior Court to 14 felony counts of grand theft, insurance fraud, […]

Medicaid Expansion Slows Mental Health Decline In Southern States

Since the Affordable Care Act first gave birth to Medicaid expansion, its success has been a matter of debate, especially when it comes to behavioral health care. Supporters tout statistics that suggest Medicaid expansion has allowed nearly 11 million more Americans to gain health care coverage. Meanwhile, opponents dispute whether Medicaid expansion has led to […]

Health Insurers Get Creative to Tackle Behavioral Health Conditions

As the opioid epidemic rages on and the behavioral health workforce shortage persists, stakeholders are getting creative when it comes to tackling addiction and other behavioral health conditions. That includes insurers, some of whom are piloting and pioneering creative approaches designed to curb those problems. America’s Health Insurance Plans (AHIP) highlighted some of those strategies […]

CMS Announces State Awardees for Medicaid Models to Curb Opioid Epidemic

The Center for Medicare & Medicaid Innovation (CMMI) at the Centers for Medicare & Medicaid Services (CMS) has announced the state awardees for two new models designed to help curb the effects of the opioid epidemic.  The models are called the Maternal Opioid Misuse (MOM) model and the Integrated Care for Kids (InCK) model. Both […]

Medicaid Work Requirements Could Threaten Behavioral Health Providers’ Bottom Line

Despite the push by federal courts to block Medicaid work requirements nationwide, states continue to pursue restrictions that would tie health coverage to employment for certain beneficiaries. In fact, on Thursday, South Carolina became the 11th state to have such requirements approved by the Centers for Medicare and Medicaid Services (CMS) — much to the […]

Despite Uncertainty, Policy Expert Optimistic About 2020 Behavioral Health Outlook

As 2020 approaches, behavioral health providers are staring down the barrel of financial and regulatory uncertainty. While they may not know exactly what to expect, policy experts at the National Council for Behavioral Health are optimistic about the behavioral health landscape in the year ahead. “[A government shutdown] seems extremely unlikely this year,” Rebecca Farley […]

State Behavioral Health Group Bets on Development Center to Help Labor Shortage

From coast to coast, the workforce shortage is hurting behavioral health providers, leaving many stumped as to how to fix the problem, which has been affecting access to care and providers’ business operations for years. But industry leaders and advocates in Illinois have a plan: They’re hoping for the development of a unique state-wide workforce […]

Another State Removes Prior Authorization For Medication-Assisted Treatment

Behavioral health providers in one state have come out on top in a battle to remove prior authorization requirements for opioid use disorder (OUD) treatment. The Michigan Department of Health and Human Services (MDHHS) announced this week it would do away with prior authorization requirements for medication-assisted treatment (MAT) drugs in Medicaid plans, effective immediately.  […]