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: Medicare
The ongoing need for behavioral health services will be no surprise to anyone involved in the industry. Patients continue to have high rates of need and often present with greater acuity. This demand for behavioral health services was reflected across payers’ Q3 earnings calls. The result? Sky-high utilization levels. For example, David Cordani, the CEO […]
LifeStance Health (Nasdaq: LFST) is overhauling its facilities with a new operating model — one that it hopes will strengthen its position ahead of what executives expect to be a rocky 2025. The outpatient mental health giant’s executives project that federal reimbursement rate cuts will challenge the company’s financial progress. LifeStance is banking on momentum […]
The National Quality Forum (NQF) has partnered with a coalition of health plans and the national digital therapy enablement platform Headway to create a new assessment tool that standardizes how behavioral health clinicians measure the progress of care. The behavioral health industry, across specialties, has struggled with a lack of a standardized data measurement set. […]
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 […]
Companies that treat opioid use disorder could commend themselves last month when the federal government reported overdose deaths were down nearly 11% for the first eight months of 2024, marking the second-straight year of decline. “It’s fantastic news,” Jason Kletter, president of BayMark Health Services, told Addiction Treatment Business. “It’s something to celebrate.” But the […]
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 […]
A federal audit released last week found that, despite changes in the law, Medicare and Medicaid enrollees may not have access to medications for opioid use disorder (OUD). In assessing why swaths of the country have spotty or nonexistent access to the federally approved medications methadone and buprenorphine, the U.S. Department of Health and Human […]
Behavioral health providers are increasingly expanding care continuums to include teenagers and meet the growing need for age-specific care. Virtual behavioral health provider Brightside Health is the latest to do so. Announced Tuesday, its expansion into care options for teens aims to address what Brad Kittredge, founder and CEO of Brightside, calls a “teen mental […]
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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