Ghost networks and inadequate behavioral health network directories continue to plague Medicare Advantage (MA) and managed Medicaid plans. That’s according to a recent report from the Office of the Inspector General (OIG), which found that on average, 55% of providers listed in Medicare Advantage plans networks were inactive. OIG analysts found that 72% of inactive […]
Medicare could have saved $301.5 million if bundled payments for opioid use disorder (OUD) treatments were better matched to the services actually provided to patients. That’s equivalent to 53% of the total payments in this space of $564.6 million, according to an audit by the Office of Inspector General (OIG). For the audit, the OIG […]
Behavioral health services were mostly exempt from the pre-pandemic telehealth limitations that kicked in for Medicare recipients when the federal government shutdown began 15 days ago. Yet, a newly announced freeze on claims dated Oct. 1 and beyond will pause reimbursement for providers in the mental health and substance use disorder (SUD) space. “In the […]
Portland, Oregon-based nonprofit managed care organization CareOregon is limiting its networks for “non-contracted behavioral health providers.” On Friday, the organization announced that its Medicaid and Medicare Advantage (MA) members would be required to get routine mental health and substance use disorder treatment from in-network providers. Further, MA-covered behavioral health services provided by non-contracted providers will […]
A united front of leaders from Acadia Healthcare (Nasdaq: ACHC) and Geisinger Health System are pressing for the annulment of Medicare’s longstanding 190-day lifetime coverage cap for inpatient psychiatric treatment. Acadia Chief Strategy Officer Andrew Lynch, CEO Chris Hunter and Chief Medical Officer Stephanie Eken, as well as Imad Melhem, chair of psychiatry and behavioral […]
New data from the federal government found that only a slim majority of behavioral health providers are able to take on new patients covered by Medicare or Medicaid in a timely manner. The data also revealed that telehealth is not an extender of providers’ availability. The latest in a series of reports by the U.S. […]
Preventing unnecessary care and medication prescriptions is the primary purpose of prior authorization. Instead, it has all too often led to slower, burdensome delays to critical care for mental health and substance use treatment, but that could soon change. A group of major insurers – including UnitedHealthcare, Aetna, Cigna Group, Humana, Blue Cross Blue Shield […]
UnitedHealth Group’s (NYSE: UNH) CEO Andrew Witty has announced his plans to step down after leading the health care giant through a period of turmoil, citing “personal reasons.” The company’s former CEO, Stephen Hemsley, will return to the role effective immediately. In addition to his leadership role, Hemsley will remain the chairman of UnitedHealth Group’s […]
Behavioral health is in the political crosshairs. This series tracks the Trump administration’s proposed policy changes, funding cuts and structural overhauls that could reshape behavioral health care in the U.S. From HHS reorganizations to Medicaid shifts, we’re following what matters — and what’s at stake — for providers, payers and investors. (Last update: May 8, […]
Trump administration health care officials on Wednesday revealed further information about plans to create an autism spectrum disorder (ASD) data bank – a project that has sparked a mix of support, skepticism and alarm from autism-community stakeholders. On May 7, the U.S. Centers for Medicare & Medicaid Services (CMS) announced a new “landmark” partnership with […]
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