Medicare ACOs’ Approach to Mental Health Treatment Found Lacking 

Accountable care organizations (ACOs) have become the “de facto” strategy for traditional Medicare. Their incentives for proactive care were designed to improve quality and access to care by aligning incentives among clinicians, hospitals and behavioral health providers. But a new Health Affairs study found that being enrolled in an ACO was not associated with any […]

Telehealth-Focused Practices Offer Medicare Patients With SMI 13% More Visits

During the pandemic, Medicare patients with serious mental illness who accessed care at practices that mainly used telehealth had 13% more mental health visits than those mainly receiving in-person care. However, researchers found no changes in these patients’ medication adherence, hospital and emergency department use or mortality, according to a recent study published in JAMA. […]

New Bill Aims to Cut Down on Behavioral Health ‘Ghost Networks’

Almost half of Medicare Advantage online provider directories have at least one inaccuracy – with issues often related to behavioral health services. A new bipartisan bill would protect seniors from the consequences of these inaccuracies, if passed.  And by doing so, the bill could also lead to MA plans strengthening their provider networks, which could […]

CMS to Increase 2024 Medicare Payments to Inpatient Psychiatric Facilities by 2.3%

The U.S. Centers for Medicare & Medicaid Services (CMS) announced that it will raise the total estimated Medicare spending for inpatient psychiatric facilities by 2.3% next year. This means that total payments to inpatient psychiatric facilities (IPF) are projected to increase by $70 million in fiscal year 2024. CMS will also update Medicare’s payment rate […]

‘That’s Where Medicare Needs to Go’: What CMS’ New IOP Proposal Means for Behavioral Health Providers

Thursday night, the U.S. Centers for Medicare & Medicaid Services (CMS) dropped a new proposed rule that would allow Medicare to cover intensive outpatient programs (IOPs) for mental health and substance use disorder (SUD) treatment. The proposed changes could open the door for IOP providers to work with the Medicare population and give patients a […]

CMS Looking to Establish New Behavioral Health Intensive Outpatient Medicare Program

The U.S. Centers for Medicare & Medicaid Services (CMS) revealed a series of important behavioral health proposals on late Thursday afternoon.  First, in its proposed 2024 Medicare Physician Fee Schedule, the agency pitched changes that would allow marriage and family therapists (MFTs) and mental health counselors (MHCs), including substance use disorder (SUD) counselors, to enroll […]

Cigna Grew Its Behavioral Health Network by 30% in 2022

The Cigna Group (NYSE: CI) expanded its behavioral health provider network by 30% in 2022, doubling its size in the past four years. The Bloomfield, Connecticut-based health insurance and service giant also nearly doubled the size of its virtual care network, according to its latest impact report. The Cigna Group now engages more than 300,000 […]

How ACOs Are Integrating Behavioral Health Services

Many Accountable Care Organizations (ACOs) are eyeing behavioral health integration to drive down the cost of care, boost accessibility and improve overall health outcomes. ACOs work outside the traditional fee-for-service model. Instead, provider reimbursement is tied to the quality of care and overall spending reduction. While several studies have documented the impacts of behavioral health […]

Medicare Advantage Psychiatric Networks Limited Compared to Medicaid, Exchange Plans

Psychiatry networks in Medicare Advantage plans are more limited than in Medicaid or individual health exchange plans. A study by researchers at Oregon Health & Science University (OHSU), Johns Hopkins University and the University of Pittsburgh found that 65% of Medicare Advantage plans had psychiatrist networks that were considered narrow or included fewer than 25% […]

Senators Blast Health Plans for ‘Fleecing American Consumers’ with Behavioral Health Ghost Networks

The Senate Finance Committee signaled bipartisan interest in holding health plans to account for ghost networks. On Wednesday, the committee heard testimony from health care advocates and providers on ghost networks. Although the committee did not take action, members discussed the importance of tackling ghost networks as part of its work in reforming mental health […]