U.S. employees are far more likely to go out of network and see lower reimbursement for behavioral health services than for physical health services. Despite a nationwide push for parity, those equality gaps are widening, according to a new study. The report — published by Seattle-based actuarial and consulting firm Milliman Inc. and commissioned by […]
Category: Reimbursement
For years, federal rules have prevented Medicaid from paying for patients to stay in inpatient psychiatric treatment facilities with more than 16 beds, which are known as institutions for mental diseases (IMDs). The rule is known as the IMD exclusion. But in recent years, that’s started to change. Now, states can work around the IMD […]
Despite the push for parity, Americans are more likely to go out of network and pay higher out-of-pocket costs for behavioral health care treatment than for treatment of chronic conditions such as diabetes and congestive heart failure. That’s according to research out of Ohio State University published in JAMA Network Open. The findings illustrate the […]
With minimum wage on the rise and unemployment rates at the lowest they’ve been in 50 years, it’s no surprise that a number of industries — from home care to education — are facing labor shortages. Behavioral health care is no exception. However, low reimbursement from payers for behavioral health services is only exacerbating the […]
The Centers for Medicare & Medicaid Services (CMS) has expanded coverage for treatment of Medicaid beneficiaries with opioid use disorder (OUD). The recently finalized 2020 Physician Fee Schedule creates a new enrollment category and benefit for providers who offer OUD treatment programs. The rule also establishes payment codes for bundled payments, which include medication-assisted treatment […]
The Centers for Medicare & Medicaid Services (CMS) proposed a new rule Tuesday designed to increase oversight of Medicaid supplemental payments by creating new reporting requirements. While it’s not yet clear what the changes would mean for the behavioral health care industry, Medicaid is one of the largest financing sources in the space. It accounted […]
A first-of-its-kind Medicaid demonstration project aimed to improve care for beneficiaries with serious mental illness (SMI) and/or serious emotional disturbance (SED) has been approved in Washington, D.C. The Centers for Medicare & Medicaid Services (CMS) announced the approval of D.C.’s Section 1115 Medicaid waiver Wednesday. It quite literally waives federal rules that typically prevent Medicaid […]
The number of doctors in Montana prescribing medication-assisted treatment (MAT) has increased about 650% in just two years, according to the Montana Department of Health and Human Services (MDHHS). Back in January, 2017, the state had just over 20 MAT providers — but today, it has more than 130. MDHHS released those numbers in conjunction […]
As payers continue to recognize the importance of and the demand for behavioral health care, coverage for those services is expanding like never before. While that’s true across the board, the Medicaid program could present special opportunities for behavioral health care providers in the years to come, according to some legal experts. “Medicaid is an […]
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