UnitedHealth Group avoided a parity fight Monday, when a California federal judge dismissed a lawsuit claiming the insurer unfairly denied a man his right to receive coverage for addiction treatment. However, the insurer isn’t in the clear just yet, according to Law 360. The class action suit, originally filed last July, stated that the lead […]
Category: Reimbursement
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, […]
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, […]
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 […]
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 […]
The Certified Community Behavioral Health Clinic (CCBHC) demonstration program is set to be extended through May 2020. That’s thanks to the fiscal year 2020 funding package President Donald Trump is set to sign by midnight on Friday, Dec. 20. Congress passed the legislation earlier this week. Without the package, funding for the program would run […]
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 […]
Federal agencies may not be doing enough to ensure behavioral health parity within health plans, according to a recent report from the United States Government Accountability Office (GAO). In response, advocates are calling for more extensive oversight of employer-sponsored group plans. The report found that the vast majority of federal reviews and investigations into parity […]
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 […]
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 […]
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