CMS Fee Schedule Calls for Digital Therapeutics Reimbursement

The Centers for Medicare & Medicaid Services’ latest proposed fee schedule includes codes for providers to bill Medicare for certain digital therapeutics. On July 10, CMS released its proposed 2025 Physician Fee Schedule (PFS) rule. It contained several behavioral health-related provisions, including changes to how intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) will […]

HHS Authorizes Pre-Release SUD Treatment for Incarcerated People in 5 States

Five U.S. states are now allowed to provide incarcerated people with coverage for substance use disorder (SUD) care and other services before their release. Medicaid traditionally does not provide SUD treatment to otherwise eligible people who are incarcerated in jails, prisons or youth correctional facilities. Now, the U.S. Department of Health and Human Services (HHS) […]

Massive Federal Opioid Trial Falls Short of Overdose Death Reduction Goals

An ambitious federal trial to curb opioid-related deaths by using community interventions came up short.  Despite the implementation of public education campaigns, increased naloxone distribution and improved access to medications for opioid use disorder (MOUD), as well as many other interventions, the trial failed to demonstrate a statistically significant reduction in overdose deaths. The large-scale […]

Only 8% of Medicaid and 4% of Medicare Enrollees Received Behavioral Health Services

New government findings add details to the lack of availability of behavioral health services for America’s poor and elderly.  The Office of Inspector General (OIG) for the U.S. Health and Human Services Department found that about one-third of behavioral health providers in selected counties serve patients in the Medicare, Medicare Advantage, or Medicaid programs. “Despite […]

How Biden’s Anti-Competitive Merger Plan Could Impact Behavioral Health

The federal government could begin scrutinizing private equity-owned behavioral health practices. The Biden-Harris administration announced new initiatives to thwart anti-competitive mergers and practices that could increase health care costs for patients. Private equity firms, health insurers and health systems will be subject to additional surveillance to foster competition in the behavioral health sector.  Although still […]

Giving Teeth To Parity: New York Paves the Way for More Medicaid Managed Care Oversight

The state of New York fined five Medicaid managed care plans a total of $2.6 million for denying claims or failing to pay for specialty behavioral health services. Other states may start to follow New York’s example. The enforcements were filed after New York’s office of mental health conducted a comprehensive examination of behavioral health […]

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 […]

CMS Rolls Out an All-Payer Cost Control Initiative Featuring Behavioral Health Integration

Behavioral health integration will play a major role in The Centers for Medicare & Medicaid Services’ (CMS) latest cost control initiative. On Tuesday, CMS unveiled the States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model). It is an 11-year total cost-of-care reduction model meant to give state governments the tools to reduce spending […]

CMS Clears Kentucky, California for Medicaid Mobile Crisis Intervention Program

Kentucky and California are the latest states to join the federal government’s Medicaid mobile crisis intervention initiative. The Centers for Medicare & Medicaid Services (CMS) announced the addition of Kentucky and California to the federal program on Thursday. The participants bring the number of states partnering with the federal government to provide community-based mobile crisis […]

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 […]