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Thursday, August 31, 2017

Medicaid will pay for mental-health treatment at institutions, once states adapt to the change

In response to the opioid epidemic, the Medicaid program has begun paying for treatment at institutions for mental disease, "which include most residential treatment facilities for mental-health and substance-use disorders with more than 16 beds," but states have been slow to adopt the change, Virgil Dickson reports for Modern Healthcare.

The change lets Medicaid managed-care plans pay IMDs for 15 or fewer days of treatment in a month. "Only seven of the 39 states with managed-care Medicaid programs have started paying IMDs for those stays, according to email responses to a Modern Healthcare inquiry from state Medicaid agencies," Dickson reports. "Those states are Florida, Indiana, Michigan, Ohio, Rhode Island, Tennessee and Wisconsin. . . . States that haven't started paying for Medicaid beneficiaries' IMD stays say they are still trying to figure out how to develop rates for the facilities or have pending waivers with the CMS to pay for more than 15 days of care."

The Centers for Medicare and Medicaid Services "estimates that 7.1 percent of adults ages 21 to 64 meet the criteria for serious mental illness that requires at least some inpatient treatment, and that 13.8 percent experience serious substance abuse disorders," Dickson notes. Mental-health and substance-abuse treatment is typically in short supply in rural areas.

In West Virginia, the Charleston Area Medical Center "has to ask a local court to conduct mental-hygiene hearings that Medicaid patients need in order for the state to approve their transfer to a free-standing psychiatric hospital that can provide them better care for their severe mental-health or substance-abuse issues," Dickson reports. "In the meantime, those patients are spending hours or days in ... emergency departments, unable to get the level of care they need. Unlike general acute-care hospitals, free-standing psychiatric facilities have staff that specialize in a gamut of mental illnesses."

West Virginia officials have balked at a provision "that asked them to take back any reimbursement paid out by a managed-care plan for treatment that surpassed the 15-day limit," saying it posed "serious operational challenges." The state is seeking a waiver to let it pay for 30 days' treatment. "Other managed-care states such as California and Maryland say their plans are not paying for the services because behavioral health is carved out of managed-care contracts, and they are only offered on a fee-for-service basis," Dickson reports.

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