Excellence in Mental Health Act Medicaid Pilot Program: Summary and Details

Transcription

1 Excellence in Mental Health Act Medicaid Pilt Prgram: Summary and Details March 31, 2014 On March 31, 2014, Cngress passed the Prtecting Access t Medicare Act (H.R. 4302). This legislatin includes prvisins f the Excellence in Mental Health Act, which will increase access t cmmunity mental health and substance use treatment services while imprving Medicaid reimbursement fr these services. A summary f these prvisins is as fllws: Creates criteria fr Certified Cmmunity Behaviral Health Clinics as entities designed t serve individuals with serius mental illnesses and substance use disrders that prvide intensive, persncentered, multidisciplinary, evidence-based screening, assessment, diagnstics, treatment, preventin, and wellness services. The Secretary f the Department f Health and Human Services is directed t establish a prcess fr selecting states t participate in a 2-year pilt prgram. Prvides $25,000,000 that will be available t states as planning grants t develp applicatins t participate in the 2- year pilt. Only states that have received a planning grant will be eligible t apply t participate in the pilt. Stipulates that eight (8) states will be selected t participate in the 2-year pilt prgram. The match rate fr CCBHC services varies by state and beneficiary. It is either the Enhanced FMAP/CHIP rate r, fr newly eligible expansin Medicaid beneficiaries, the current FMAP fr that ppulatin (which is 100% nw and mves dwn t 90% by 2020). Requires participating states t develp a Prspective Payment System fr reimbursing Certified Behaviral Health Clinics fr required services prvided by these entities. The details: Criteria Fr Certified Cmmunity Behaviral Health Clinics T Participate In Demnstratin Prgram. PUBLICATION. Nt later than September 1, 2015, the Secretary shall publish criteria fr a clinic t be certified by a State as a certified cmmunity behaviral health clinic fr purpses f participating in the demnstratin prgram REQUIREMENTS. The criteria published under this subsectin shall include criteria with respect t the fllwing: STAFFING. Staffing requirements, including criteria that staff have diverse disciplinary backgrunds, have necessary State-required license and accreditatin, and are culturally and linguistically trained t serve the needs f the clinic s patient ppulatin. AVAILABILITY AND ACCESSIBILITY OF Services Availability and accessibility f services, including crisis management services that are available and accessible 24 hurs a day, the use f a sliding scale fr payment, and n rejectin fr services r limiting f services n the basis f a patient s ability t pay r a place f residence.

2 CARE COORDINATION. Care crdinatin, including requirements t crdinate care acrss settings and prviders t ensure seamless transitins fr patients acrss the full spectrum f health services including acute, chrnic, and behaviral health needs. Care crdinatin requirements shall include partnerships r frmal cntracts with the fllwing: Federally-qualified health centers (and as applicable, rural health clinics) t prvide Federally-qualified health center services (and as applicable, rural health clinic services) t the extent such services are nt prvided directly thrugh the certified cmmunity behaviral health clinic. Inpatient psychiatric facilities and substance use detxificatin, pst-detxificatin stepdwn services, and residential prgrams. Other cmmunity r reginal services, supprts, and prviders, including schls, child welfare agencies, juvenile and criminal justice agencies and facilities, Indian Health Service yuth reginal treatment centers, State licensed and natinally accredited child placing agencies fr therapeutic fster care service, and ther scial and human services. Department f Veterans Affairs medical centers, independent utpatient clinics, drp-in centers, and ther facilities f the Department as defined in sectin 1801 f title 38, United States Cde. Inpatient acute care hspitals and hspital utpatient clinics. SCOPE OF SERVICES. Prvisin (in a manner reflecting persn-centered care) f the fllwing services which, if nt available directly thrugh the certified cmmunity behaviral health clinic, are prvided r referred thrugh frmal relatinships with ther prviders: Crisis mental health services, including 24-hur mbile crisis teams, emergency crisis interventin services, and crisis stabilizatin. Screening, assessment, and diagnsis, including risk assessment. Patient-centered treatment planning r similar prcesses, including risk assessment and crisis planning. Outpatient mental health and substance use services. Outpatient clinic primary care screening and mnitring f key health indicatrs and health risk. Targeted case management. Psychiatric rehabilitatin services. Peer supprt and cunselr services and family supprts. Intensive, cmmunity-based mental health care fr members f the armed frces and veterans, particularly thse members and veterans lcated in rural areas, prvided the care is cnsistent with minimum clinical mental health guidelines prmulgated by the Veterans Health Administratin including clinical guidelines cntained in the Unifrm Mental Health Services Handbk f such Administratin. QUALITY AND OTHER REPORTING. Reprting f encunter data, clinical utcmes data, quality data, and such ther data as the Secretary requires. ORGANIZATIONAL AUTHORITY. Criteria that a clinic be a nn-prfit r part f a lcal gvernment behaviral health authrity r perated under the authrity f the Indian Health Service, an Indian tribe r tribal rganizatin pursuant t a cntract, grant, cperative agreement, r cmpact with the Indian Health Service pursuant t the Indian Self-Determinatin Act (25 U.S.C. 450 et seq.), r an urban Indian

3 rganizatin pursuant t a grant r cntract with the Indian Health Service under title V f the Indian Health Care Imprvement Act (25 U.S.C et seq.). Guidance On Develpment Of Prspective Payment System Fr Testing Under Demnstratin Prgrams. Nt later than September 1,2015, the Secretary, thrugh the Administratr f the Centers fr Medicare & Medicaid Services, shall issue guidance fr the establishment f a prspective payment system that shall nly apply t medical assistance fr mental health services furnished by a certified cmmunity behaviral health clinic participating in the demnstratin prgram REQUIREMENTS. The guidance issued by the Secretary shall prvide that: n payment shall be made fr inpatient care, residential treatment, rm and bard expenses, r any ther nn-ambulatry services, as determined by the Secretary; and n payment shall be made t satellite facilities f certified cmmunity behaviral health clinics if such facilities are established after the date f enactment f this Act. Planning Grants Nt later than January 1, 2016, the Secretary shall award planning grants t States fr the purpse f develping prpsals t participate in time-limited demnstratin prgrams USE OF FUNDS. A State awarded a planning grant under this subsectin shall: slicit input with respect t the develpment f such a demnstratin prgram frm patients, prviders, and ther stakehlders; certify clinics as certified cmmunity behaviral health clinics fr purpses f participating in the demnstratin prgram; and establish a prspective payment system fr mental health services furnished by a certified cmmunity behaviral health clinic participating in the demnstratin prgram in accrdance with the guidance issued by the Secretary f Health and Human Services. Demnstratin Prgrams. Nt later than September 1, 2017, the Secretary shall select States t participate in demnstratin prgrams that are develped thrugh planning grants awarded, meet the requirements f this subsectin, and represent a diverse selectin f gegraphic areas, including rural and underserved areas. APPLICATION REQUIREMENTS. The Secretary shall slicit applicatins t participate in demnstratin prgrams under this subsectin slely frm States awarded planning grants. REQUIRED INFORMATION. An applicatin fr a demnstratin prgram under this subsectin shall include the fllwing: The target Medicaid ppulatin t be served under the demnstratin prgram. A list f participating certified cmmunity behaviral health clinics. Verificatin that the State has certified a participating clinic as a certified cmmunity behaviral health clinic in accrdance with the requirements set frth.

4 A descriptin f the scpe f the mental health services available under the State Medicaid prgram that will be paid fr under the prspective payment system tested in the demnstratin prgram. Verificatin that the State has agreed t pay fr such services at the rate established under the prspective payment system. Such ther infrmatin as the Secretary may require relating t the demnstratin prgram including with respect t determining the sundness f the prpsed prspective payment system. NUMBER AND LENGTH OF DEMONSTRATION PROGRAMS Nt mre than 8 States shall be selected fr 2-year demnstratin prgrams under this subsectin. REQUIREMENTS FOR SELECTING DEMONSTRATION PROGRAMS The Secretary shall give preference t selecting demnstratin prgrams where participating certified cmmunity behaviral health clinics: prvide the mst cmplete scpe f services t individuals eligible fr medical assistance under the State Medicaid prgram; will imprve availability f, access t, and participatin in, services t individuals eligible fr medical assistance under the State Medicaid prgram; will imprve availability f, access t, and participatin in assisted utpatient mental health treatment in the State; r demnstrate the ptential t expand available mental health services in a demnstratin area and increase the quality f such services withut increasing net Federal spending. Cnditins Regarding Payment Payments shall be made under this paragraph t a State nly fr mental health services that are described in the demnstratin prgram applicatin fr which payment is available under the State Medicaid prgram; and that are prvided t an individual wh is eligible fr medical assistance under the State Medicaid prgram. PROHIBITED PAYMENTS N payment shall be made fr inpatient care, residential treatment, rm and bard expenses, r any ther nn-ambulatry services, as determined by the Secretary; r with respect t payments made t satellite facilities f certified cmmunity behaviral health clinics if such facilities are established after the date f enactment f this Act. WAIVER OF STATEWIDENESS REQUIREMENT The Secretary shall waive sectin1902(a)(1) f the Scial Security Act (42 U.S.C.1396a(a)(1)) (relating t statewideness) as may be necessary t cnduct demnstratin prgrams in accrdance with the requirements f this subsectin.

5 ANNUAL REPORTS Nt later than 1 year after the date n which the first State is selected fr a demnstratin prgram under this subsectin, and annually thereafter, the Secretary shall submit t Cngress an annual reprt n the use f funds prvided under all demnstratin prgrams cnducted under this subsectin. Each such reprt shall include an assessment f access t cmmunity-based mental health services under the Medicaid prgram in the area r areas f a State targeted by a demnstratin prgram cmpared t ther areas f the State; an assessment f the quality and scpe f services prvided by certified cmmunity behaviral health clinics cmpared t cmmunity-based mental health services prvided in States nt participating in a demnstratin prgram under this subsectin and in areas f a demnstratin State that are nt participating in the demnstratin prgram; and an assessment f the impact f the demnstratin prgrams n the Federal and State csts f a full range f mental health services (including inpatient, emergency and ambulatry services). RECOMMENDATIONS. Nt later than December 31, 2021, the Secretary shall submit t Cngress recmmendatins cncerning whether the demnstratin prgrams under this sectin shuld be cntinued, expanded, mdified, r terminated. Questins? Cntact Chuck Ingglia at chucki@thenatinalcuncil.rg