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State investigates managed care company in Medicaid fraud

 
 

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[ MM Curator Summary]: More details have come out about issues at the struggling AR PASSE.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

LITTLE ROCK — Empower Healthcare Solutions, a managed care organization that serves roughly 20,000 high-need Medicaid beneficiaries in Arkansas, is under investigation by state regulators and the attorney general’s office for allegedly defrauding Medicaid.

In a letter sent to the state’s Office of Medicaid Inspector General last week, Deputy Attorney General Lloyd Warford said a full investigation into allegations of fraud was only now getting under way. But an initial review found “sufficient credible evidence” to support the suspension of Empower from the Medicaid program, he wrote.

The Office of Medicaid Inspector General notified Empower the next day it was being sanctioned and would be subject to enhanced monitoring. The inspector general stopped short of suspending all payments to the company, however, “due to the fact Empower currently serves over 20,000 Medicaid beneficiaries who depend on Empower for continuity of care.”

 
 

Empower is the largest of the state’s four Provider-led Arkansas Shared Savings Entities, or PASSEs: managed care organizations that contract with the Arkansas Department of Human Services (DHS) to pay for and coordinate care for high-need, high-cost Medicaid beneficiaries with intellectual or developmental disabilities, behavioral health disorders or both.

PASSEs must be majority owned by health care providers, but their role is similar to insurance companies. Each PASSE receives a fixed monthly sum per member from DHS, the agency that administers Medicaid in Arkansas. The PASSE then pays for care for all its members, which can include costly services like inpatient treatment or around-the-clock help for people with disabilities. In 2020, Medicaid paid out almost $1.3 billion for the state’s roughly 50,000 PASSE beneficiaries, according to documents provided to a legislative committee in June.

 
 

Mitch Morris, Empower’s CEO, said in an email Thursday evening that the organization “denies any allegations of fraud or any other misconduct.”

“As stated by the AG’s office, a final determination has not been made and Empower will continue to cooperate with the investigation. We look forward to resolving these issues with the state of Arkansas and continuing our focus on advancing health services and outcomes for the 20,000 Arkansans served by Empower,” Morris said.

The letter from Warford, the deputy attorney general, gives limited information about the nature of the allegations. Empower is accused of misappropriating money claimed as “community investment” expenses – a type of capacity-building expenditure allowed under the PASSE program. Almost $4.7 million in community investments claimed by Empower in 2020 have “no support,” the letter says.

The letter also says a group of 25 behavioral health providers “were collectively overpaid approximately $3.7 million” by a program set up by Empower in the early months of the COVID-19 pandemic. At the time, medical and community services across the country were being interrupted by shutdowns.

Empower created a “stabilization” program designed to give short-term payments to the 25 behavioral health providers that treated the largest number of the PASSE’s members. But an actuarial consultant hired by Empower determined those providers were collectively overpaid some $3.7 million, the letter says.

Empower also allegedly protected some providers from its internal audit process, Warford wrote.

Morris said in an email that “the programs under review comply with federal and state laws and are designed to enhance the delivery of services and to improve care to our beneficiaries.”

“The issues being investigated do not involve care provided to members,” he noted.

Empower faced mounting problems even before the fraud allegations surfaced. Fallout from the departure of one of the company’s co-owners has raised questions about whether the PASSE will have the capacity to keep operating next year.

DHS temporarily suspended new enrollments to Empower on Nov. 19. The agency completed a “readiness review” of Empower last week but has not yet made a decision about the PASSE’s status for 2022, a DHS spokesman said last week.

Nonetheless, DHS sent a letter to Empower clients notifying them of Empower’s partial suspension from Medicaid and letting them know they may change to a different PASSE if they so choose.

“Don’t worry. You’re not losing coverage, and nothing will change for you at this time,” the DHS letter says. “To ensure you continue to have the access to care and services that you need, Empower will continue to get payment from Medicaid for services. You may remain in your current PASSE. However, should you want to switch to another PASSE you may do so by contacting 1-833-402-0672.”

Danette Smith, a Hot Spring County resident whose daughter is an Empower member, had already decided to change to a different PASSE before news of the fraud allegations broke this week.

Smith’s daughter, Sophia, 28, is autistic and mostly nonverbal. She requires 24/7 assistance and has other complex medical needs, Smith said. When the PASSE system was first rolled out, in 2018, Sophia was initially assigned to a different PASSE, Summit Community Care. But not all of Sophia’s doctors were included in Summit’s network at that time, Smith said, so she switched to Empower.

Smith hasn’t been satisfied with Empower in the years since. The PASSE has denied claims for medications and supplements, she said, and often has failed to communicate with her and other parents. The recent uncertainty over Empower’s future has been the final straw. She believes Empower is unlikely to be re-authorized to participate in the system in 2022, which would mean its thousands of members would be reassigned to other PASSEs by DHS.

“I have already chosen to move [Sophia], because I’m not going to wait until January,” Smith said. “It’s very concerning to parents, because we put our trust in them.

“On the front end, they made a lot of promises that didn’t come through. And now we have a PASSE that’s going under. … It’s all about money. Not about the members, not about my daughter – it’s all about money,” she added.

The recent turmoil within Empower stems from its ongoing breakup with Beacon Health Options, a Boston-based company that is one of the nation’s largest behavioral health organizations. Beacon has owned a 16.66 percent stake in Empower since the PASSE was formed in 2017. (The remainder of Empower is owned by several health care entities based in Arkansas.) Beacon also contracts with Empower to provide administrative services and has played a critical role in Empower’s day-to-day operations.

But in 2020, Beacon was acquired by insurance giant Anthem. Anthem also owns a stake in Summit Community Care – another PASSE and a rival of Empower. A state law passed earlier this year prohibited companies from owning portions of more than one PASSE, and Beacon soon began separating itself from Empower.

On Nov. 2, Empower sued Beacon, accusing it of sabotaging Empower for the benefit of its new owner. The lawsuit claims Beacon has refused to turn over phone numbers, email accounts and critical databases and documents as the two companies worked towards finalizing their divorce at the end of the year. Empower and Beacon have also sparred over the issue of credentialing providers within Empower’s provider network.

“Since the merger, Beacon has engaged in conduct that suggests that it is functioning as a Trojan-horse for Anthem,” Empower’s complaint says. (The lawsuit was originally in federal court but was refiled in Pulaski County Circuit Court on Nov. 15. No hearing date had been set as of Dec. 2.)

In addition to Beacon, Empower is co-owned by five Arkansas-based health care organizations. They are Arkansas Community Health Network, a consortium of four hospital systems; Statera, a long-term care company; Independent Case Management, a provider of home and community-based services for people with developmental disabilities; The Arkansas Healthcare Alliance, a group of providers for behavioral health and developmental disability services; and, ARcare, a network of clinics and other providers.

According to documents provided to a legislative committee in June, Empower has the largest share of beneficiaries among the four Arkansas PASSEs, with some 20,000 members. Summit Community Care, the PASSE that is co-owned by Anthem, had more than 16,000 members. Arkansas Total Care, which is partially owned by health insurance company Centene, had over 13,000 members. The fourth PASSE is a newcomer to the state: CareSource PASSE, partially owned by an Ohio-based managed care company, was licensed earlier this year and is also undergoing a readiness review.

 
 

Clipped from: https://www.jonesborosun.com/news/state-investigates-managed-care-company-in-medicaid-fraud/article_1a994ad2-e557-5cc4-b15b-3f282d762316.html

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Expansion of Arkansas Medicaid system announced

 
 

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[ MM Curator Summary]: New monies are being appropriated to clear some of the I/DD waiting list.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

LITTLE ROCK, Ark. – The developmentally disabled waiting list became a bit of a topic during the special session as part of the debate against making income tax cuts.

Gov. Asa Hutchinson said on Tuesday they have been aware of the issue for a while now.

The Arkansas Medicaid waiver provides services to those with intellectual disabilities, with the waiver covering about 500 Arkansans.  However, there is a waiting list in the thousands to get those services.

All together there are 3,204 on the list.

Over half on the list have incomes low enough to qualify them for some Medicaid services, but the rest are getting none.

 
 

Hutchinson is requesting 200 additional slots and those will be funded with existing revenue.

He is also asking the general assembly at some point to add 37.6 million dollars to create more slots so that everyone on the list can be served by 2025.

Director of Disability Services, Melissa Stone, said this will help those who need services to live more normally.

“People have waited a very long time and because of this announcement we are now able to move quickly to get them the services they need to stay in their home and in the community,” Stone said.

Hutchinson said he hopes to take that action during the fiscal session, and once that is done, DHS will submit a request to add those slots progressively over the next three years.

 
 

Clipped from: https://www.kark.com/news/state-news/expansion-of-arkansas-medicaid-system-announced/

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Medicaid managed care company sues outgoing corporate co-owner, alleging ‘sabotage’

 
 

 
 

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An Arkansas provider-led BH organization is claiming Beacon Health has been working to destroy it from the inside.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

LITTLE ROCK — Empower Healthcare Solutions, a managed care organization that serves almost 20,000 Arkansas Medicaid beneficiaries with complex health needs, filed a lawsuit in federal court on Tuesday against a Boston-based company that owns a portion of Empower but is planning to leave by the end of the year.

The suit accuses Beacon Health Options of “seeking to destroy Empower … from within” to benefit one of Empower’s competitors.

Meanwhile, a letter obtained by the Arkansas Nonprofit News Network shows state Medicaid officials have concerns about Empower’s ability to operate after Beacon’s departure is finalized. The Arkansas Department of Human Services (DHS) said in its Nov. 2 letter to Empower that it has until Nov. 24 to complete a “readiness review” ordered by DHS, which oversees Arkansas’s Medicaid program.

 
 

Empower is one of four managed care organizations that contract with DHS to pay for and coordinate care for Medicaid beneficiaries with severe behavioral health disorders, intellectual or developmental disabilities, or both. Known as Provider-led Arkansas Shared Savings Entities, or PASSEs, they were created by a 2017 state law that promised to both control spending and provide better services to this high-need, high-cost group of patients. PASSEs basically play the role of insurance companies but must be partly owned by health care providers; it also provide “care coordinators” who act as case managers for beneficiaries.

Beacon, one of the nation’s largest behavioral health companies, has owned a 16.66 percent stake in Empower since the PASSE was formed in 2017. (The rest of Empower is owned by several health care entities based in Arkansas.) Beacon also contracts with Empower to provide administrative services and has played a critical role in Empower’s day-to-day operations.

 
 

But in 2020, Beacon was acquired by insurance giant Anthem. Anthem also owns a stake in another Arkansas PASSE, Summit Community Care, a rival of Empower. A state law passed earlier this year prohibited ownership in more than one PASSE, and Beacon began separating itself from Empower.

Now, Empower’s lawsuit says Beacon has been “intentionally attempting to sabotage Empower” on its way out the door.

“Since the merger, Beacon has engaged in conduct that suggests that it is functioning as a Trojan-horse for Anthem,” Empower’s complaint says. Empower claims Beacon has refused to turn over phone numbers, email accounts and critical databases and documents as the two companies finalize their divorce.

A representative for Beacon did not respond to a request for comment on the lawsuit. But a letter Beacon sent to DHS Aug. 26 show Beacon has had its own complaints about the separation.

The Aug. 26 letter, obtained from DHS with a public records request, described a dispute over Empower’s adoption of new policies for credentialing health care providers in its network after Beacon leaves. Beacon has been responsible for provider credentialing as part of its management services to Empower. The letter indicated Beacon considers the fruits of that work to belong to it alone – not Empower – and suggested Empower’s board was attempting to “negate Beacon’s credentialing of its own network.”

“The proposed Credentialing policy could have the effect of invalidating the credentialing decisions of our existing network,” wrote Melissa Ortega, a vice president of Beacon based in Little Rock. “Beacon obviously cannot agree to any policy that will have this result. Empower has been combative and non-cooperative in addressing these concerns.”

In its lawsuit, Empower cites this episode as further evidence of Beacon’s alleged attempts to sabotage Empower. “Beacon made false representations about Empower to DHS, which representations (if believed by DHS) could jeopardize Empower’s future participation in the PASSE program,” the complaint says.

The Department of Human Services pays each PASSE a fixed monthly amount per beneficiary enrolled. PASSEs must then cover the cost of care for those members, which can include costly services such as inpatient treatment or at-home help for disabled people. In 2020, the cost to Medicaid for the roughly 50,000 PASSE beneficiaries in Arkansas was almost $1.3 billion, according to documents provided to a legislative committee in June. (Empower’s revenues for 2020 were over $460 million, according to the lawsuit.)

Empower’s complaint says that Beacon was “essentially the operations manager” for the PASSE. Under the terms of a service agreement between the two companies, Beacon provided all “services required for [Empower’s] performance of the PASSE Contract [including] all staffing and administrative services.” Beacon was “compensated handsomely” for these services, the complaint says, receiving “more than $52 million in 2020 alone.”

But because Beacon has played such a large role in Empower’s day-to-day operations, the impending breakup raises questions about what comes next for the PASSE and the beneficiaries who rely on it.

The same day Empower filed its lawsuit, Nov. 2, DHS sent it a letter warning the PASSE that it had yet to complete a mandatory “readiness review” in advance of Beacon’s exit on Dec. 31. DHS gave Empower until Nov. 24 to address a list of outstanding requirements. If the PASSE misses that deadline, the letter suggested, it could be in danger of losing its contract with the state – its sole source of business.

DHS is obligated “to ensure a smooth transition and continuation of services for any Medicaid enrollee of a managed care entity whose contract is terminated or dissolved for any reason,” wrote DHS Division of Medical Services Director Elizabeth Pitman in the letter. The agency “must be able to make a final decision” by Dec. 1, she added, so that beneficiaries “and their receiving PASSEs have adequate notice to ensure continued services and as smooth a transition as possible.”

A DHS spokeswoman did not respond to questions about steps DHS might take if the Nov. 24 deadline is not met or whether Empower’s members would be assigned to one of the other PASSEs.

Empower CEO Mitch Morris said in an email that the company was “prepared to demonstrate compliance to DHS and remain[ed] very confident that it will provide formal approval for Empower to continue operating as an Arkansas PASSE for calendar year 2022 and beyond.” Morris declined to comment on the lawsuit.

When provided with the Nov. 2 letter for review, Thomas Nichols, a lawyer with the advocacy organization Disability Rights Arkansas, said DHS was likely “covering their bases to make sure there’s not a gap in services” for beneficiaries.

PASSE members can’t afford any disruption in their coverage, Nichols said, because they are so deeply reliant on the services Medicaid pays for.

“Folks aren’t relying on this just for primary care appointments,” he said. “You have people who require 24/7 staff because they need that in order to live safely in a community setting. Folks rely on this sometimes for tube feedings … Some people rely on this for life-saving medication.”

“These are things that people have to have every single day. They have to be paid for every single day.”

Nichols said the uncertainty around Empower’s future illustrated the pitfalls of transferring responsibility for Medicaid to managed care companies.

“It is predictable that privatizing Medicaid services and feeding it to a for-profit world would result in the types of potential harms we now have,” he said. “It is inexcusable that individuals with significant developmental disabilities and mental illness are suddenly on the brink due to mergers and acquisitions.”

In addition to Beacon, Empower is co-owned by five other health care organizations. They are Arkansas Community Health Network, a consortium of four hospital systems; Statera, a long-term care company; Independent Case Management, a provider of home and community-based services for people with developmental disabilities; The Arkansas Healthcare Alliance, a group of providers for behavioral health and developmental disability services; and, ARcare, a network of clinics and other providers.

According to documents provided to a legislative committee in June, Empower has the largest share of beneficiaries among the four Arkansas PASSEs, with almost 20,000 members. Summit Community Care, the PASSE that is co-owned by Anthem, had more than 16,000 members. Arkansas Total Care, which is partially owned by health insurance company Centene, had over 13,000 members. The fourth PASSE is a newcomer to the state: CareSource PASSE, partially owned by an Ohio-based managed care company, was licensed earlier this year.

 
 

Clipped from: https://www.jonesborosun.com/news/medicaid-managed-care-company-sues-outgoing-corporate-co-owner-alleging-sabotage/article_bdf459e8-031e-5b4a-8360-72d21cfcbc52.html

 
 

 
 

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State official announce new initiative that will fund mental health and addiction care through Medicaid

 
 

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Michigan lawmakers are planning on reimbursing CCBHCs at full cost.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

State official announce new initiative that will fund mental health and addiction care through Medicaid

https://www.abc12.com/2021/10/13/state-official-announce-new-initiative-that-will-fund-mental-health-addiction-care-through-medicaid/

Senator Debbie Stabenow announced on Wednesday an initiative that would fund the two as healthcare-reimbursed through Medicaid for the full cost…

 
 

By Dawn Jones

Published: Oct. 13, 2021 at 5:48 PM CDT|Updated: 17 hours ago

FLINT, Mich. (WJRT) – A major change is coming to how mental health and addiction treatment is funded in Michigan.

Senator Debbie Stabenow announced on Wednesday an initiative that would fund the two as healthcare-reimbursed through Medicaid for the full cost of services.

Starting this month, the nearly three dozen Certified Community Behavioral Health Clinics in Michigan will begin to be reimbursed through Medicaid for the cost of services. This is something that has never been done.

“I use the example all of the time you have a heart attack, you go into the emergency room, actually you need surgery. They would never say I’m so sorry that grant ran out six months, ago, but that’s what happens to somebody with a mental illness or with a substance abuse issue everyday that kind of thing is said to folks and that’s what we want to stop,” said Stabenow.

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According to the CDC, one in five Americans will experience Mental illness in their lifetime. The Agency also reporting that in 2020, during the pandemic, drug overdose deaths rose by 30%.

Wednesday’s announcement by Michigan Senator Debbie Stabenow would give people in these crisis access to help through Certified Community Behavioral Health Clinics.

Clinics that are held to the same standards as health centers and are funded to meet those standards. Stabenow explains why it’s a game changer for the mentally ill and drug addicted among us.

“It includes 24 hour psychiatric crisis services so people aren’t sitting in the emergency room, people aren’t sitting in jail just because there is no help available to them. And it places where this has been robustly funded now in other states we are seeing really meaningful changes in peoples lives and frankly with how we are using public services,” said Stabenow.

She said that this is one step to achieving the vision laid out by President John Kennedy in the 1963 Community Mental Health Act.


 

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LA- Mental health providers frustrated with state’s Medicaid managed care organizations

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Results of a recent survey of providers show that they are not happy with the state’s mental health benefit administrators.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

A recent survey of mental health providers found dissatisfaction with several of the organizations the state uses to manage Medicaid services.

The report, released this month, comes as the state prepares to choose a new set of managed care organizations. The multibillion-dollar contracts account for about 25% of Louisiana’s annual operating budget and cover health care for one-third of Louisiana’s residents, according to The Associated Press. They allow private companies to oversee health care services for about 90% of Louisiana’s Medicaid enrollees, mostly adults covered by Medicaid expansion, pregnant women and children.

Magellan Health, which focuses on behavioral health, received an A- on the Louisiana Rural Mental Health Alliance’s report card, but no other MCO graded higher than a C+, which was the overall grade for Louisiana Healthcare Connections and United Healthcare Community Plan. Aetna and AmeriHealth Caritas Louisiana both received a C- and Healthy Blue received a D. 

The report card is the result of an association-wide provider satisfaction survey seeking to compare how the current Medicaid managed care organizations are performing with their network community mental health providers.

Responses to the Louisiana Department of Health’s request for proposals for MCOs was due Sept. 3, according to the department’s website. Secretary Courtney Phillips announced last year that she would restart the Medicaid managed care contractor search rather than continue a yearlong legal fight over the deals her predecessor approved.

 
 

Clipped from: https://www.businessreport.com/business/mental-health-providers-frustrated-with-states-medicaid-managed-care-organizations

 
 


 

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Medicaid Behavioral Health: CMS Guidance Needed to Better Align Demonstration Payment Rates with Costs and Prevent Duplication

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GAO was unable to determine if the CCBHC experiment was successful.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Fast Facts

Behavioral health conditions such as depression and opioid use disorder affected an estimated 61 million U.S. adults in 2019. Research has shown that low-income individuals, such as those enrolled in Medicaid, are at greater risk of developing such conditions.

Eight states received funds to test whether changes to the delivery and payment of behavioral health care would help improve beneficiaries’ access to and use of these services.

Better federal guidance could help states ensure that payments for these services meet Medicaid requirements—especially as the tests expand to other states. Our recommendations are to help improve that guidance.

 
 

Skip to Highlights

Highlights

What GAO Found

In 2016, the Department of Health and Human Services (HHS) selected eight states to participate in a time-limited demonstration to establish certified community behavioral health clinics (CCBHC). These states, in turn, certified 66 behavioral health clinics as CCBHCs. Required to provide a broad range of behavioral health services—mental health and substance use services—CCBHCs are reimbursed by state Medicaid programs using clinic-specific rates designed to cover expected costs. Under the demonstration, states receive enhanced federal funding for CCBHC services provided to Medicaid beneficiaries.

GAO found that five of the eight demonstration states reported generally increased state spending on CCBHCs, which officials from these states attributed to an increased number of individuals receiving treatment, an increased array of services provided, or both. In contrast, officials from the other three demonstration states did not report that the demonstration resulted in greater state spending. Officials from two of these states noted that the demonstration resulted in spending decreases, citing factors such as the demonstration’s enhanced federal Medicaid funding. Officials from the remaining state said the effects on spending were unknown. In addition, four of the eight states assessed potential cost savings from the demonstration resulting from reductions in the use of more expensive care, such as emergency department visits. Officials from three of the four states viewed the results of their assessments as suggestive of potential cost savings, while officials from the fourth state did not.

GAO’s review of payment guidance for the demonstration from the Centers for Medicare & Medicaid Services (CMS), an agency within HHS that oversees Medicaid at the federal level, found that the guidance lacked clear and consistent information on better aligning CCBHC payment rates with costs and preventing duplicate payments. For example:

CMS guidance gives states the option to rebase their initial payment rates after the first demonstration year (i.e., use data on actual costs incurred and number of client visits during the first demonstration year to recalculate rates for subsequent years). CMS officials said rebasing would mean states would not have to rely on anticipated cost and client visit data after the first year, and would align rates more closely with costs. While officials said CMS expected all states to rebase their rates at some point, CMS’s guidance does not reflect this expectation, or provide details on rebasing, such as suggested time frames.

CMS guidance conflicts as to whether CCBHCs that are also Federally Qualified Health Centers (FQHC)—safety net providers that generally provide some behavioral health services—should receive CCBHC and FQHC payments for the same client on the same day if provided services overlap.

Addressing these weaknesses is important to help ensure that Medicaid CCBHC payments meet requirements for Medicaid payments under federal law, including that they be consistent with efficiency, economy, and quality of care, and are sufficient to ensure access to care.

Why GAO Did This Study

Behavioral health conditions affected an estimated 61.2 million adults in 2019. Congress has taken steps to expand access to behavioral health treatment, including authorizing the CCBHC demonstration, which is intended to improve the availability of community-based behavioral health services.

The CARES Act included a provision for GAO to report on states’ experiences participating in the CCBHC demonstration. Among other objectives, this report describes what states reported about how the CCBHC demonstration affected state spending on behavioral health services; and examines CMS guidance for states on Medicaid CCBHC payments.

GAO reviewed documentation from and interviewed Medicaid and behavioral health officials from the eight CCBHC demonstration states, as well as federal officials tasked with demonstration oversight. GAO also reviewed documentation and interviewed officials from a nongeneralizable sample of three CCBHCs, which GAO selected for a number of reasons, including variation in geographic location.

Skip to Recommendations

Recommendations

GAO is making two recommendations, including that CMS issue clear and consistent written guidance to help states (1) better align payment rates with clinics’ costs; and (2) avoid potential duplication between CCBHC and other Medicaid payments.

HHS concurred with GAO’s recommendations, and provided technical comments, which were incorporated as appropriate.

Clipped from: https://www.gao.gov/products/gao-21-104466

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CMS Investing $15M in Medicaid Mobile Health Crisis Intervention

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CMS is seeding innovations in how first responders can deliver on-scene behavioral health crisis services.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The rescue plan funds will be used by state Medicaid programs and community health groups to develop mobile health intervention services for people experiencing a behavioral health or opioid use disorder crisis.

 
 

Source: Getty Images

 
 

By Eric Wicklund

September 21, 2021 – Federal authorities are awarding $15 million in rescue plan funding to 20 states to help expand mobile health intervention services for Medicaid patients in crisis.

The planning grants, administered through the Centers for Medicare & Medicaid Services, will help state Medicaid agencies and community health organizations develop emergency intervention services for people experiencing a mental health or substance abuse disorder crisis. This may include the use of mHealth apps or telehealth services to connect those in crisis to a behavioral health specialist or other care provider.

“With these grants, CMS is taking strides to connect individuals in crisis with the high-quality, expert care they need. Providing behavioral health care experts as alternatives to police is an example of how we can better help communities deliver on the behavioral health needs of all its residents,” CMS Administrator Chiquita Brooks-LaSure said in a press release.

Programs like this are designed to connect people to healthcare providers during an emergency, rather than using police intervention or transports to a jail or hospital. In some instances police and EMS units are provided with tablets or apps to connect with care providers at the scene for a virtual consult, while other programs create multi-disciplinary teams capable of responding in person or via connected health channels.

The interventions are designed to not only take pressure off of police to deal with mental health emergencies, but to improve access to care and speed up treatment for people in crisis.

The funding will be used to develop and launch Medicaid-based 24-hour community-based mobile crisis intervention services, offering training and technical assistance.

States receiving the grants are Alabama, California, Colorado, Delaware, Kentucky, Massachusetts, Maryland, Maine, Missouri, Montana, North Carolina, New Mexico, Nevada, Oklahoma, Oregon, Pennsylvania, Utah, Vermont, Wisconsin and West Virginia.

Officials say all states should be eligible for a temporarily enhanced matching rate for implementing a qualified community-based mobile crisis intervention option in the Medicaid programs by April 2022.

Clipped from: https://mhealthintelligence.com/news/cms-investing-15m-in-medicaid-mobile-health-crisis-intervention

 
 

 
 

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Colorado violating Medicaid mandate by not providing mental health services to children, lawsuit alleges

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CO HHS is being sued for not providing long-term residential MH/BH programs to members seeking treatment in ERs.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The suit was filed against the head of the sate Department of Health Care Policy and Financing

Colorado is violating a Medicaid Act mandate by not providing certain mental health services to eligible children at home or in their community, which in some cases has led to teenagers experiencing “unnecessary institutionalization,” a federal lawsuit filed Friday alleges.

The lawsuit was filed in U.S. District Court of Colorado against Kim Bimestefer, the head of the state Department of Health Care Policy and Financing, on behalf of three unnamed teenagers and their families, including one with a history of suicide attempts and self-harm who was in a metro Denver emergency room for about a month.

“Colorado has been ignoring their duty to provide mental health services to the children of Colorado for too long,” attorney Robert H. Farley Jr. said in a statement. “We hope this lawsuit will force the state to find a solution for providing care to all of Colorado’s children and youth who need it.”

Marc Williams, spokesman for the Department of Health Care Policy and Financing, declined to comment on the lawsuit, citing pending litigation.

The suit is also seeking class-action status on the behalf of people under the age of 21 who qualify for Medicaid and have been diagnosed with mental health or behavioral disorders and who have been recommended to receive Intensive Home and Community-based services.

The plaintiffs in the suit include a 16-year-old girl who was in an emergency room between July 31 to Aug. 24 because the state has been unable to find a long-term residential program in the state to help her get treatment. Another is a 13-year-old boy who has been hospitalized since March 9, according to the news release.

The third is a 13-year-old girl who is at home, but needs servers to help with her behavioral disorders. The teenager has been in a psychiatric hospital three times since March 22.

Updated 1 p.m. Sept. 3, 2021 This story has been updated to correct how long the 16-year-old was in a metro Denver emergency room. A news release contained incorrect information.

Clipped from: https://www.denverpost.com/2021/09/03/colorado-medicaid-mandate-mental-health/

 
 

 
 

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NCDHHS Announces Medicaid Managed Care Regional Behavioral Health I/DD Tailored Plans- Bladen County Included

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The winners were announced last week, and will be live Sept 1.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

The North Carolina Department of Health and Human Services announced the selection of seven organizations to serve as Behavioral Health and Intellectual/Developmental Disability Tailored Plans (Behavioral Health I/DD Tailored Plans). Individuals who need certain services to address a serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual/developmental disability or traumatic brain injury may be eligible to enroll in a Behavioral Health I/DD Tailored Plan.

Following a competitive selection process, the following organizations were awarded a contract to serve as regional Behavioral Health I/DD Tailored Plans:

• Alliance Health

• Eastpointe

• Partners Health Management

• Sandhills Center

• Trillium Health Resources

• Vaya Health

• Cardinal Innovations Healthcare*

*While Cardinal Innovation Healthcare was awarded a contract, it is anticipated they will not operate a Behavioral Health I/DD Tailored Plan at launch due to the consolidation with Vaya Health. 

Behavioral Health I/DD Tailored Plans will provide integrated physical health, behavioral health, long-term care, pharmacy services and will address unmet health-related resource needs for qualifying North Carolinians under one plan. These plans will provide the same services as NC Medicaid Standard Plans with additional specialized services to serve individuals with significant behavioral health conditions, including those utilizing 1915(c) Home and Community-Based Services waivers and those utilizing State Funded Services. 

“NCDHHS looks forward to working with the awardees to make this innovative design a reality for the thousands of North Carolinians who will benefit from a whole person centered, well-coordinated system of care,” said NCDHHS Secretary Mandy K. Cohen, M.D. “Today moves us closer to that goal as we begin to implement this important program design.” 

At launch, Behavioral Health I/DD Tailored Plans will operate regionally, offering robust care management to approximately 200,000 individuals estimated to enroll. An additional unique feature of Behavioral Health I/DD Tailored Plans is the combination of Medicaid and state funding to support enrolled populations. 

The contract award covers counties in each catchment area as of July 26, 2021, as well as realignments approved by Secretary Cohen effective Sept. 1, 2021. Given additional county requests for disengagement, NCDHHS anticipates county alignments for Behavioral Health I/DD Tailored Plans will be significantly different at launch. County realignment and disengagement requests must go through the process identified in law and rule which ultimately require DHHS Secretary’s approval. The list below indicates the anticipated county alignments at go-live. 

“We will work closely with LME/MCO’s to assure a smooth transition to Behavioral Health I/DD Tailored Plans while they continue to oversee the crucial services currently provided through the LME/MCO’s” said Deputy Secretary of NC Medicaid, Dave Richard. 

Only entities operating as LME/MCOs were eligible to apply to become Behavioral Health I/DD Tailored Plans. The first Behavioral Health I/DD Tailored Plans contract term will last four years. The Department has the authority to award no more than seven and no fewer than five regional Behavioral Health I/DD Tailored Plan contracts and may not award any statewide contracts.

Under Medicaid Managed Care, Standard Plans and the Eastern Band of Cherokee Indians (EBCI) Tribal Option launched on July 1, 2021, followed by Tailored Plans on July 1, 2022. 

For information specific to Behavioral Health and I/DD Tailored Plans, please visit the Behavioral Health I/DD Tailored Plans page

More information about the transition to NC Medicaid Managed Care can be found on the Medicaid website at medicaid.ncdhhs.gov/transformation.

 
 

Projected County Alignments at Tailored Plan Launch for July 1, 2022

This list reflects projected county assignments based on disengagements requested or approved. County realignment and disengagement requests must go through the process identified in law and rule which ultimately require approval by the NCDHHS Secretary.

Alliance Health: Cumberland, Durham, Johnston, Orange, Mecklenburg and Wake. 

Eastpointe: Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne and Wilson.

Partners Health Management: Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union and Yadkin.

Sandhills Center: Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond and Rockingham. 

Trillium Health Resources: Bladen, Brunswick, Carteret, Columbus, Nash, New Hanover, Onslow, Pender, Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell and Washington.

Vaya Health: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Swain, Transylvania, Vance, Watauga, Wilkes and Yancey.

Pending: Chatham, Halifax, Stokes and Warren. 

 
 

Clipped from: https://bladenonline.com/ncdhhs-announces-medicaid-managed-care-regional-behavioral-health-i-dd-tailored-plans-bladen-county-included/

Posted on

Virginia launches new behavioral health services for Medicaid members

MM Curator summary

 
 

Virginia now covers three news services to try and help members avoid inpatient stays for mental health.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

RICHMOND, Va. (WAVY)– New state-funded behavioral health services will give Medicaid members in Virginia greater access to community-based care.

The new services, which began on July 1, will give Medicaid members alternatives to inpatient hospitalizations and offer supports for those discharged from an inpatient facility to reduce readmissions.

The services were developed through a collaboration between the Department of Behavioral Health and Developmental Services (DBHDS) and the Department of Medical Assistance Services (DMAS) with support from hundreds of stakeholders.

The services covered by Medicaid will include:

  • Assertive Community Treatment (ACT): Adults with serious mental illness receive care through a single team that works closely together to support the individual and is available 24/7.
  • Mental health partial hospitalization program: Adults and youth receive intensive services during daytime hours for five or six days per week while continuing to live in their homes.
  • Mental health intensive outpatient program: Adults and youth receive short-term, focused therapy and counseling both individually and with members of their support system two to three times weekly.

Virginia Medicaid members interested in the new services should contact their managed care organization or their behavioral health provider for more information.

An additional set of six new services will launch in December 2021.

Clipped from: https://www.wavy.com/news/virginia/richmond/virginia-launches-new-behavioral-health-services-for-medicaid-members/