Alan | LinkedIn Learn more. County specialty mental health plans in the region have adopted more holistic approaches to addressing behavioral health needs, developing partnerships with health plans and adding new services. All responding states (47) reported that they sometimes or always covered audio-visual delivery of FFS mental health and SUD services. ARPA provides 85% federal matching funds for these crisis intervention services for the first three years, with these additional funds to supplement, not supplant, the level of state spending for these services. Reviews applications that focus on clinical services and service systems, such as innovative service delivery systems; studies at the interface of service and interventions, such as studies of treatment guidelines and practice patterns; and policy, cost and dissemination research. and treatment of mental illnesses. BHCS Providers Website - acbhcs.org Medi-Cal Explained: Administration of Non-Specialty Mental Health Services It is mandatory to procure user consent prior to running . Additionally, it is unclear how behavioral health service patterns may change in the aftermath of the COVID-19 pandemic and whether or how states may modify or adopt new initiatives in this area. The below chart indicates the access criteria for MCPs and the types of Non-SMHS these Plans can provide (see QA Bulletin . One approach to address care fragmentation and better integrate physical and behavioral health care is co-location of both types of care at the same site. 705 0 obj <> endobj Published: Dec 09, 2021. %%EOF If you have any questions, please feel free to call us at 1-408-874-1788 or email us at providerservices@scfhp.com. Regarding BHSIN #21-073 and the changes effective January 1, 2022, a new Welfare and Institutions Code section 14184.402(f)(1)(A) clarifies that a mental health diagnosis is not a prerequisite for access to covered Specialty Mental Health Services (SMHS). Explore the NIMH grant application process, including how to write your grant, how to submit your grant, and how the review process works. Learn about how NIMH manages research grants, including policies and reporting requirements. Services studies may include data from human subjects of all age ranges and from all cultural and socio-economic backgrounds. Effective January 1, 2023, . ), Phone: 1-866-615-6464 PDF FAQ: CalAIM No Wrong Door - SF Alameda County Behavioral Health Care Services. The BBBA would also expand funding for a community mental health services Medicaid demonstration program for states to implement Certified Community Behavioral Health Clinics. These include managed care requirements and/or initiatives, efforts to improve data collection and stratification, and eligibility or benefit expansions that would address behavioral health disparities. NIMH hosts an annual lecture series dedicated to innovation, invention, and scientific discovery. hb```f``:?AX,3 Haa|~@eP?/48y> The National Institute of Mental Health (NIMH) is part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services. Our services include the most intuitive health insurance offering, our Alan Clinic to navigate the healthcare system and Alan Mind, our mental well-being offer among other things! PDF State of CaliforniaHealth and Human Services Agency - DHCS appropriate and covered non-specialty mental health services (NSMHS) and the regulatory requirements for the Medicaid Mental Health Parity Final Rule (CMS-2333-F). Some interviewees commented on the potential benefits to bill for CHW/P services through California's State Plain Amendment and CalAIM (California Advancing and Innovating Medi-Cal). Outside of Medicaid, other state agencies may also take steps to address behavioral health outcomes, sometimes including Medicaid populations but often broader. hbbd```b``n\1D2ELjX6 %,,LjH`ve"u$6 vX30120: 1 @ 2 Email: nimhinfo@nih.gov ARPA also authorized $15 million for state planning grants; these were awarded to 20 states in September 2021 (however, under ARPA, all states are eligible to take up this option beginning April 1, 2022, including those that did not receive planning grants). States may limit enrollees choice of provider for these services. Learn more about research conducted at NIMH. California is planning to add the mobile crisis benefit to the Medi-Cal program as soon as January 1, 2023. Types of Mental Health Professionals - NAMI New Programs Key Changes Timeline Downloads & Related Resources Summary California Advancing and Innovating Medi-Cal more commonly known as CalAIM is a far-reaching, multiyear plan to transform California's Medi-Cal program and enable it to work more seamlessly with other social services. On KFFs 21st annual Medicaid budget survey, all responding states reported at least one initiative to expand behavioral health care in Medicaid in state fiscal year (FY) 2021 and/or 2022,1 including crisis service and other benefit expansions, initiatives to expand telehealth and address equity, and managed care changes. non spec mental 2 Part 2 - Non-Specialty Mental Health Services: Psychiatric and Psychological Services . Some of these initiatives are limited to Medicaid enrollees and funding, but others have a broader focus. These in lieu of services (ILOS) must be identified in the MCO contract and enrollees may not be required to use them.8 In recent years, states have increasingly used MCO in lieu of authority to cover services provided to nonelderly adults in institutions for mental disease (IMDs) that otherwise would be ineligible for federal Medicaid funding. Use these free education and outreach materials in your community and on social media to spread the word about mental health and related topics. A few states mentioned incentive payments for providers or MCOs who promote integrated care. PDF Non-Specialty Mental Health Services: Reimbursement Rates and Billing The 2018 SUPPORT Act codified the existing Medicaid managed care regulation allowing capitation payments to include IMD services up to 15 days per month using in lieu of authority. endstream endobj startxref Medi-Cal managed care plans cover these services in one of two ways: "In-house," wherein the plans contract directly with behavioral care providers and manage all aspects of providing NSMHS to their members. Some of these initiatives are limited to Medicaid enrollees and funding, but others have a broader focus. These mobile crisis services generally do not have to be offered statewide and can be targeted to specific groups of enrollees (rather than be available to all Medicaid enrollees). The Medi-Cal program is a public health insurance program which provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities and pregnant women. Some behavioral health benefit expansions are targeted to specific populations such as children or pregnant/postpartum women. More than four-fifths of states reported initiatives in place related to screening enrollees for behavioral health needs, in fee-for-service (FFS) and/or through MCO contract requirements. For example, state legislation in Kansas directs the state to establish a certified CCBHC model in FY 2022, which will encourage CMHCs to begin offering physical health services. Under federal Medicaid regulations, states may allow MCOs to offer services or settings that substitute for those that are covered under the state plan. other embedded contents are termed as non-necessary cookies. KFF Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 6201 San Ignacio Ave., San Jose, CA 95119, Report health care fraud, waste, and abuse, Request information in other languages or formats, Health Care Quality Assessment Form Provider Incentive, Stopping healthcare fraud, waste, and abuse, Medi-Cal nondiscrimination notice language assistance, DualConnect nondiscrimination notice language assistance, Report healthcare fraud, waste, and abuse. Use these free digital, outreach materials in your community and on social media to spread the word about mental health. The survey also asked states to identify the top two or three categories of behavioral health services that had the highest telehealth utilization during FY 2021; states most frequently identified psychotherapy, counseling (for mental health conditions and/or SUD), and patient evaluations. Federal law mandates Medicaid coverage of many behavioral health benefits, and states may also cover additional optional behavioral health benefits. The purpose of the P&P Manual is to ensure that everyone associated with ACBH operations is aware of and consistently implements the requirements under federal, state, and local laws and regulations. Continued efforts at the federal levelincluding the proposed BBBAmay affect the level of enhanced Medicaid funding available to states and their take-up of expanded behavioral health services. Lessons from the Field: How an Ad Hoc Stakeholder Network Is Helping Redefine Medical Respite Care in Los Angeles. Across service categories, most states are considering post-pandemic telehealth policies, with many weighing expanded access against quality concerns especially for audio-only telehealth. Assessment Start Date is the date the client keeps a first assessment appointment. Member can call the medical group/IPA and the IPA will contact SCFHP to coordinate the services. Find out how NIMH engages a range of stakeholder organizations as part of its efforts to ensure the greatest public health impact of the research we support. The Alameda County Behavioral Health (ACBH) Policies & Procedures (P&P) Manual is a compilation of all the policies and procedures that apply to ACBH staff and contractors. 6001 Executive Boulevard, Room 6200, MSC 9663 States reported approaches to targeting SUD including new or expanded residential/inpatient SUD benefits, coverage of opioid treatment programs, and enhanced care management.5 States are also implementing other targeted benefit expansions to address mental health and other needs that have been adversely affected by the COVID-19 pandemic, such as exposure to gun violence (addressed by a benefit expansion in Illinois). Crisis hotlines include 988 hotlines, which were designated by the Federal Communication Commission as the new phone number to connect individuals with suicide prevention and mental health crisis counselors. Medi-Cal Explained: 2024 Medi-Cal Managed Care Plans by County Medi-Cal Specialty Mental Health Services Covered by County Mental PDF DATE: April 1, 2022 BHRS POLICY: 22-01 AUTHORITY - San Mateo County Health Learn more about NIMH newsletters, public participation in grant reviews, research funding, clinical trials, the NIMH Gift Fund, and connecting with NIMH on social media. A: The current carve out does not change. NIMH offers expert-reviewed information on mental disorders and a range of topics. More than half of states reported plans to take up the new ARPA community-based mobile crisis intervention service option and about two-thirds reported another crisis service initiative. Adverse effects of the COVID-19 pandemic on mental health and substance use outcomes have brought further focus to behavioral health issues and prompted the Substance Abuse and Mental Health Services Administration (SAMHSA) to issue multiple COVID-19 grants, available to state agencies to address mental health and SUD outcomes. Specialty Mental Health Services (SMHS) are delivered by county Mental Health Plans (MHPs) for Medi-Cal beneficiaries who have a moderate-to-severe mental health condition. Per forthcoming DHCS guidance, Medi-Cal Managed Care Health Plan Responsibilities For Non-Specialty Mental Health Services, and the Medi-Cal Provider Manual: Non-Specialty Mental Health Services: Psychiatric and Psychological Services, MCPs are 10/25/22), 1603-4-1 Unusual Occurrence and Death Reporting (4/25/22), 1603-5-1 Medi-Cal Site Certification for Providers of Mental Health Services (8/15/2022), 1603-6 Concurrent Review of Crisis Residential Treatment Services and Adult Residential Treatment Services (10/07/22), 1650-1-1 Drug Medi-Cal Compliance & Administrative Quality Management (5/1/15), 1702-1 Record and Data Retention and Destruction of Protected Health Information (6/11/21), 1703-1-1 Service Verification for Medi-Cal Reimbursed Services (10/8/15), OCS.C.001 "EXCLUSION SCREENING" (09/01/21), 1703-3-1 Whistleblower Program for Fraud, Waste, and Abuse (10/7/16), 1704-1-1 Privacy and Security Incident Reporting (7/6/18), 1901-1-1 Tobacco Policies and Consumer/Client Treatment Protocols (11/10/16), 2050-1-1 Drug Free Workplace (10/24/16), 2101-2-1 BHCS Internal Critical Incident Response Policy (10/21/16), Progress Notes for Mental Health Services: Timeline for Completion and Documentation Requirement, Documentation Requirements for all Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) Services, Specialty Mental Health Services (SMHS) Clinical Documentation Standards Policy & Procedure Manual, Verification of Professional Credentials for Substance Use Disorder Treatment Services, Credentialing & Re-Credentialing Verification for ACBH Mental Health & Substance Use Service Providers, 300-1 CONSUMER GRIEVANCE AND APPEAL PROCESSES, 1603-3 CREDENTIALING AND SCOPE OF PRACTICE. If you need immediate assistance or need to find services in your area, please call the ACCESS Center 24/7 Helpline at 1-800-854-7771. Non-Specialty Mental Health Services Psychiatric and Psychological Services (Nov. 2022) All Plan Letter 22-29: Dyadic Care Services and Family Therapy Benefit (Dec. 2022) endstream endobj 453 0 obj <. Introduction Both state and federal laws require health plans to provide treatment for mental health and substance use disorder conditions. Looking ahead, more than one-third of responding states mentioned behavioral health initiatives as a future priority, and several identified behavioral health services as an upward spending pressure in FY 2022. One state (New Hampshire) is planning implementation of a Critical Time Intervention model to provide support to individuals with SMI during vulnerable periods of transition (e.g., discharge from a psychiatric hospital). Medi-Cal Explained: Administration of Non-Specialty Mental Health Services. Read more about the NIMH Strategic Plan for Research, Strategic Research Priorities, the anatomy of NIMH funding, and our yearly funding strategy for research grants. Some states reported initiatives across many areas, often as part of wide-ranging statewide initiatives identified as top priorities for their Medicaid programexamples include Californias CalAIM initiative, Colorados behavioral health care coordination efforts, Massachusetts Roadmap for Behavioral Health Reform, Montanas pending HEART Section 1115 demonstration and parallel service additions, and Washingtons efforts to build an effective community behavioral health system. Non-Specialty Mental Health Services: Reimbursement Rates and Billing Codes Page updated: December 2021 This section lists the CPT and HCPCS codes and rates for Non-Specialty Mental Health Services (NSMHS). An additional CHCF fact sheet, Medi-Cal Explained: Administration of Non-Specialty Mental Health Services, lists all 2024 Medi-Cal managed care plans and indicates how they cover non-specialty mental health services. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KFF | twitter.com/kff. In the years prior to the COVID-19 pandemic, states were increasingly expanding optional behavioral health benefits and taking advantage of federal options in the SUPPORT Act. The ARPA model dispatches multidisciplinary mobile crisis teams to provide Medicaid-covered services to enrollees experiencing a mental health or SUD crisis outside a hospital or other facility setting. (* These descriptions should to be used as guidelines when determining the appropriate review locus for your application. hb```f`` B,@Q P UAF;geIyM9[`|kv>:~,Q{9e30wtt400T` 0.`:c`~HK M!L*W0eTT)i6>hp1/>pgB}%d4 b By far, the most commonly cited ILOS was services provided to nonelderly adults in IMDs, which are otherwise ineligible for Medicaid funding except through in lieu of or waiver authority.11 Some states also mentioned other approved behavioral health services (including mental health and SUD services). The proposed Build Back Better Act (BBBA) passed by the House of Representatives on November 19, 2021 would build on both ARPA provisions and also expand funding for community mental health services. Learn more about NIMHs commitment to accelerating the pace of scientific progress and transforming mental health care. States have broad flexibility to determine whether and how to cover services (including behavioral health) delivered via telehealth in their Medicaid programs. Non Specialty Behavioral Health Provider news | Monday, December 23, 2013 Previously behavioral health was a "carve out" and all behavioral health services for Medi-Cal managed care members were provided by the Santa Clara County Mental Health Department (SCMHD). Live Online Chat: Talk to a representative Nearly half of states reported initiatives to promote physical and behavioral health co-location in place in or planned for FY 2022. This trend tracks with the Biden Administrations identification of behavioral health policy and investments as a key federal Medicaid priority. Share on Facebook. June 27, 2023. Continued efforts at the federal level may affect the level of enhanced Medicaid funding available to states for expanded behavioral health services. Office of Science Policy, Planning, and Communications Hours: 8:30 a.m. 5 p.m. About two-thirds of responding states indicated they have other, non-ARPA-related crisis service initiatives in place in or planned for FY 2022. Many states plan to continue this coverage post-pandemic. A: NO, SCFHP and SCMHD will take full risk for this new benefit. Previously behavioral health was a "carve out" and all behavioral health services for Medi-Cal managed care members were provided by the Santa Clara County Mental Health Department (SCMHD). Eight states reported current or planned initiatives to address racial/ethnic disparities in behavioral health in Medicaid.6 Prior to the pandemic, Black and Hispanic people were less likely to receive needed behavioral health services compared to the general population, and during the pandemic, Black and Hispanic adults have been more likely to report symptoms of anxiety and/or depressive disorder. Non-Specialty Mental Health Services: Psychiatric and Psychological Services Page updated: December 2021 Mental health services are reimbursable for Medi-Cal eligible recipients when they are reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain. Department of Health and Human ServicesUSA.gov. Eleven states reported making recent changes to how behavioral health benefits are delivered under MCO contracts: three states in FY 2021 only, four states in FY 2022 only, and four states in both FY 2021 and 2022. endstream endobj 706 0 obj <. SPECIALTY MENTAL HEALTH SERVICES DOCUMENTATION ATAGLANCE * A DESK REFERENCE FOR BASIC STATE DOCUMENTATION REQUIREMENTS 2 List of MediCal Reimbursable Specialty Mental Health Services Specialty Mental Health Services that may be provided to clients and are reimbursed by MediCal include: States were more likely to report plans to maintain audio-only coverage for mental health and SUD services compared to other, non-behavioral health services. Research may examine organizations, systems and/or communities. The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California. For SRNS, the focus will particularly be on applications assessing service sites that are considered non-specialty mental health settings, such as primary or specialist medical care, schools, child welfare agencies, criminal justice settings, shelters, and other social service agencies where the primary focus of care is not mental health. PDF 3.20 Medical Necessity and Authorization of Specialty Mental Health
