CMS announces CPC+ primary care model

On April 11, 2016, the Centers for Medicare and Medicaid Services (CMS) announced the Comprehensive Primary Care Plus (CPC+) model. The CPC+ model, which builds on the CPC model launched in October 2012, is designed to align Medicare, state Medicaid agencies, and commercial insurance payers to achieve comprehensive, coordinated primary care, especially for patients with complex medical and behavioral health needs. [More]

NEJM examines Medicare physician reimbursement system

On April 7, 2016, the New England Journal of Medicine (NEJM) published an article entitled, “Finding Value in Unexpected Places – Fixing the Medicare Physician Fee Schedule.” The NEJM article notes that the Medicare physician fee schedule (MPFS) may: affect how physicians spend time with patients, drive unneeded tests and procedures, influence physicians’ specialty choices, and worsen shortages of much-needed primary care physicians and geriatricians. [More]

CMS finalizes mental health parity rules

On March 30, 2016, the Centers for Medicare and Medicaid Services (CMS) published final rules on mental health/substance use disorder parity requirements applicable to Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and the Children’s Health Insurance Program (CHIP). The final Medicaid/CHIP rules are based on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which generally prohibits more restrictive cost-sharing (e.g., co-payments and deductibles), quantitative limitations (e.g., visit limits), and non-quantitative limitations in mental health/substance use disorder benefits under a health plan than in medical/surgical coverage under the same plan. [More]

HHS issues report on behavioral health benefits of Medicaid expansion

On March 28, 2016, the U.S. Department of Health and Human Services (HHS), Assistant Secretary for Planning and Evaluation (ASPE) issued a report entitled, “Benefits of Medicaid Expansion for Behavioral Health.” The report estimates that about 1.9 million low-income uninsured persons with mental illness or substance use disorders live in states that have not yet expanded Medicaid under the Affordable Care Act (ACA). [More]

Adopting Science-based Policies to Combat Child Neglect Can Increase Wellbeing, Boost Opportunity, and Curb Costs of Government, Concludes Report by Institute for Child Success and Public Consulting Group

Boston, MA – March 31, 2016. Neuroscience-based policies to combat child neglect can usher a new era of wellbeing and opportunity while reducing strain on government services, according to a recent report by the Institute for Child Success and Public Consulting Group, a leading public sector consulting firm. [More]

Behavioral Health’s Move Toward Value-Based Purchasing

“Alternative payment models are not an option for behavioral health providers,” Arizona Medicaid Director Tom Betlach said, “They are your growth strategy.” Betlach’s point was very clear and it resonated with the more than 5,500 attendees at NatCon, where Payment Reform – be it alternative payment methodologies (APMs) or value-based purchasing (VBP) models like Delivery System Reform Incentive Payment (DSRIP) initiatives – was a key theme. In line with this, New York State’s DSRIP efforts were highlighted repeatedly throughout the conference. (PCG has played an instrumental role in spearheading New York’s initiative). Government agencies have become “first movers” towards VBP, stressing the importance of “whole person care,” not just “sick care.” [More]

CCBHC Is The Start of Something Good!

CCBHCs! That’s Certified Community Behavioral Health Centers, for those not familiar with the billion dollar investment that the Substance Abuse and Mental Health Services Administration (SAMHSA) will soon make to state behavioral health systems. In 2014, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included a demonstration program based on the Excellence in Mental Health Act. [More]

The Science of Addiction

Research presented by Dr. Nora Volkow, Director of the National Institute on Drug Abuse, at NatCon used brain imaging to dramatically illustrate how addiction changes brain function. Dr. Volkow’s research demonstrates, for example, that the frontal cortex – or reward center – of the brain weakens as a result of alcohol and illicit drug use. Because the tissue no longer functions in the same way, addiction must be considered a disease of the brain, just as heart disease is a disease of the heart. [More]