Carol Robinson’s Post

State DHS and Medicaid agencies can get 90/10 federal Medicaid match funding for health information technology solution DDI, and 75/25 funding for ongoing M&O, for technology that promotes interoperability and exchange of health information that facilitates coordination of care for individuals experiencing Mental Health and SUD conditions. These are solutions such as electronic management of patient consent permissions for their health records to be shared across organizations that are members of their care team with patient mediation and role-based access; solutions such as Midato’s ShareApprove™️ software currently being implemented by the Washington State Health Care Authority as ConsentLink. Our company stands ready to assist state agencies with the drafting of APDs to access this funding and lobbying state legislators to approve appropriations for the state matching funds so that individuals can have the best possible coordinated care and personal agency over who can view their medical records! Let’s get this done everywhere, and build consumer trust in our delivery systems’ ability to protect their privacy and the security of their health data!! #healthinformationexchange #healthdataprivacy #dataprivacy #mentalhealth #SUD #ONC www.midatohealth.com

A very sincere congratulations to Kirsten Beronio for getting this guidance out. Medicaid is articulating support for the states in developing behavioral health technology for Medicaid providers and Medicaid beneficiaries. Brent Weaver, MS, PMP, SPC and Edward Dolly worked to ensure that the 90% match for these technologies is described thoughtfully, addressing frequent state questions on various cost allocation approaches (allocations for provider facing technologies, etc.). And, my favorite, specific guidance on if/how/when to *weight* cost allocation by patient, as Medicaid beneficiaries with multiple conditions, BH concerns, SDOH concerns, etc., certainly take more provider time than college well-visits! Some behavioral health projects included in this guidance eligible for support (not an exhaustive list)! ·      Opportunities for: telehealth modalities for BH/SUD interventions; ·      Recent CMS Mental Health parity work which allows for improved compensation; ·      Care coordination connections between hospitals, community based BH/SUD providers, schools, primary care, criminal justice settings ·      BH/SUD screening tools ·      Smartphone applications ·      Creation of a public-facing website that links enrollees to social networks, peer support groups, resource sharing, and other functions ·      Implementation and maintenance of an information exchange platform connecting Medicaid beneficiaries on a Medicaid provider network of peer support specialists and addiction clinical staff who share resources ·      Establishment of an eConsent Management System that could support exchange of MH and SUD treatment information using common health information exchange standards and application programming interfaces (APIs) to connect and support data exchange ·      Development of a platform to facilitate patient consent to exchange of information regarding MH and SUD treatment , e.g., Consent2Share, an opensource software application developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) that allows patients to determine which health information they would like to share with their primary care and specialty health care providers (potentially coupled with a web-based health information exchange tool and clinical document repository that enable providers to access continuity of care documents and view key clinical data ·      Creation of an email or other electronic alert system ensuring MH and SUD treatment providers receive information on admissions, discharge, or transfer (ADT) so that when an enrollee with serious mental illness or serious emotional disturbance is being discharged from a hospital, that enrollee’s records regarding treatment could more easily be transferred to a community-based treatment provider. And thorough discussion of all the ways Medicaid can align with state 988 efforts. Congrats again team! https://lnkd.in/eifTf7a4

Launch of Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans At a legislative committee hearing earlier this month, NC Medicaid officially announced that all Tailored Plans are ready to go live on July 1. Tailored Plans are a new kind of NC Medicaid Managed Care health plan for approximately 210,000 beneficiaries with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual/developmental disability or a traumatic brain injury in North Carolina. They will cover doctor visits, prescription drugs and services for mental health, substance use, I/DD and traumatic brain injury in one plan. Eligible North Carolinians who are covered by NC Medicaid Direct will be covered by a Tailored Plan beginning July 1. The name of their Medicaid plan will change but the services covered remain the same. A bilingual toolkit with accessible resources is now available for people impacted by the transition to Tailored Plans. The NC Medicaid Enrollment Broker will mail a letter this week to anyone moving to a Tailored Plan. Tailored Plan beneficiaries will need to choose a primary care provider between now and May 15, 2024. If you don’t choose a PCP by May 15, the Tailored Plan will assign one to you. People can change their PCP through Jan. 31, 2025. Tailored Plans will be managed by the Local Management Entities (LMEs) Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health. For more information about Tailored Plans, visit: https://buff.ly/4atFYGg. To access the toolkit, visit: https://buff.ly/3VYJHHz.

"North Carolina’s regional managed care organizations that will administer specialized #Medicaid plans for people with complex needs say they’re ready for the plans — which have had multiple delays — to finally go live on July 1. "CEOs for the four organizations, known as LME-MCOs, appeared Tuesday before the state legislature’s Joint Legislative Oversight Committee on Medicaid. They assured lawmakers that the so-called “tailored plans,” which are expected to cover about 150,000 Medicaid participants, will launch on that schedule. "The tailored plans will serve people with intellectual or developmental disabilities, traumatic brain injuries, complex psychiatric disorders and substance use disorders — all conditions that require more extensive care and support than that for typical enrollees. The N.C. Department of Health and Human Services originally hoped to implement the plans in December 2022, but the rollout was pushed back multiple times to give the LME-MCOs more time to prepare and nail down contracts with providers. “We all feel highly confident and highly prepared about going forward,” Rhett Melton, CEO of Partners Health Management, told the committee. He added that his organization has “passed the readiness reviews” and the “re-reviews of the re-reviews of the re-reviews.” "Partners will be working with Alliance Health to administer tailored plans across a 22-county swath of central North Carolina. Vaya Health will manage 32 counties, most of them in the western part of the state. Trillium Health Resources will handle 46 counties in the east." https://lnkd.in/eUW5pj2y

Harnessing the Power of CCBHC Medicaid Demonstration Program to Transform Behavioral Health in the United States Introduction: In response to the recent expansion of the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration Program across ten new states, including Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island, and Vermont successfully built the state-level infrastructure to develop programs that meet the CCBHC requirements. Thurman Brown Consultant Inc. (TBCI) stands ready to support and empower behavioral health providers in maximizing the benefits of this transformative initiative. Our tailored services are designed to enhance operational efficiency, optimize service delivery, and foster community resilience. Understanding the Opportunity: The addition of States to the CCBHC Medicaid Demonstration Program signifies a pivotal moment in expanding access to quality behavioral health care. This program offers sustainable funding and comprehensive service mandates that enable CCBHCs to deliver timely, integrated care to individuals regardless of their ability to pay. TBCI’s Value Proposition: 1. Operational Excellence: TBCI specializes in strategic guidance and operational optimization for CCBHCs, ensuring compliance with program requirements while maximizing service accessibility and efficiency. 2. Workforce Development: We offer tailored training programs and workforce development strategies that empower clinical staff and peer specialists to deliver high-quality, person-centered care. 3. Quality Assurance: Our robust quality assurance frameworks ensure adherence to evidence-based practices, fostering continuous improvement in service outcomes and client satisfaction. 4. Partnership Facilitation: TBCI facilitates strategic partnerships with local stakeholders and community organizations, enhancing service integration and resource sharing to meet diverse community needs. 5. Data-driven Insights: Leveraging advanced analytics, TBCI supports CCBHCs in measuring and optimizing performance metrics, enabling informed decision-making and program evaluation. The Impact: By partnering with TBCI, CCBHCs can enhance their operational infrastructure, expand service offerings, and improve outcomes for individuals facing behavioral health challenges. Together, we can build a more resilient, inclusive behavioral health ecosystem that prioritizes equity and access. Conclusion: Join TBCI in leveraging the CCBHC Medicaid Demonstration Program to revolutionize behavioral health care in [State Name]. Together, we can ensure that every individual receives the compassionate, comprehensive care they deserve, regardless of their circumstances. Contact us today to explore how TBCI can support your CCBHC in achieving excellence in care delivery and community impact. Sincerely, Thurman Brown Thurman Brown Consultant Inc. Thurmanbrownconsultant@gmail.com

Good read from "Addiction Treatment Business" on how Medicaid is making major progress in SUD treatment, but critical coverage gaps still occur. In summary, Medicaid coverage for treatment medication is now almost 100% with recovery support reimbursement also on the rise. Gaps still exist in residential and intensive outpatient programs with a strong path toward negotiating more value-based contracts with Medicaid providers that are focused on holistic care. As the government continues to make progress but continues to play catch-up with the opioid crisis, Red Tide Advisory Services is happy to discuss obtaining the needed accreditation and certification to bill Medicaid for services. mmumma@redtideadvisory.com

Today, the Centers for Medicare and Medicaid Services (CMS) announced the release of the NOFO application for the Innovation in Behavioral Health (IBH) Model. The IBH Model is focused on improving the behavioral and physical health outcomes and quality of care for people with Medicaid and Medicare who experience moderate to severe behavioral health conditions. The model seeks to bridge the gap between behavioral and physical health by enabling specialty behavioral health practices to integrate behavioral health with physical health care and health-related social needs. The IBH Model is a state-based model, led by state Medicaid agencies (SMAs), with a goal of aligning payment between Medicaid and Medicare for integrated care. CMS will select up to eight SMAs to participate in the IBH Model, and these SMAs will use cooperative agreement funding to develop necessary infrastructure and capacity to implement the IBH Model. SMAs will recruit “Practice Participants” to deliver care, and they will receive funding to support necessary upgrades to health information technology, electronic health records, practice transformation activities, and staffing to implement the model. Award notices will be issued to selected SMAs in mid-December. https://lnkd.in/eMdXpUmp

🚨 New behavioral health model by Centers for Medicare & Medicaid Services coming out- The Innovation in Behavioral Health (IBH) Model. Bottom line: Excited about this! It should improve access to care for patients with mental illness primarily depression and anxiety and those with substance use disorders. Biggest benefit is access for these services for Medicare and Medicaid patients- has been a huge existing gap in coverage. A quarter of all people enrolled in Medicare experience mental illness, and 40 percent of all adults enrolled in Medicaid experience mental illness or SUD. Medicaid and Medicare populations also experience higher than average rates of SUD. People with behavioral health needs often have trouble accessing necessary health care, have unmet health-related social needs, experience poor health outcomes, and have premature mortality. 💠 The IBH Model is a person-centered approach to addressing whole-person health represents a “no wrong door” approach that prioritizes close collaboration with primary care and other physical health providers to support all aspects of a patient’s care. 💠 The model focuses on patients’ behavioral and physical health and health-related social needs. It's pillars are: care integration, care management, health equity, and health IT. 💠 8 years model awarded to 8 states 💠 IBH is a state-based model focused on community-based behavioral health practices that treat Medicaid and Medicare beneficiaries and includes both Medicaid and Medicare-aligned payment models. 💠 Practices can volunteer to enroll in Medicare program. 💠 The selected states will partner with their state’s agencies for mental health and/or SUD through a partnering Medicaid Managed Care Organization (MCO) in the state. #behavioralhealth #populationhealth #integration #medicare #medicaid #healthcareonlinkedin

Do you find yourself plagued with questions like these: “Can I see a Medicaid client if I’m not a Medicaid provider?” “Can a Medicaid insured client pay me in cash since I’m not a Medicaid provider?” “What are the requirements to get credentialed as a Medicaid provider?” “Are there any special record keeping requirements for taking Medicaid?” “How do I bill Medicaid? Can I negotiate my fees with Medicaid?” “Can I be prelicensed and accept Medicaid if I am supervised by a Medicaid provider?” “What happens if my Medicaid clients no show for appointments? Can I charge them?” “I don’t understand all the different types of Medicaid programs. Do I have to be separately credentialed with each of them?” Medicaid can be confusing. It’s a state-run program filled with regulations and requirements that can be daunting to even the most seasoned of therapists. If you are a Medicaid provider and struggling to understand Medicaid’s regulations or a provider thinking you want to take Medicaid then this symposium is for you. This full-day online symposium features experts in the field covering topics: • Best Practices in Clinical Supervision • Supervisory Billing with Candidates and Interns • Creating Cohesive Teams that Serve Medicaid Clients • Neurofeedback with Medicaid Populations • Medicaid Compliant Clinical Writing and Notes in 5 Minutes or Less • Co-Occuring Disorders in the Medicaid Population • Managing Chronic Suicidal Ideation with Medicaid Clients • RAE Updates  To register and for more information, head to

Key Takeaways (notes) from the Dept of HHS, zoom call, and webinar from CMS administrator and  team this morning. "Affordability is the Guiding Light " ; "North Star is the Consumer"; " Every American must have health care coverage" - CMS Administrator and team Reforms: * Extra help - Drug Law 1/1/24 - * High drug cost – relief – inflation reduction (www.cms.gov) * People with Medicare whole persons - access to behavioral health: Marriage and family therapy and addiction counseling. * New payments for community health integration and payments for psychotherapy - outpatient therapy * Medicare Advantage - remains strong and Thriving; no steering allowed 2024 will maintain the momentum, lower drug cost, transform care, and improve Medicare Advantage. Trust the MEdicare program solvency Increasing coverage - including improving transitions in coverage (Seamless experience) Increasing value; Drive Quality Outcomes;Finalizing consumer protection rules CMS remains committed to Improving access and quality of care to CHIP enrollees. Addressing challenges to the 4 Walls policy (Indian Health Services ) Developed LTC proposal for staffing rule Digital transformation Expanding access to mental health services includes rural health communities. Transparency TCET (Transitional Coverage for Emerging Technologies) From Innovation Center: continue working on health equity, new models include, primary, guide model (dementia), AHEAD (all-payer health equity approaches and development) , transforming maternal health outcomes (supports whole person approach to pregnancy, childbirth and care) Goal - Improve safety, and whole person and increase access to care IBH -integrated services state-based model on integrated whole person care mental health and or substance abuse care CMS cancelled over 2500 unauthorized enrollments and remains committed in 2024 Striving to work against bad actors and fraudulent COVID testing billing Ensure hospice provides quality care, and decrease bad actors AI – focus on integrity and ensure ethical application of this technology OMH (Office of minority health) – sustain the momentum built- Note: May 29 and 30th,  2024 -  Health Equity Recognize and support data, research and analysis to decrease disparities. Health Equity Assistance program continues to provide support with additional tools and resources in 2024 Final rule for prior authorizations will help patients access care in a timely manner (72 hours ; 7 days ) Payors will need to report certain prior auth metrics. Patients will be empowered with access to more of their data. #nationalstakeholdercallwithcmsadministrator#cms#medicare#medicaid#Medicarestrong https://lnkd.in/gY5XFrVj