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Authors Posts by Jim Sharp

Jim Sharp

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The Department of Human Services (DHS), in collaboration with the Insurance Department, will be implementing updated physical health and behavioral health autism spectrum disorder (ASD) related procedure and diagnosis codes as a key element of the state’s Medicaid (MA) cost avoidance initiative, effective September 30. These changes will reflect a more complete and updated array of ASD related procedure and diagnostic codes that will be recognized by commercial insurance plans as well as MA. The goal of these changes is to identify the service array that is covered by commercial health insurance plans, reduce the financial burden on the MA system, and to improve the uniformity of coding and billing for services. The September 30 implementation date will allow additional time for the state, in collaboration with RCPA, to provide outreach and training to providers of services for children with an ASD. As a member of the state’s Act 62 External Work Group, RCPA will be meeting with DHS to develop materials and plan for informational webinars to prepare providers for these changes. RCPA will provide information and updates as they become available.

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A recent news release from the American Psychiatric Association reports that diagnosis of autism spectrum disorder before the age of 4 means that a child is more likely to get effective, evidence-based treatment, such as behavioral therapy. When children are diagnosed after that threshold, they are less likely to receive such treatment, but they are more likely to be treated with medication, according to research published online in the August 1 release of Psychiatric Services in Advance. The strongest evidence for effective treatment for autism is for behavioral intervention therapy directed at core autism symptoms, such as social skills and inflexible behaviors. Early intensive treatments may have long-term benefits for children’s functioning. Other therapies, including complementary and alternative medicine and medication treatments for autism, are more controversial and are not as strongly supported by scientific studies. Psychiatric Services in Advance articles have been peer reviewed but have not yet appeared in the print journal. Publication ahead of print allows articles to become available in a rapid and timely manner.

The American Academy of Pediatrics recommends that all children be screened for autism at 18 months and again at 24 months. Current information suggests that only about half of primary care practitioners screen for autism. The average age at diagnosis in the United States is more than 4 years old.

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In June, the Behavioral Health Rehabilitation Service (BHRS) Regulations Work Group completed a series of conference calls with RCPA members and other providers, managed care representatives, and advocacy groups. Meeting notes provided by the Office of Mental Health and Substance Abuse Services and the Bureau of Autism Services from the several work group conference calls are available below. While these notes don’t fully reflect the active and thoughtful discussions that were evident in each of the work group’s conference calls, they may provide some insight into those conversations. The Department of Human Services will be working throughout the month of July to put together a document based on the BHRS Regulation Work Group’s feedback, and ideas for review and comments by work group members, in early August.

Meeting documents are below:

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The Department of Human Services (DHS) is implementing a number of measures related to services for children and adolescents with behavioral health needs. The full text of their announcement is available for review and a summary of key elements of the DHS action plans are highlighted below:

 

Behavioral Health Rehabilitation Services (BHRS)

  • Concentrating efforts on the development of appropriate regulatory guidance for BHRS.
  • Established a work group that will review existing policies, bulletins, and data that will be used to draft the regulations by November 2016.

 

Applied Behavioral Analysis (ABA)

  • Developed a two-year action plan to enhance access and quality of ABA services.
  • Will develop new requirements for the training, qualifications, skills, and experience of practitioners.
  • Issued bulletins clarifying the training requirements for TSS workers and newly licensed behavior specialists who use BSC-ASD services to provide ABA.
  • Issued a bulletin that provides guidelines to assess the medical necessity of ABA.

 

Behavior Specialist Licensure

  • Will send out guidance to accredited colleges and universities that are interested in developing graduate-level coursework or programs.
  • Will provide guidance for students on how they can satisfy the coursework and experience requirements while working towards their degree.

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A recent edition of the Pittsburgh Post-Gazette focused on the planning efforts by Highmark Insurance to assure health care parity and the economic and health care value of integrated health care.

The Post-Gazette article notes that “behavioral health care is still provided under a “separate and unequal” system, eight years after enactment of a federal law that meant to curb such disparity,” noted Patrick Kennedy in a meeting with a group of Pittsburgh-area health insurance caseworkers. “But that may start to change by fall when employer compliance monitoring is expected to begin for the Mental Health Parity and Addiction Equity Act,” the 49-year-old former Rhode Island congressman told about 20 case managers at Highmark Health. Mr. Kennedy was upbeat, saying a renaissance was at hand as employers and insurers learn about the cost-saving value of behavioral health coverage. “The business model isn’t there yet. This is going to take time,” he said. “Let’s find the value so it makes sense for insurance companies.”

In a related effort, the Pennsylvania Parity Coalition will be meeting this week with the Pennsylvania Insurance Department, to discuss the implementation and monitoring of commercial insurance plans as part of the federal parity requirements in the move toward integrated health care. RCPA, along with leading provider and consumer advocacy groups and representatives of ParityTrack, supported by the Kennedy Forum, make up the core leadership of the Pennsylvania Parity Coalition.

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Research position or fellowship in suicide prevention research in schools

Leaders in mental health and suicide prevention research are working to implement a grant to study an evidence-based approach to youth suicide prevention. They are now looking for a project coordinator (masters or doctoral level preferred) and a research assistant (BA level) to run a large, school-based suicide prevention study with teachers in urban and suburban middle and high schools in Pennsylvania. This project will study a promising prevention model by recruiting 30 schools and training over 1,000 teachers.

The work of the research team will involve identifying schools, working with school personnel to plan the training, implementation of the assessment system, coordinating the training, and collecting pre-, post-, and follow-up quantitative and qualitative data. Both the project coordinator and research assistant are 18-month positions starting September 1. Interested individuals should send their resumes with cover letters to Guy Diamond, PhD and Matthew Wintersteen, PhD.

RCPA has played a long-standing role in the Pennsylvania Youth Suicide Prevention Initiative and works in collaboration with state and local organizations to reduce the risk and rate of youth suicide in communities across the Commonwealth.

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Behavioral health issues rarely occur in a vacuum. Many individuals with behavioral health needs also suffer from chronic physical ailments, including diabetes, asthma, and heart disease. This CHCS blog, The Thrust to Integrate Behavioral Health Services in Medicaid, highlights how policymakers are increasingly focused on the need to better coordinate care for this population. It outlines emerging state and federal efforts that are moving toward whole-person care on many fronts — including programs to integrate physical and behavioral health services, reduce homelessness, end the cycle of repeat jail visits, and, ultimately, improve this vulnerable population’s overall quality of life.

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The Office of Vocational Rehabilitation (OVR) is conducting a comprehensive statewide needs assessment designed to meet and satisfy the state plan requirements in the Rehabilitation Act of 1973, as amended, and the Workforce Innovation and Opportunity Act. As part of this assessment, the Institute on Disabilities at Temple University is asking Pennsylvania employers and workforce professionals to complete a brief survey to identify how OVR can better support employers and employees across Pennsylvania.

This project is being conducted in cooperation with the Pennsylvania Rehabilitation Council and with the assistance of the Institute on Disabilities. If you are an employer or a workforce professional you are encouraged to complete this brief survey by Monday, August 1. Once you’ve completed the survey, you can enter in a drawing to win a $20 Target gift card.

The Institute on Disabilities is also seeking employer stakeholders to participate in brief phone interviews and share their expertise with the Institute. Interested employers can email or call 215-204-9544.

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Integration is a hot topic and buzzword in health care. And, integrated primary and behavioral health care is the best approach to care for people with complex health care needs. But do you have an elevator speech when someone asks you about integrated care? What do you tell new staff during orientation and how do you communicate the value to potential partners and your board of directors? Join this webinar to go back to the basics of primary and behavioral health care integration and learn how to effectively communicate the importance of integrated care and the benefits to the people you serve.

Continue

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Last week Insurance Commissioner Teresa Miller reiterated to consumers that enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) is a priority for her department. Miller also encouraged consumers to understand what benefits they are entitled to under the law and to file complaints with the Insurance Department if they believe they are not getting proper insurance coverage. “The Pennsylvania Insurance Department takes this law very seriously, and we will us our statutory authority to enforce parity requirements on plans over which we have jurisdiction,” said Commissioner Miller.

The MHPAEA of 2008 requires health insurance plans to contain the same level of coverage for mental health and substance use disorders as for medical or surgical care. This coverage includes quantitative limitations (copays, deductibles, and limits on inpatient or outpatient visits that are covered) and non-quantitative limitations (pre-authorizations, providers available through a plan’s network, and what a plan deems “medically necessary”).

One important step toward a well-integrated system of health care, both physical and behavioral, is full implementation of the letter and spirit of MHPAEA. RCPA is actively working with health care advocates as part of the state’s Parity Coalition to assure consumers and providers/practitioners that Medicaid, CHIP, and private health plan coverage include quantitative and non-quantitative parity.

For more information on the MHPAEA or to file a complaint or ask a question, visit the insurance department website or call 877-881-6388.

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