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Authors Posts by Jim Sharp

Jim Sharp

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Lack of BH Providers in Medicare and Medicaid Impedes Enrollees’ Access to Care

The Office of the Inspector General (OIG) has released a report citing there are not enough behavioral health providers participating in Medicare and Medicaid networks.

In an analysis published April 2, the government watchdog studied one urban and one rural county in 10 states across the country. The analysis found relatively few behavioral health providers are participating in Medicaid, Medicare, and Medicare Advantage programs, leading to difficulties in access for enrollees.

Notable Findings:

  1. On average, there were fewer than five active behavioral health providers accepting Medicare and Medicaid patients per 1,000 enrollees. Traditional Medicare had the lowest rates of providers, at 2.9 per 1,000 on average, and Medicare Advantage had the highest rate at 4.7 per 1,000 enrollees.
  2. Rural counties had fewer providers accepting Medicare and Medicaid than urban counties. In rural counties, there were 1.5 providers accepting traditional Medicare per 1,000 patients, compared to 4.4 in urban counties.
  3. Across Medicaid, traditional Medicare, and Medicare Advantage, there were fewer than two providers per 1,000 enrollees that could prescribe medication for mental health issues, such as psychiatrists and psychiatric nurse practitioners.
  4. Active providers accepting public insurance make up around one-third of the behavioral health workforce, according to the report.
  5. Fewer than 10% of public insurance beneficiaries received mental health treatment in 2023.
  6. CMS could also tighten network adequacy standards in Medicare Advantage and Medicaid to increase the size of insurers’ networks, the OIG said in its report.
  7. The OIG recommended CMS up its oversight of Medicaid and Medicare enrollees’ use of behavioral health services, and recommended CMS examine allowing more types of behavioral health providers to participate in Medicare and Medicaid.
  8. CMS said it concurred with the OIG’s recommendations and said it has already taken several steps to improve access to behavioral health providers for Medicare and Medicaid beneficiaries.

If you have questions please contact RCPA COO and Director of Mental Health Jim Sharp.

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The Office of Mental Health and Substance Abuse Services (OMHSAS) has released the OMHSAS-24-01 Restraint Seclusion and Exclusion Bulletin, updating policies on restraint, seclusion, and exclusion in state mental hospitals to reduce these practices. This bulletin supersedes OMHSAS-09-06, necessitating adjustments in local hospital policies. Changes include shifting from “manual hold” to “physical restraint” terminology and clarifications in definitions. It strictly prohibits mechanical and chemical restraints, allowing physical restraint only as a last-resort emergency measure with detailed guidelines on application, documentation, and debriefing protocols. The emphasis is on individualized care, de-escalation techniques, and personnel training to ensure the humane and judicious use of physical restraint.

If you have any questions, please contact RCPA COO and Policy Director Jim Sharp.

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The Office of Mental Health and Substance Abuse Services (OMHSAS) April 2024 Stakeholder Webinar is scheduled for Thursday, April 18, 2024, from 3:00 pm � 4:00 pm. You can now register for the meeting here. After registering, you will receive a confirmation email containing information about joining the webinar.

If you have any questions, please contact RCPA Policy Director Jim Sharp.

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Photo by Larry Crayton on Unsplash

The Department of Human Services Office of Children, Youth, and Families (OCYF) has launched the Pennsylvania Meaningful Family Engagement Toolkit, a web-based resource developed through statewide quality improvement efforts. Over a two-year collaboration period, Pennsylvania system partners defined meaningful family engagement, set consistent expectations for day-to-day practice, and prioritized organizational cultures supporting family engagement. The toolkit provides a comprehensive definition of meaningful family engagement and offers specific strategies and skill-building opportunities for child welfare professionals to enhance engagement and improve outcomes. It also highlights populations needing additional support for engagement, which they have included as fathers, youth, out-of-state parents, incarcerated parents, and extended family. Child welfare professionals are encouraged to utilize this resource to ensure consistent and sincere practice of meaningful family engagement.

If you have any questions, please contact RCPA Policy Director Jim Sharp.

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Image by David Mark from Pixabay

President Biden signed the Further Consolidated Appropriations Act, 2024 into law on March 23. This Act includes the Labor, Health and Human Services, Education, and Related Agencies Appropriations Act, 2024. Notable FY 2024 funding totals for mental health and substance use include:

  • $385 million for Certified Community Behavioral Health Clinics (level with FY 2023);
  • $986,532,000 for the Mental Health Block Grant, which includes maintaining the existing 5% of the total set aside for evidence-based crisis care programs that address the needs of individuals with serious mental illnesses, children with serious emotional disturbances, or individuals experiencing a mental health crisis (level with FY 2023);
  • $153 million for the Behavioral Health Workforce Education and Training Program, including $40 million for the Substance Use Disorder Treatment and Recovery Loan Repayment Program (level with FY 2023);
  • $1,575,000,000 for State Opioid Response Grants (level with FY 2023); and
  • $1,928,879,000 for Substance Use Prevention, Treatment, and Recovery Services Block Grants (level with FY 2023).

Additionally, key provisions of the Act include an $18 million increase in funding for the 988 Suicide & Crisis Lifeline and a $1 million increase for the Primary and Behavioral Health Care Integration grant technical assistance program. There is also a $75 million increase for mental health research conducted by the National Institute of Mental Health. Various mental health and substance use programs maintained funding levels similar to those of FY 2023. For more information, you can access the full explanatory text as well as the comparative highlights table.

If you have any questions, please contact RCPA Policy Director Jim Sharp.

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The Office of Children, Youth & Family has compiled a list of the top 10 frequently asked questions (FAQ) regarding the renewal process for existing Certificates of Compliance/Licenses. These FAQs cover essential information for providers operating under office regulations, including document requirements, submission procedures, and anticipated timelines. Providers can access the Licensing Administration Top 10 FAQs and are able to share these FAQs with relevant personnel. Providers are also encouraged to include their Certificate of Compliance or License number and agency/facility name in all communications with Licensing Administration staff.

If you have any questions, please contact RCPA Policy Director Jim Sharp.

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