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Children's Services

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A new report finds that there have been substantial gains on the issue of making addiction and mental health coverage equal to physical health coverage. Much work still needs to be done, especially for children, according to Ron Manderscheid, PhD, Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD) and the National Association for Rural Mental Health. “Children can’t speak for themselves on the issue of parity,” Manderscheid says. “That’s why it’s very important for the Department of Health and Human Services (HHS) and state health insurance commissioners to protect the rights of children around parity. Any child who has health insurance coverage through the individual marketplace under the Affordable Care Act (ACA), or through the ACA’s Medicaid expansion, is entitled to parity protection, but we don’t really know how well it’s working.” The estimated 8.4 million children enrolled under the Children’s Health Insurance Program, which is part of Medicaid, are not covered by parity protections, Manderscheid noted. “The field has so focused on problems with implementing parity with adults that children haven’t gotten equal attention in this process.” In October, the White House Mental Health and Substance Use Disorder Parity Task Force issued a report that concluded that overall, state-level substance use disorder parity laws have helped to increase the treatment rate by approximately 9 percent across substance use disorder specialty facilities and by about 15 percent in facilities that accept private insurance. This effect was found to be more pronounced in states with more comprehensive parity laws.

“The concept of parity is simple, but the implementation of it is incredibly complex,” said Manderscheid. The trickiest part of parity is a concept called non-quantitative treatment limitations, which are processes that managed care firms use to determine who will and won’t get care, he explains. Currently, the burden chiefly falls on the consumer to report to the federal or state government if their claims for addiction or mental health treatment are denied. “The enforcement burden should fall on HHS, state insurance commissioners, and the insurance companies themselves.”

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“Cancer doesn’t just happen to one person; it has an impact on the entire family.” “Nearly half (42%) of the partners of young breast cancer survivors (diagnosed at age ≤40 years) experience anxiety, even years after their partner’s diagnosis, according to a new survey of 289 such partners.” These are the findings of a recent study reported in Medscape in advance of the 2017 Cancer Survivorship Symposium, held in San Diego, California. Lead author Nancy Borstelmann, MPH, MSW, Director Of Social Work at Dana-Farber Cancer Institute in Boston, Massachusetts, found that maladaptive coping includes behaviors such as emotional withdrawal, denial, drinking alcohol, blaming, and aggression, adding that this behavior was “strongly” associated with higher levels of anxiety. Intervene early, she advised: “Ask partners how they are doing to bring them into the conversation.” Helpful resources include support groups, information materials on cancer, and meetings with a social worker or psychologist. Study respondents had a median age of 43 years, were mostly Caucasian (93%), working full time (94%), and college educated (78%), and were parents of children younger than 18 years (74%). A minority (29%) reported some financial stress and one third (32%) reported at least a fair amount of relationship concern.

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In recent months, Pennsylvania’s Learning Community has focused on challenges to financing and payment for mental health care in the primary care and collaborative care settings. The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) has provided the field with an array of information, presentations, and other resources related to the financing of mental health services in primary care and integrated care settings. Below are some of the resources that CIHS has made available to us here in Pennsylvania.

  • The ability to bill for both behavioral health and primary care services on the same day is an essential part of integrating care. The Center for Medicare and Medicaid Services (CMS) created the Billing Properly for Behavioral Health Services booklet to help providers understand the laws and regulations that govern billing for behavioral health services.
  • The resource also includes a checklist to help evaluate your billing procedures and identify potential errors, as well as a resource guide for your billing staff to review current guidelines, billing and coding, covered services, and compliance information.
  • Learn ways you can enhance and streamline your billing process through Improving Your Third-Party Billing System, a self-paced online course from SAMHSA’s BHbusiness initiative.

CIHS continually updates its website to present the best and newest resources and information relevant to integrated primary and behavioral health care.

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From: “HS, Secretary’s Office”
Date: January 5, 2017 at 1:01:56 PM EST
To: “[email protected]”
Subject: [DHS-STAKEHOLDERS] DHS Awards Medicaid Agreements

Department of Human Services (DHS) Secretary Ted Dallas announced that DHS has agreed to move forward and negotiate agreements with six managed care organizations (MCOs) to deliver physical health services to Pennsylvanians through HealthChoices, Pennsylvania’s mandatory Medicaid managed care program since 1997.

“These agreements will be the most significant changes to Pennsylvania’s Medicaid program since we moved to managed care two decades ago,” said Dallas. “Over the next three years, MCOs will be investing billions of dollars in innovative approaches that reward high-quality care that improves patient health rather than just providing services for a fee.”

The $12 billion, three-year contracts include a 30 percent target for payments based on value received or outcomes, rather than on the quantity of services provided.

The MCOs were selected based on several criteria, including their current performance, the level of customer service delivered, member satisfaction, and their value-based performance plan. Performance criteria measured, among other things, management of chronic conditions such as high blood pressure, diabetes, and asthma; frequency of prenatal and post-partum care; and access to preventive services.

“The average performance ratings of the selected organizations are consistently higher than the current averages in every region. This transition will result in higher levels of quality care for the 2.2 million Pennsylvanians served by Medicaid,” said Dallas.

To drive Pennsylvania’s Medicaid system towards these better outcomes, the three-year agreements set gradual targets for all MCOs to increase the percentage of value-based or outcome-based provider contracts they have with hospitals, doctors, and other providers to 30 percent of the medical funds they receive from DHS. The result will be that billions in funds that would have otherwise been spent on traditional payment arrangements will instead be invested in outcome or value-based options such as:

  • Accountable care organizations (voluntary networks of hospitals, doctors, and other providers that work together to provide coordinated care to patients);
  • Bundled payments (increases value-based purchasing);
  • Patient-centered medical homes; and
  • Other performance-based payments.

“We’re going to reward folks for providing the right services, not just more services. You get what you pay for so we’re shifting the focus of Pennsylvania’s Medicaid system toward paying providers based on the quality, rather than the quantity of care they give patients,” said Dallas. “In addition, by focusing on improving the health of consumers, we will drive down the cost of care and ultimately save the taxpayer funds we spend on health care in Pennsylvania.”

HealthChoices delivers quality medical care and timely access to all appropriate services to 2.2 million children, individuals with disabilities, pregnant women, and low-income Pennsylvanians.

For more information, visit www.HealthChoicesPA.com or www.dhs.pa.gov.

DHS has selected the following MCOs to proceed with negotiations to deliver services in Pennsylvania beginning in June 2017. The agreements are awarded in five geographic regions:

Southeast Region Gateway Health
Health Partners Plans
PA Health and Wellness
UPMC for You
Vista–Keystone First Health Plan
Southwest Region Gateway Health
PA Health and Wellness
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Lehigh/Capital Region Gateway Health
Geisinger Health Plan
Health Partners Plans
PA Health and Wellness
Northeast Region Gateway Health
Geisinger Health Plan
UPMC for You
Northwest Region Gateway Health
UPMC for You
Vista—AmeriHealth Caritas Health Plan

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Registration is now open for the 2017 Social and Emotional Learning (SEL) Conference: Building Skills for Lifelong Success, to be held Monday, March 13, 2017, at the Hilton Harrisburg.

There is an amazing lineup of national experts who will present workshops on SEL policy and practice. The keynote speaker will be Dave Levin, Co-Founder of the Knowledge is Power Program (KIPP). When registering, be sure to pre-select the workshops that are of most interest to you. Selecting workshops may be difficult, considering the number of great topics and presenters available, so bring along a few colleagues and gather as much information as you can.

Participants are responsible for their own travel and lodging arrangements/costs. A limited block of rooms has been reserved at a discounted rate of $139 single/double occupancy per night plus tax at the Hilton Harrisburg until Monday, February 20, 2017. Make reservations online or call 717-233-6000 and reference group code “SEL” in order to obtain the discounted rate. Rooms are available on a first-come, first-served basis.

Find workshop descriptions, additional conference information, and registration on the conference website. For additional questions, feel free to contact Amy Moritz, Youth Development Coordinator, Center for Schools and Communities, at 717-763-1661.

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The Alliance of Community Health Plans (ACHP) invites our Learning Community to discuss the innovative approaches that not-for-profit, community-based health plans are using to integrate primary care and behavioral health on Wednesday, January 18, at 1:00 pm. The presentation and discussion of innovative examples of integrating primary care and behavioral health features Dr. Judith Feld (Independent Health), Dr. James Schuster (UPMC), and Dr. Mason Turner (Kaiser Permanente), and focuses on:

UPMC Health Plan is integrating primary care and behavioral health with programs such as co-locating behavioral health specialists at primary care sites, placing care managers within primary care practices to assist with care coordination, and reverse co-locating primary care physicians in behavioral health settings.

Independent Health has fully integrated behavioral health consultants within nine patient-centered medical homes, resulting in high patient satisfaction and significantly increased use of screening rates for mental health and substance abuse.

Kaiser Permanente’s evidence-based collaborative care approach to depression treatment helps adult members who have been newly diagnosed with mild-to-moderate depression and who have started an antidepressant.

Registration for this webinar is required.

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The decision for Pennsylvania to postpone the implementation of Community HealthChoices (CHC) was announced today. This decision was made as a result of the delays associated with the resolution of several bid protests.

Following the announcement of the selection of the managed care organizations (MCOs) that would deliver health care coverage in Community HealthChoices, several protests were filed. As a result, the progress of major components of CHC implementation was delayed, resulting in the Department of Human Services (DHS) feeling uncertain with moving forward with their established start dates. Some of the impacted activities associated with this decision include:

  • Developing an adequate network: DHS has not been able to engage with the selected offerors. The agreement and rate negotiations and finalization typically take six weeks, and the agreements need to be finalized before the MCOs are able to engage in network development activities. The current delays mean the MCOs will not have enough time to meet the network adequacy requirements by July 1, 2017.
  • Completing a readiness review: Readiness review is a requirement for the MCOs before they are certified to be able to go live and provide services. Protests prohibit MCO engagement for readiness review and the window to complete the certification continuously shrinks. New programs require a minimum of six months to complete a readiness review.
  • Communicating: Communication about selected MCOs and their available networks is a critical component to CHC education and outreach. Individuals who will be enrolling in CHC need to have complete information about the MCO provider network in order to be able to make an informed provider choice. That communication will not be able to take place until the agreements are largely finalized and the MCOs are in a position to provide network information.

Important dates to note include:

  • Phase 1 will now begin in January 2018 in the Southwest region of the state.
  • Phase 2 will now begin in July 2018 in the Southeast region of the state.
  • The January 2019 start date for the rest of the state remains unchanged.
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