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Nina Marshall

, National Council for Behavioral Health

National Council Releases Integrated Managed Care Guide

November 5, 2014 | Integrated Care | Medicaid | Comments
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The National Council is pleased to release an update to our managed care contracting paper, Ensuring Access to Behavioral Healthcare through Integrated Managed Care: Options and Requirements. Created for state government officials and advocates, this paper is designed to have upstream impact on contracts between MCOs and State Medicaid agencies. Chock full of sample contract language and interview questions for MCOs, this paper can be used during the procurement, contracting, and oversight phases of managed care implementation. Do you know when your state’s managed care contracts will next be renewed?

In the three years since this paper was last issued, state adoption of managed care has risen dramatically, both generally and specifically for behavioral health services. In 2013-2014, 39 states expanded or made significant changes to their managed care programs. Recent projections estimate that by 2016, three out of four Medicaid and CHIP beneficiaries will be enrolled in some form of risk-based managed care arrangement. Much of this growth is due to states implementing Medicaid expansion and choosing to put those new enrollees into managed care. Along with that choice comes the state’s responsibility to assure parity in mental health and addiction services, resulting in some states adding new addiction treatment services to their Medicaid State Plans and demanding new attention to addiction treatment requirements in managed care contracts.

States are also changing the scope of previously existing managed care arrangements – either by adding populations who were previously carved out, such as individuals with behavioral health disorders or intellectual and developmental disabilities, or by increasing the geographic footprint of the program and expanding to new regions of the state.

Additionally, in the past three years implementation of the “duals demos” has begun in earnest. Through these demonstration programs, states and CMS are seeking financial and administrative alignment of services for dually eligible Medicare-Medicaid enrollees. Fifteen states are moving forward, and 11 of them have chosen a capitated managed care approach. An entire section of our paper is dedicated to specific considerations when contracting for services for Medicare-Medicaid enrollees.

Managed care policy is dynamic and ever-changing. Early next year, CMS will release revised regulations for managed care for the first time in over a decade. In 2014-2015, 34 State Medicaid agencies are expecting to expand managed care. This past September, the Office of the Inspector General for the Department of Health and Human Services released recommendations on MCO Access Standards. New quality measures are always in development, and states are constantly trying their hand at innovative approaches to achieving the triple aim.

Stay tuned to the Capitol Connector for ongoing National Council analysis of all of these developments, and never hesitate to reach out to us directly for ideas on how to make the most of managed care in your state.