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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

CMS, SAMHSA Announce Medicaid Coverage Options for Early Intervention in Psychosis

October 23, 2015 | Children and Youth | Medicaid | Comments
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On Friday, the Centers for Medicare & Medicaid Services (CMS) released an informational bulletin intended to assist states in designing a benefit package to guide early treatment intervention options that will meet the needs of youth and young adults experiencing first-episode psychosis. The National Institute of Mental Health (NIMH), Centers for Medicare & Medicaid Services’ Center for Medicaid and CHIP Services (CMCS) and Substance Abuse and Mental Health Services Administration (SAMHSA) created the bulletin through their ongoing partnership to support early intervention services for young adults that experience first episode psychosis. Early intervention has been touted as one of the most effective treatments to reduce the severity of first episode psychotic symptoms, combat the progression of the mental illness, and allow for individuals to live in community settings and participate fully in family and community life.


The informational bulletin addresses important considerations for states as they design their benefit package, including:

  • Benefit Design – The agency group highlighted a series of early intervention services for individuals experiencing their first episode of psychosis, including: (1) recovery-oriented psychotherapy, (2) family psychoeducation and support, (3) supported employment and education, (4) pharmacotherapy and primary care coordination, and (5) case management. A full description of each service is available beginning on page 4 of the document.
  • Financing Approaches – Financing for such programs through SAMHSA block grants and Medicaid was also discussed. In particular, the bulletin detailed the services that can be reimbursed under Medicaid’s 1905(a) statutory authority, including (1) targeted case management services, (2) preventative services, (3) early and periodic screening, diagnostic, and treatment (EPSDT), and (4) home and community-based services. The document also briefly touches on statutory authority the Department of Health and Human Services (HHS) Secretary has in approving experimental projects that can further the delivery of such services under Section 1115 of the Social Security Act.

Other topics discussed by the bulletin include both CMS and SAMHSA quality measures, an assessment of mental health block grants, and the integration of resources and services between CMS SAMHSA, and the National Institutes of Health (NIH).