Medicaid (Title XIX) is the federal-state medical assistance program designed to pay for healthcare services used by eligible people. It is operated and partially funded by the states under general federal rules and with federal financial assistance.
The Medicaid program is a vital source of support for people with mental disorders, funding more than 50% of state and local spending on mental health services.
NAPHS advocates on a variety of issues related to Medicaid, including dual eligibles, the Medicaid Emergency Psychiatric Care Demonstration, Medicaid RACs, expansion of Medicaid coverage under healthcare reform, and quality.
CMS final rule: "Medicaid Program; Disproportionate Share Hospital Payments—Treatment of Third Party Payers in Calculating Uncompensated Care Costs"
NAPHS letter on the Medicaid IMD exclusion submitted for the record to House Energy & Commerce Health Subcommittee's hearing on "Strengthening Medicaid and Prioritizing the Most Vulnerable"
CMS Center for Medicaid and CHIP Services: "State Guide to CMS Criteria for Medicaid Managed Care Contract Review and Approval"
HHS/OIG final rule: “Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Exclusion Authorities”
CMS Center for Medicaid and CHIP Services (CMCS) Informational Bulletin: "The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for children and youth in managed care"
CMS Center for Clinical Standards and Quality/Survey & Certification Group: "Updated Guidance to Surveyors on Federal Requirements for Providing Services to Justice Involved Individuals"
Center for Medicaid and CHIP Services Informational Bulletin: "Section 1115 Demonstration Opportunity to Allow Medicaid Coverage to Former Foster Care Youth Who Have Moved to a Different State"
HHS notice: "Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for Medicaid, the Children’s Health Insurance Program, and Aid to Needy Aged, Blind, or Disabled Persons: October 1, 2017 - September 30, 2018" (and correction)
CMS: "Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) Frequently Asked Questions (FAQs)"
CMS notice: "Medicaid Program; Final FY14 and Preliminary FY16 Disproportionate Share Hospital Allotments, and Final FY14 and Preliminary FY16 Institutions for Mental Diseases (IMD) Disproportionate Share Hospital Limits"
Letter from Senate authors of P.L.114-97 to CMS urging reconsideration of cost-neutrality findings on Medicaid Emergency Psychiatric Demonstration
NAPHS statement on Medicaid Emergency Psychiatric Demonstration
OIG/HHS proposed rule: "Medicaid; Revisions to State Medicaid Fraud Control Unit Rules"
HHS/OIG/CMS interim final rule: "Adjustment of Civil Monetary Penalties for Inflation"
NAPHS statement: "NAPHS Applauds House Passage of Legislation to Address Nation's Mental Health Crisis; Urges Congress to Pass Comprehensive Reform Now"
NAPHS fact sheet: Summary of Medicaid managed care final rule provision on Medicaid IMD exclusion
Center for Medicaid and CHIP Services (CMCS) Informational Bulletin: "Federal public notice and public process requirements for changes to Medicaid payment rates"
CMS proposed rule: "Medicare & Medicaid: Hospital & Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care" (proposed changes to Hospital CoPs)
NAPHS statement: "NAPHS Applauds House Energy and Commerce Committee's Markup of Legislation to Address Nation's Mental Health Crisis; Urges Congress to Pass Comprehensive Reform"
Center for Medicaid and CHIP Services Informational Bulletin: "Maternal Depression Screening and Treatment: A Critical Role for Medicaid in the Care of Mothers and Children"
Fact sheet: "Comprehensive Mental Health Reform Requires Action on the Medicaid Institutions for Mental Disease (IMD) Exclusion; The Medicaid Managed Care Final Rule Is Only One Step Toward Fixing the Problem"
CMS final rule (including a provision giving MCOs flexibiiity on IMD exclusion--p.27555-27563): "Medicaid & CHIP Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability." Also see CMS fact sheets, 7.20.16 correcting amendment, 1.3.17 correcting amendment, and 3.6.17 correcting amendment.
CMS Center for Clinical Standards and Quality/Survey & Certification Group "Guidance to Surveyors on Federal Requirements for Providing Services to Justice Involved Individuals" (see 12.23.16 update)
CMS Center for Medicaid and CHIP Services' State Health Officials Letter (SHO#16-007): "to facilitate successful re-entry for individuals transitioning from incarceration to their communities"
NAPHS ad as seen in Politico and Roll Call titled "OVERDUE: Mental Health Reform: It's time to fix the Institutions for Mental Disease (IMD) exclusion that prohibits adult Medicaid beneficiaries (21-64) from accessing short-term, acute care in psychiatric hospitals"
CMS final rule: "Medicaid Program: Deadline for Access Monitoring Review Plan Submissions" (state deadline extended to October 1, 2016)
Parity Implementation Coalition: “Summary of Key Provisions in Medicaid Parity Final Rule”
CMS final rule: "Medicaid and Children’s Health Insurance Programs (CHIP): The Application of Mental Health Parity (MHPAEA) Requirements to Coverage Offered by Medicaid Managed Care Organizations, CHIP, and Alternative Benefit Plans." Also see a fact sheet, FAQs, and a CMS news release.
CMS Center for Medicaid and CHIP Services state Medicaid Directors letter (SMD#16-003) detailing an initiative to bring interoperable technology to a broader universe of healthcare providers (including behavioral health providers, substance abuse treatment centers, and other providers). Also see a CMS blog on "Bridging the Healthcare Digital Divide: Improving Connectivity among Medicaid Providers."
CMS proposed rule: "Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process"
CMS notice: "Medicaid Program; Final FY13 and Preliminary FY15 Disproportionate Share Hospital Allotments, and Final FY13 and Preliminary FY15 Institutions for Mental Diseases (IMD) Disproportionate Share Hospital Limits"
NAPHS comment letter to CMS on "Medicare and Medicaid Programs; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies”
NAPHS release: "NAPHS Applauds Final Passage of Bipartisan Legislation To Extend and Expand the Medicaid Emergency Psychiatric Demonstration Project; Bill Next Goes to President for Signature." [NOTE: Signed into law 12.11.15 as P.L.114-97.]
CMS proposed rule: "Medicare and Medicaid Programs; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies"
CMS final rule with comment period: "Medicaid Program; Methods for Assuring Access to Covered Medicaid Services"
Medicaid Program: Request for Information (RFI)—Data Metrics and Alternative Processes for Access to Care in the Medicaid Program
House bill (H.R.3681) introduced to extend and expand the Medicaid Emergency Psychiatric Demonstration Project
NAPHS release: "NAPHS Applauds Passage of Senate Legislation (S.599) To Extend and Expand the Medicaid Emergency Psychiatric Demonstration Project"
NAPHS release: "NAPHS Applauds Introduction of Senate Legislation [the Mental Health Reform Act] to Address Nation’s Mental Health Crisis; Urges Congress to Pass Comprehensive Reform." See fact sheet from Sens. Murphy and Cassidy.
CMS Center for Medicaid and CHIP Services letter to state Medicaid directors: "Re: New Service Delivery Opportunities for Individuals with a Substance Use Disorder" (SMD #15-003)
CMCS Informational Bulletin: "Implementation of a 'Fast Track' Federal Review Process for Section 1115 Medicaid and CHIP Demonstration Extensions"
NAPHS comment letter to CMS on IMD exclusion provision in proposed rule on "Medicaid & Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, etc."
NAPHS letter of support to Sens. Hatch and Wyden (Senate Finance Committee) on S.599, the Improving Access to Emergency Psychiatric Care Act
NAPHS statement on Helping Families in Mental Health Crisis Act, H.R. 2646 ("NAPHS Commends Rep. Tim Murphy for Bipartisan Reintroduction of Legislation to Address the Nation’s Mental Health Emergency"), See fact sheet on bill.
CMS proposed rule: "Medicaid & Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability." Also see CMS fact sheet.
CMS final rule: "Medicare and Medicaid Programs: Revisions to Deeming Authority Survey, Certification,and Enforcement Procedures"
Parity Implementation Coalition release: "Release of Medicaid Parity Proposed Rule Lauded as Important Step for Those with Addiction and Mental Illness"
S.599, the Improving Access to Emergency Psychiatric Care Act introduced by Sens. Ben Cardin (D-MD), Patrick Toomey (R-PA), and Susan Collins (R-ME) to extend and expand the Medicaid Emergency Psychiatric Demonstration. See Congressional Record statement on S.599 by Sen. Cardin (scroll down to pages S1168-S1170).
NAPHS release: "President’s FY16 Budget Tackles Lingering Discrimination; NAPHS Applauds Proposal to Eliminate the Medicare 190-Day Lifetime Limit, Urges Action to Address Discrimination in Medicaid"
MACPAC presentation at 1.29.15 meeting: "Medicaid’s Role in Behavioral Health: Background and Policy Issues"
Center for Medicaid and CHIP Services (CMCS)/SAMHSA informational bulletin on “Coverage of Behavioral Health Services for Youth with Substance Use Disorders”
CMS final rule: "Medicaid Program; Disproportionate Share Hospital Payments-Uninsured Definition"
Center for Medicaid and CHIP Services Informational Bulletin: "Delivery Opportunities for Individuals with a Substance Use Disorder" (offering help to states interested in transforming care delivery systems). Part of the Medicaid Innovation Accelerator Program (IAP).
CMS Informational Bulletin: "Medication Assisted Treatment for Substance Use Disorders"
CMCS Informational Bulletin: "Clarification of Medicaid Coverage of Services to Children with Autism"
CMS Medicaid Managed Care Information Resource Center Technical Assistance Brief (No.2): "Coverage and Delivery of Adult Substance Abuse Services in Medicaid Managed Care"
CMS proposed rule: "Medicare and Medicaid Programs: Fire Safety Requirements for Certain Health Care Facilities"
NAPHS comment letter to CMS proposed rule on "Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers"
NAPHS release: "Millions of Disabled and Poor Americans Encounter Discrimination When They Face Mental or Addictive Disorders, Says NAPHS; NAPHS Applauds House Oversight Hearing on Challenges Facing Families in Mental Health Crisis."
NAPHS letter submitted to House Energy and Commerce Oversight Committee hearing on “Where Have All the Patients Gone? Examining the Psychiatric Bed Shortage.”
Senate Finance Committee "Summary and Overview of Mental Health Recommendations" received in response to their 8.1.13 Open Letter seeking input on how to improve the US mental health system.
CMS Center for Medicaid & CHIP Services: "Medicaid and CHIP FAQs: Implementing Hospital Presumptive Eligibility Programs"
CMS final rule: "Medicaid Program; State Plan Home and Community-Based Services, 5-Year Period for Waivers, Provider Payment Reassignment, and Home and Community-Based Setting Requirements for Community First Choice and Home and Community-Based Services (HCBS) Waivers"
Health Affairs Health Policy Brief: "Hospital Presumptive Eligibility"
MedPAC/MACPAC data book: Beneficiaries Dually Eligible for Medicare and Medicaid (with demographic, expenditure, and healthcare utilization information)
NAPHS statement: "NAPHS Applauds Rep. Tim Murphy for Introduction of Comprehensive Mental Health Reform Legislation; Dialogue on Tough Challenges Will Help Advance Policy Changes"
CMS/HHS final rule: "Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment"
NAPHS comment letter on proposed rule on "Medicare/Medicaid Programs: Survey, Certification and Enforcement Procedures”
CMCS-MMCO-CM Informational Bulletin: "Payment of Medicare Cost Sharing for Qualified Medicare Beneficiaries (QMBs)." Tells states that they “have a legal obligation to reimburse providers for any Medicare cost sharing due for QMBs according to the state’s CMS-approved Medicare cost-sharing payment methodology.”
Joint NAPHS / NAMI letter: Urging HHS not to apply the IMD exclusion to the Medicaid expansion population
OIG final rule: "State Medicaid Fraud Control Units; Data Mining"
CMCS / SAMHSA Informational Bulletin to states: "Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions"
National Association of Medicaid Directors letter to Senate HELP Committee: Includes a call for elimination of the IMD exclusion
CMS issues informational bulletin on EPSDT.
Center for Medicaid & CHIP Services Informational Bulletin: "Coverage and Service Design Opportunities for Individuals with Mental Illness and Substance Use Disorders"
CMS' Center for Medicaid and CHIP Services Informational Bulletin (guidance on the mechanisms states may use to reimburse the cost of medical care for children residing in psychiatric hospitals or PRTFs)
NAPHS Action Alert: Tell Congress to support behavioral health as fiscal cliff solutions are discussed
Mental Health Liaison Group (MHLG) ad on demonstration programs for dual-eligibles (as seen in Politico): "Living with mental and addictive disorders is hard enough...don't make it worse for us" [View]
CMS notice: "Disproportionate Share Hospital Allotments and Institutions for Mental Diseases Disproportionate Share Hospital Limits for FYs 2010, 2011, and Preliminary FY12 DSH Allotments and Limits " [View]
Mental Health Liaison Group (MHLG) release: "Mental health groups raise concerns about the current structure of dual-eligible demonstrations." Also see a MHLG letter to the Senate Special Committee on Aging
Mental Health Liaison Group letter to CMS on concerns related to dual-eligible demonstrations as they impact individuals with mental illness [View]
MedPAC Chapter 3 on dual eligibles (from A Data Book: Health care spending and the Medicare Program)
Kaiser Commission on Medicaid & the Uninsured: "Geographic Variation in Dual-Eligible Enrollment" (by state) [View]
CMS final rule: "Medicare and Medicaid Programs: Reform of Hospital and Critical Access Hospital Conditions of Participation" [View]
CMS final rule: "Medicare and Medicaid Programs: Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction" [View]
CMS final rule: "Medicare & Medicaid: Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements" (including use of NPI) [View]
CMS final rule (and interim final rule for some sections): "Medicaid Program: eligibility changes under the Affordable Care Act of 2010" [View]
NAPHS comment letter and position paper on dual-eligible demonstrations sent to CMS Medicare-Medicaid Coordination Office (in response to request for feedback on Massachusetts dual-eligible demonstration). [NOTE: Check periodically online to view additional state demonstrations as they become available for comment.]
CMS release: "Affordable Care Act Demonstration to Expand Access to Emergency Psychiatric Care; New Demonstration Program to Help States Improve the Quality of Care for Patients with Psychiatric Emergency." Also see additional information.
CMS final rule: "Medicaid Program: Review and Approval Process for Section 1115 Demonstrations" [View]
HHS final notice: "Medicaid Program: Initial Core Set of Health Care Quality Measures for Medicaid Eligible Adults" [View]
Frequently Asked Questions on the Medicaid RAC Program [View]
CMS final rule: "Medicaid Program: Recovery Audit Contractors" [View]
NAPHS comment letter: "Medicare and Medicaid Programs: Opportunities for Alignment Under Medicaid and Medicare" [View]
NAPHS comment letter to CMS on proposed rule: "Medicare and Medicaid Programs: Influenza Vaccination Standard for Certain Participating Providers and Suppliers" [View]
NAPHS comment letter to CMS on proposed rule: "Medicaid Program: Methods for Assuring Access to Covered Medicaid Services" [View]
June 2011 MACPAC Report to the Congress: "The Evolution of Managed Care in Medicaid" [View]
Final rule: Medicare & Medicaid: Changes Affecting Hospital and Critical Access Hospital Conditions of Participation: Telemedicine Credentialing and Privileging [View]
NAPHS comment letter to AHRQ on "Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults" [View]
NAPHS comment letter to CMS on Medicaid Recovery Audit Contractor (Medicaid RAC) proposed rule (published 11/10/10) [View]
Federal Register notice with comment period: "Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults" [View]
Federal Register: Final rule: "Medicare and Medicaid Programs: Changes to the Hospital and Critical Access Hospital Conditions of Participation to Ensure Visitation Rights for All Patients" [View]
Federal Register: Medicare program final rule, including...."Medicaid Program: Accreditation for Providers of Inpatient Psychiatric Services" (large file--please allow time for file to open) [View]
NAPHS comment letter: Accreditation Requirements for Providers of Inpatient Psychiatric Services for Individuals Under Age 21 [View]
NAPHS statement: Reform law includes provisions important to Americans facing mental and addictive disorders. Includes IMD/EMTALA demonstration on emergency psychiatric care. [View]
"Medicaid Program: Rescission of School-Based Administration/Transportation Final Rule, Outpatient Hospital Services Final Rule, and Partial Rescission of Case Management Interim Final Rule" [CMS–2287–F2; CMS–2213–F2; CMS 2237–F]. Also "Medicaid Program; Health Care-Related Taxes" Final Rule [CMS-2275-F2].
"Hospital Conditions of Participation: Requirements for History and Physical Examinations; Authentication of Verbal Orders; Securing Medications; and Postanesthesia Evalutions (CMS-3122-F)."
NAPHS teams with the National Association for Children's Behavioral Health to tell Congress that Medicaid dollars spent on children & youth with emotional and substance use disorders pay long-term dividends. The two associations also have released Principles for Treatment of Children and Youth with Emotional and Substance Use Disorders, which include recommended action steps for Congress and the states.
OIG Report: Seven States Medicaid Claims for 21- to 64-year old residents of private and county-operated IMDs [View]
RECURRING: CMS Web site on RACs (Recovery Audit Programs).