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.
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 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"
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"
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.
CMS proposed rule: “Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals, etc.” Comment deadline extended to 2.21.13.
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).