Health Care Policy, Quality, & Payer Administration Archives

Access & Affordability: Exploring SMI Coverage & Trends In The U.S. Behavioral Health System

On-Demand Webinar August 22, 2023

Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The… Read More

Minnesota HealthPartners To Revise Processes & Pay Fine For Mental Health Parity Violations

Article July 20, 2023

On May 4, 2023, the Minnesota Department of Commerce announced a consent order with HealthPartners that requires the company to revise its processes to ensure that coverage for behavioral health… Read More

SAMHSA Unveils National Model Standards For Peer Support Certification

Article July 3, 2023

On June 6, 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) released national model standards for peer support certification to be used for peer workers providing assistance for… Read More

Arizona Medicaid Cuts Payments To More Than 100 Behavioral Health Provider Organizations Due To Fraud Allegations

Article July 3, 2023

On May 17, 2023, the Arizona Health Care Cost Containment System (AHCCCS), which oversees the state’s Medicaid program, announced actions against over 100 Medicaid behavioral health residential and outpatient treatment… Read More

Clinical Consistency, It Matters

Article June 12, 2023

Clinical “consistency” is a key quality issue. Defined as “treating similar conditions in a similar manner,” organizations with clinical consistency reduce variability, are more likely to improve consumer health, produce… Read More

Planning For 10.1%

Article June 5, 2023

Last week, the Congressional Budget Office (CBO) released new estimates quantifying the extent to which the “unwinding” of COVID Medicaid eligibility and Marketplace subsidy policies will affect Americans’ health care… Read More

Be Careful What You Ask For

Article May 29, 2023

Our most recent analysis, U.S. Behavioral Health Spending: A 2023 OPEN MINDS Market Intelligence Report, found that behavioral health spending has increased—a lot—over the past decade. At $329 billion in 2022, there has… Read More

Demographics Are Destiny

Article May 22, 2023

Another milestone. Enrollment in Medicare Advantage surpassed traditional Medicare for the first time. As of January, 2023, 30.19 million of the 59.82 million people eligible for Medicare were enrolled in… Read More

Over Half Of Young Adults Concerned About Their Mental Health, But Only 12% Of Adults Report Mental Health Visits

Article May 22, 2023

Among adults ages 18 to 32, 60% said they were concerned about their mental health in response to a CVS Health/Harris Poll survey. However, only 12% reported visiting a psychiatrist,… Read More

CMS Finalizes Medicare Advantage Prior Authorization Reforms

Article May 22, 2023

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) finalized its proposals to reform Medicare Advantage plan prior authorization policies to improve transparency. The new regulations are… Read More

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