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« April 2014 »

DHMH has now selected a model for its behavioral health integration initiative.  Model 2, which continues the “carve-out” approach for mental health services, will be implemented.  It uses an administrative services organization (ASO) with significant and meaningful performance risk at the ASO and behavioral health provider levels.

As we approach the fourth anniversary of the enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA) on October 3, 2008, your help is needed to make the purpose of the federal parity law a reality. Although MHPAEA was enacted nearly four years ago, a final rule implementing the law has not yet been issued.  Without a final rule from the Administration, many individuals seeking care for mental health and addictive disorders have been unable to access the health care services they need.

Maryland has been working for several months on integration of “behavioral health services” with “somatic care.”  The MPS Behavioral Health Integration Workgroup (BHI Workgroup) has contributed actively to the deliberations with the DHMH and other stakeholders.

Organized medicine is pushing back against a Medicare proposal to recoup overpayments quickly from physicians, who would be required to go back through up to 10 years of medical records when determining if they received excess pay. The AMA and about 110 state and specialty medical organizations have called on CMS to clarify — or in some cases abandon — new requirements that practices must return overpayments within 60 days.

An estimated 20 percent gap between what Medicare pays physicians and their cost to provide the care means that some physicians have had to limit the number of Medicare patients they see or withdraw from Medicare altogether. The Medicare

The Maryland Parity Project reports that beginning this year any insurer who wishes to have their utilization review policies, procedures, and criteria accredited by the Utilization Review Accrediting Commission (URAC) will need to demonstrate compliance with the Mental Health Parity and Addiction Equity Act.  Consumers insured by URAC-accreditated plans can file complaints about non-compliance with URAC at  MPS member, Steven R.

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, the Parity Act) ushered in a new era for health insurance coverage for mental health and substance use (mh/sud) disorders. The foundation for this was laid by the Mental Health Parity Act of 1996, and, significantly, the Patient Protection and Affordable Care Act (the ACA) that was passed in 2010 contains a number of provisions that expand the reach of the mental health parity requirements of MHPAEA through yet-to-be-established health plans .

CMS has posted two new sections on its website addressing the 2009 Electronic Prescribing (E-Prescribing) Incentive Program: and Highmark has an online appeals center available at http://www.highmarkmedicareservices

Drs. Prescott and Crawford discussed the following bills at the March 11th Council meeting. The details are current as of March 19, 2008.

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