|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Medicaid
Background
News

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.

6/2/2017

CMS guidance to state survey agency directors: "Advanced Copy- Appendix Z, Emergency Preparedness Final Rule Interpretive Guidelines and Survey Procedures" (to start 11.15.17)

6/1/2017

NAPHS comment letter to CMS on request by state of Arizona to amend its Arizona Health Care Cost Containment (AHCCCS) Demonstration (regarding IMDs)

4/3/2017

CMS final rule: "Medicaid Program; Disproportionate Share Hospital Payments—Treatment of Third Party Payers in Calculating Uncompensated Care Costs"

3/14/2017

Joint HHS/CMS letter to governors: "Affirming Partnership of HHS, CMS, and States to Improve Medicaid Program." Also see HHS release.

2/1/2017

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"

1/20/2017

CMS Center for Medicaid and CHIP Services: "State Guide to CMS Criteria for Medicaid Managed Care Contract Review and Approval"

1/12/2017

HHS/OIG final rule: “Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Exclusion Authorities”

1/5/2017

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"

12/23/2016

CMS Center for Clinical Standards and Quality/Survey & Certification Group: "Updated Guidance to Surveyors on Federal Requirements for Providing Services to Justice Involved Individuals"

11/21/2016

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"

11/10/2016

CMS: "Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) Frequently Asked Questions (FAQs)"

10/25/2016

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"

9/30/2016

CMS: "Medicaid Emergency Psychiatric Services Demonstration Evaluation: Final Report. August 18, 2016." Also see appendices.

9/26/2016

Social Security Administration final rule: "Revised Medical Criteria for Evaluating Mental Disorders." Also 12.2.16 correction.

9/23/2016

Letter from Senate authors of P.L.114-97 to CMS urging reconsideration of cost-neutrality findings on Medicaid Emergency Psychiatric Demonstration

9/22/2016

NAPHS statement on Medicaid Emergency Psychiatric Demonstration

9/16/2016

CMS final rule: "Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers."  Also see 11.16.16 corrections.

9/6/2016

HHS/OIG/CMS interim final rule: "Adjustment of Civil Monetary Penalties for Inflation"

7/6/2016

NAPHS statement: "NAPHS Applauds House Passage of Legislation to Address Nation's Mental Health Crisis; Urges Congress to Pass Comprehensive Reform Now"

6/27/2016

NAPHS fact sheet: Summary of Medicaid managed care final rule provision on Medicaid IMD exclusion

6/24/2016

Center for Medicaid and CHIP Services (CMCS) Informational Bulletin: "Federal public notice and public process requirements for changes to Medicaid payment rates"

6/16/2016

CMS proposed rule: "Medicare & Medicaid: Hospital & Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care" (proposed changes to Hospital CoPs)

6/15/2016

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"

6/8/2016

Joint Commission announces it will begin surveying to the 2012 version of the National Fire Protection Association’s 101 Life Safety (LS) Code as of 7/5/16. Also see 5.4.16 CMS final rule.

5/11/2016

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"

5/11/2016

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"

5/6/2016

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

5/4/2016

CMS final rule: "Medicare and Medicaid Programs: Fire Safety Requirements for Certain Health Care Facilities." Also see 6.30.16 correction.

5/3/2016

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)

4/28/2016

NAMI / NAPHS letter to Chairman Hatch and Ranking Member Wyden (focusing on the Medicaid IMD Exclusion) for Senate Finance Committee hearing on "Mental Health in America: Where Are We Now?"

4/28/2016

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"

4/12/2016

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"

4/12/2016

CMS final rule: "Medicaid Program: Deadline for Access Monitoring Review Plan Submissions" (state deadline extended to October 1, 2016)

3/31/2016

Parity Implementation Coalition: “Summary of Key Provisions in Medicaid Parity Final Rule

3/30/2016

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.

3/3/2016

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."

3/1/2016

CMS proposed rule: "Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process"

2/2/2016

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"

1/4/2016

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”

11/20/2015

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.]

11/3/2015

CMS proposed rule: "Medicare and Medicaid Programs; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies"

11/2/2015

CMS final rule with comment period: "Medicaid Program; Methods for Assuring Access to Covered Medicaid Services"

11/2/2015

Medicaid Program: Request for Information (RFI)—Data Metrics and Alternative Processes for Access to Care in the Medicaid Program

10/2/2015

House bill (H.R.3681) introduced to extend and expand the Medicaid Emergency Psychiatric Demonstration Project

9/29/2015

NAPHS release: "NAPHS Applauds Passage of Senate Legislation (S.599) To Extend and Expand the Medicaid Emergency Psychiatric Demonstration Project"

8/4/2015

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. 

7/27/2015

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)

7/24/2015

CMCS Informational Bulletin: "Implementation of a 'Fast Track' Federal Review Process for Section 1115 Medicaid and CHIP Demonstration Extensions"

7/22/2015

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."

6/23/2015

NAPHS letter of support to Sens. Hatch and Wyden (Senate Finance Committee) on S.599, the Improving Access to Emergency Psychiatric Care Act

6/5/2015

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.

6/1/2015

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.

5/22/2015

CMS final rule: "Medicare and Medicaid Programs: Revisions to Deeming Authority Survey, Certification,and Enforcement Procedures"

4/15/2015

Parity Implementation Coalition release: "Release of Medicaid Parity Proposed Rule Lauded as Important Step for Those with Addiction and Mental Illness"

4/10/2015

CMS proposed rule on "Mental Health Parity for Medicaid and CHIP." Also see CMS fact sheet.

2/26/2015

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).

2/2/2015

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"

1/29/2015

MACPAC presentation at 1.29.15 meeting: "Medicaid’s Role in Behavioral Health: Background and Policy Issues"

1/26/2015

Center for Medicaid and CHIP Services (CMCS)/SAMHSA informational bulletin on “Coverage of Behavioral Health Services for Youth with Substance Use Disorders

12/3/2014

CMS final rule: "Medicaid Program; Disproportionate Share Hospital Payments-Uninsured Definition"

10/29/2014

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).

7/11/2014

CMS Informational Bulletin: "Medication Assisted Treatment for Substance Use Disorders"

7/7/2014

CMCS Informational Bulletin: "Clarification of Medicaid Coverage of Services to Children with Autism"

5/1/2014

CMS Medicaid Managed Care Information Resource Center Technical Assistance Brief (No.2): "Coverage and Delivery of Adult Substance Abuse Services in Medicaid Managed Care"

4/16/2014

CMS proposed rule: "Medicare and Medicaid Programs: Fire Safety Requirements for Certain Health Care Facilities"

3/31/2014

NAPHS comment letter to CMS proposed rule on "Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers"

3/26/2014

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."

3/26/2014

NAPHS letter submitted to House Energy and Commerce Oversight Committee hearing on “Where Have All the Patients Gone? Examining the Psychiatric Bed Shortage.”

3/10/2014

2014 Advocacy Priorities: 1) End discrimination (modify the Medicaid IMD exclusion); 2) Fix gaps (support H.R.3717); 3) Support Medicare/Medicaid funding for health information technology.

2/4/2014

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.

1/24/2014

CMS Center for Medicaid & CHIP Services: "Medicaid and CHIP FAQs: Implementing Hospital Presumptive Eligibility Programs"

1/16/2014

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"

1/9/2014

Health Affairs Health Policy Brief: "Hospital Presumptive Eligibility"

12/27/2013

CMS proposed rule: “Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers”. (Comment deadline extended to 3.31.14)

12/19/2013

MedPAC/MACPAC data book: Beneficiaries Dually Eligible for Medicare and Medicaid (with demographic, expenditure, and healthcare utilization information)

12/12/2013

NAPHS statement: "NAPHS Applauds Rep. Tim Murphy for Introduction of Comprehensive Mental Health Reform Legislation; Dialogue on Tough Challenges Will Help Advance Policy Changes"

9/30/2013

Mental Health Liaison Group (MHLG) comment letter responding to Senate Finance Committee open letter seeking input on how to improve the US mental health system

9/20/2013

NAPHS comment letter responding to Senate Finance Committee open letter seeking input on how to improve the US mental health system

7/15/2013

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"

7/3/2013

NAPHS comment letter on proposed rule on "Medicare/Medicaid Programs: Survey, Certification and Enforcement Procedures”

6/7/2013

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.” 

6/4/2013

Joint NAPHS / NAMI letter:  Urging HHS not to apply the IMD exclusion to the Medicaid expansion population

5/17/2013

OIG final rule: "State Medicaid Fraud Control Units; Data Mining"

5/8/2013

OIG guidance: "Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs."  Also see 5/9/13 Federal Register.

5/7/2013

CMCS / SAMHSA Informational Bulletin to states: "Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions"

4/18/2013

National Association of Medicaid Directors letter to Senate HELP Committee:  Includes a call for elimination of the IMD exclusion

4/4/2013

CMS issues informational bulletin on EPSDT

4/2/2013

CMS final rule with request for comments: "Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable Care Act of 2010." Also see 6.3.13 correction.

2/21/2013

NAPHS comment letter on proposed rule on Medicaid, CHIP expansion under ACA. NAPHS urges clarification that IMD restrictions should not apply. 

12/3/2012

Center for Medicaid & CHIP Services Informational Bulletin: "Coverage and Service Design Opportunities for Individuals with Mental Illness and Substance Use Disorders"

11/28/2012

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)

11/13/2012

NAPHS Action Alert: Tell Congress to support behavioral health as fiscal cliff solutions are discussed lock icon

8/2/2012

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]

7/24/2012

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]

7/18/2012

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

6/6/2012

Mental Health Liaison Group letter to CMS on concerns related to dual-eligible demonstrations as they impact individuals with mental illness [View]

6/1/2012

MedPAC Chapter 3 on dual eligibles (from A Data Book: Health care spending and the Medicare Program)

5/24/2012

Kaiser Commission on Medicaid & the Uninsured: "Geographic Variation in Dual-Eligible Enrollment" (by state) [View]

5/16/2012

CMS final rule: "Medicare and Medicaid Programs: Reform of Hospital and Critical Access Hospital Conditions of Participation" [View]

5/16/2012

CMS final rule: "Medicare and Medicaid Programs: Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction" [View]

4/27/2012

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]

3/23/2012

CMS final rule (and interim final rule for some sections): "Medicaid Program: eligibility changes under the Affordable Care Act of 2010" [View]

3/19/2012

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.]

3/13/2012

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.

2/27/2012

CMS final rule: "Medicaid Program: Review and Approval Process for Section 1115 Demonstrations" [View]

1/4/2012

HHS final notice: "Medicaid Program: Initial Core Set of Health Care Quality Measures for Medicaid Eligible Adults" [View]

12/1/2011

Frequently Asked Questions on the Medicaid RAC Program [View]

10/11/2011

Robert Wood Johnson Foundation: Report on "Refocusing Responsibility for Dual Eligibles: Why Medicare Should Take the Lead"

9/16/2011

CMS final rule: "Medicaid Program: Recovery Audit Contractors" [View]

7/11/2011

NAPHS comment letter: "Medicare and Medicaid Programs: Opportunities for Alignment Under Medicaid and Medicare" [View]

7/5/2011

NAPHS comment letter to CMS on proposed rule: "Medicare and Medicaid Programs: Influenza Vaccination Standard for Certain Participating Providers and Suppliers" [View]

6/21/2011

NAPHS comment letter to CMS on proposed rule: "Medicaid Program: Methods for Assuring Access to Covered Medicaid Services" [View]

6/1/2011

June 2011 MACPAC Report to the Congress: "The Evolution of Managed Care in Medicaid" [View]

5/5/2011

Final rule: Medicare & Medicaid: Changes Affecting Hospital and Critical Access Hospital Conditions of Participation: Telemedicine Credentialing and Privileging [View]

3/1/2011

NAPHS comment letter to AHRQ on "Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults" [View]

1/7/2011

NAPHS comment letter to CMS on Medicaid Recovery Audit Contractor (Medicaid RAC) proposed rule (published 11/10/10) [View]

12/30/2010

Federal Register notice with comment period: "Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults" [View]

11/19/2010

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]

8/16/2010

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]

6/15/2010

NAPHS comment letter: Accreditation Requirements for Providers of Inpatient Psychiatric Services for Individuals Under Age 21 [View]

3/23/2010

NAPHS statement: Reform law includes provisions important to Americans facing mental and addictive disorders. Includes IMD/EMTALA demonstration on emergency psychiatric care. [View]

6/30/2009

"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].

11/27/2006

"Hospital Conditions of Participation: Requirements for History and Physical Examinations; Authentication of Verbal Orders; Securing Medications; and Postanesthesia Evalutions (CMS-3122-F)."

3/1/2006

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.

1/12/2005

OIG Report: Seven States Medicaid Claims for 21- to 64-year old residents of private and county-operated IMDs [View]

1/1/1990

RECURRING:  CMS Web site on RACs (Recovery Audit Programs).

Show Archived List Items

MAJOR ACTIONS:

 

5.6.16: CMS final rule on managed Medicaid -- including a provision giving MCOs flexibility on the "Institutions for Mental Disease" (IMD) exclusion (see pgs.27555-27563).  (This rule is the first update to managed care rules in more than a decade.)

 

3.30.16: CMS final rule on the application of parity to Medicaid and CHIP

 

12.11.15: P.L.114-97 signs into law the extension of the Medicaid Emergency Psychiatric Demonstration Project (S.599)

 

 

© National Association for Behavioral Healthcare