Today, the Centers for Medicare & Medicaid Services (CMS) is sending
a letter to State Medicaid Directors that outlines both existing and new
opportunities for states to design innovative service delivery systems for
adults with serious mental illness (SMI) and children with serious
emotional disturbance (SED). The letter includes a new opportunity,
under section 1115(a) of the Social Security Act, for states to receive
authority to pay for treatment services provided to beneficiaries who are
short-term residents of psychiatric hospitals or residential treatment
settings that qualify as institutions for mental disease (IMDs) if those
states are also committing to taking action to ensure good quality of care
in those settings and to improve access to community-based services as
well.
CMS currently offers states the opportunity to pursue similar
demonstration projects focused on improving treatment for substance use
disorders (SUDs), including opioid use disorder, under section 1115(a) of
the Act. Through these SUD-focused demonstrations, CMS has been
working with participating states to cover treatment in IMDs while also
improving access for beneficiaries to a full continuum of care including
community-based outpatient services and also ensuring the quality of SUD
treatment provided to beneficiaries while residing in IMDs. To date,
CMS has approved these SUD-focused demonstrations in 17 states, and there
are already indications of improved outcomes for beneficiaries.
Similar to the SUD 1115(a) demonstration initiative, this SMI/SED
demonstration opportunity outlines a number of milestones that states will
be expected to achieve as part of these demonstrations aimed at making
progress on a number of overarching goals. These milestones
include specific activities to –
- Ensure good quality
of care in psychiatric hospitals and residential treatment settings;
- Improve care
coordination and transitions to community-based care following stays
in acute care settings;
- Increase access to a
continuum of care including crisis stabilization services and
community-based services to address chronic, on-going mental health
care needs; and
- Identify individuals
with SMI or SED earlier and engage them in treatment sooner.
States are encouraged to build on the evidence-based models discussed in
the first part of the letter in order to achieve these milestones.
As a state’s SMI/SED demonstration progresses, states will be expected
to include, in their section 1115(a) demonstration monitoring reports,
information detailing the state’s progress toward meeting the milestones
and timeframes for specific actions. These reports will also include
information and data so that CMS can monitor the impact of these
demonstrations and progress on the goals as well as ensure budget
neutrality.
CMS will work closely with states on implementation and evaluation of
these demonstrations and is hopeful that this policy guidance will create
new opportunities to partner with states committed to implementing
innovative service delivery reforms to improve care for beneficiaries with
SMI or SED.
The State Medicaid Director Letter is available on Medicaid.gov
here: https://www.medicaid.gov/federal-policy-Guidance/index.html
|
No comments:
Post a Comment