April 8, 2014
By David Humiston, Robert Bohner, and Rynicia Wilson*
On March 31 the U.S. Senate passed the Excellence in Mental Health Act (H.R. 4302) (Act) as part of the Protecting Access to Medicare Act. President Barack Obama signed it into law on April 1. The purpose of the Act is to increase access to community-based behavioral health services for mental health and substance abuse treatments and to improve Medicaid reimbursement for those services.
The Act provides criteria for federally qualified community behavioral health centers (behavioral health clinics). These clinics are to serve persons who suffer from serious mental illnesses and substance abuse disorders through intensive, person-centered, multidisciplinary, evidence-based screening, assessment, diagnostics, treatment prevention, and wellness services.
Selected states will provide these clinics under a two-year pilot program established by the Secretary of the U.S. Department of Health & Human Services (HHS). The Act appropriated $25 million in planning grants for use by the states in preparing applications to participate in the pilot program. Only states that receive a planning grant are eligible to participate in this pilot program, and no more than eight states will be selected. HHS will establish a process for selecting these participating states.
The Act establishes certain requirements for these certified clinics. Staff must have diverse disciplinary backgrounds, as well as the appropriate state licenses and accreditations. They also must have acquired the cultural and linguistic training appropriate to the patient pool that they serve. The behavioral health clinics must provide a sliding scale payment system and prohibit any rejection or limitation of services based on either an inability to pay or on the patient's residence. In addition, the clinics are required to report clinical outcome and quality data along with any other data as required by HHS.
There must be care coordination for patients across a broad range of health care services, such as those with chronic, acute, and behavioral health needs and conditions. These behavioral health clinics must establish partnerships or enter into contractual arrangements with federally qualified health clinics (and as applicable, rural health clinic services) for the provision of those services unavailable through the behavioral health clinics, such as inpatient psychiatric facilities and substance use detoxification centers; post-detoxification step-down services; residential treatment centers; inpatient acute care hospitals; hospital outpatient clinics; and community and regionally based programs, such as schools, child welfare agencies, juvenile and criminal justice centers and facilities; and U.S. Department of Veterans Affairs medical centers, including independent outpatient clinics and drop-in centers.
The behavioral health clinics must either provide or arrange for a variety of behavioral health services in a manner reflecting person-centered care. These behavioral health services must include crisis mental health services, including 24-hour mobile crisis teams; screening, assessment, and diagnostic services; risk assessment and crisis management; patient-centered treatment planning; outpatient mental health and substance abuse services; outpatient clinic primary care screening and monitoring of key health indicators and risks; targeted case management; psychiatric rehabilitation services; peer support and counselor services and family supports; and intensive community-based mental health care for members of the armed forces and veterans.
These behavioral health clinics must operate as nonprofits or as part of a local government behavioral health authority or under the authority of the Indian Health Service.
The following important deadlines are set forth in the Act:
- Not later than September 1, 2015 the Secretary shall publish criteria for certification of the community behavioral health clinics;
- Not later than September 1, 2015 the Secretary, through the Administrator of the Centers for Medicare & Medicaid Services, will issue guidance on the establishment of a prospective payment that shall only apply to the certified demonstration behavioral health clinics. Those guidance procedures will provide that no payment shall be made for in-patient care, residential treatment, room and board expenses, or any other ambulatory expenses, as determined by the Secretary. In addition, no payment shall be made to satellite facilities of the behavioral health clinics established after the date that the Act is enacted;
- Not later than January 1, 2016 the Secretary shall award planning grants to the states for the purposes of developing proposals to participate;
- Not later than September 1, 2017 the Secretary shall select states to participate in demonstration programs;
- Not later than December 31, 2021 the Secretary shall submit to Congress recommendations concerning the continuance of this program and any modifications if the program is not terminated.
*We would like to thank David M. Humiston, Robert C. Bohner, and Rynicia L. Wilson (Sedgwick LLP, Los Angeles, CA) for providing this email alert.
The Behavioral Health Task Force is supported by the following work groups: Military/Veterans; Payers; Providers/Clinicians; Risk Management; Rural; and State/Government.