The Ticket to Work and Work Incentives Improvement Act of 1999: Implications for the Design and Support of Comprehensive Integrated Health Systems for Persons with Mental Illness and Addiction Disorder Disabilities

This report is designed to provide an overview of the Medicaid provisions of the Ticket to Work and Work Incentives Improvement Act of 1999, Public Law 106-170. This report considers the implications of the Act for the design and support of comprehensive, Medicaid-financed systems of health care for workers with severe disabilities and impairments, with a specific focus on persons with mental illness and addiction disorder disabilities. The Act, described by advocates for persons with disabilities as the most important piece of disability-related legislation since the enactment of the Americans with Disabilities Act of 1990, expands the availability of health care and employment preparation and support services for working-age adults with disabilitie

Model Managed Care Contract for Health Professionals and Clinical Providers of Mental Illness and Addiction Disorder Treatment and Prevention Services

The contracting process is one that health care professionals oftentimes find complex and confusing. Furthermore, studies of managed care service contracts between managed care organizations and health professionals who furnish mental illness and addiction disorder prevention and treatment services have found that these contracts often heavily favor the managed care organization by allowing the MCO broad latitude over a network professional\u27s service responsibilities, the rate of payment for covered benefits and extensive discretion over treatment decision-making. As an aid to its members, the American Medical Association (AMA) has drafted a model provider agreement that gives physicians in both individual and group practice a tool that can be utilized in the managed care contracting process. The AMA\u27s contract is designed to help physicians understand and negotiate the contracts they sign. At the same time, the model contract is designed as a general medical services template. As a result, specialty providers such as mental health and addiction disorder treatment professionals and clinical providers may find that the model does not address certain critical contracting issues which exist as a function of their specialty practices. In order to address the need for a customized model contract designed for use by health professionals and clinics furnishing mental health and addiction disorder treatment and prevention services, the Substance Abuse and Mental Health Services Administration (SAMHSA), funded the George Washington University Center for Health Services Research and Policy (CHSRP) to adapt the AMA model contract for use in this specialty area. Working in collaboration with a number of professional organizations including the National Association of Social Workers, the American Psychological Association, the National Association of Alcohol & Drug Abuse Counselors, the American Psychiatric Association, and the University of Maryland\u27s Department of Behavioral and Community Health — CHSRP has adapted the AMA contract for use in the area of mental illness and addiction disorder network agreements

HIPAA\u27s electronic transactions rule: implications for behavioral health providers.

On August 17, 2000, the Department of Health and Human Services (HHS) adopted uniform national standards for electronic health transactions and code sets pursuant to the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Uniform standards hold the promise of improved efficiency in the health care system through standardized electronic transmission of health information. Many behavioral health care organizations (e.g., the American Psychiatric Association, the National Association of State Mental Health Program Directors, and the National Association of State Alcohol/Drug Abuse Directors) have argued that the Rule\u27s standards are insufficient for behavioral health providers. These organizations have called for the development of more appropriate codes for behavioral health services. A coalition of groups proposed new codes to HHS in February 2002 and is awaiting a response. The behavioral health provider community should continue to engage the process of modifying the Rule\u27s standards where necessary to ensure that the Rule covers key components of behavioral health care delivery