Sub-State Purchasing of Managed Behavioral Health Care: An Analysis of County-Level Managed Care Contracts

For this study, SAMHSA asked us to analyze county-level managed health care contracts that include behavioral health services. SAMHSA has indicated that sub-state entities, particularly counties, are beginning to explore the feasibility of contracting with managed care organizations, both to control costs and to improve coordination of services for the mental health or substance abuse systems they manage. In commissioning these various contract studies, SAMHSA was primarily interested in tracking the development of these new types of managed behavioral health care procurements and contracting practices, as well as determining whether there were exemplary commercial behavioral health provisions that could be adapted to public sector contracts

An Analysis of the Medicaid IMD Exclusion

This report examines the Medicaid Institutions for Mental Disease (IMD) exclusion, one of the very few instances in which federal Medicaid law prohibits federal contribution to the cost of medically necessary care furnished by licensed medical care providers to enrolled program beneficiaries. The report begins with a brief overview of Medicaid\u27s role in financing care for conditions and illnesses classified as mental diseases under professional medical guidelines and the allocation of state and federal funding responsibilities under Medicaid. The report then reviews the elements of the Medicaid IMD exclusion, as well as key judicial and administrative rulings related to the exclusion. The report concludes with a discussion of certain policy considerations related to the exclusion

An Overview of Legal Developments in Managed Care Caselaw and Selected Case Studies of Legal Developments in State Contracting for Managed Behavioral Health Services

This analysis provides an overview of recent legal developments in managed care case law. Three types of cases are reviewed: claims brought by managed care enrollees against managed care companies and health plans; cases related either directly or indirectly to managed care and brought by both beneficiaries and managed care organizations against state Medicaid agencies and other public agencies engaged in the purchase of managed care; and cases brought by individual health professionals against managed care organizations

Mental Illness and Addiction Disorders and Medicaid Managed Care

This Special Report on mental illness and addiction disorders is part of Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts, now in its third edition. Negotiating the New Health System is a nationwide point-in-time study of agreements between state Medicaid agencies and managed care organizations (MCOs) offering general or specialized managed behavioral health care products. Each individual edition of Negotiating the New Health System is a point-in-time study or snapshot of these agreements for a particular year. However, the current series of editions, taken together, are beginning to form a longitudinal basis for reviewing the evolution of the agreements, for evaluating progress, and for identifying areas needing further work or scrutiny

An Analysis of Contracts for the Delivery of Managed Behavioral Health Care Services in State Correctional Facilities

This issue brief, prepared by the George Washington University Center for Health Services Research and Policy (CHSRP), presents an analysis of a sample of contractual agreements entered into by State Departments of Corrections with managed care organizations (MCOs) for the provision of managed behavioral health care services in State prisons. It is part of a series of contract studies undertaken by CHSRP that examine the implications of managed care contracting by public and private sector purchasers for the financing and delivery of behavioral health care services

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

Reasonable Modification or Fundamental Alteration? Recent Developments in ADA Caselaw and Implications for Behavioral Health Policy

This issue brief examines the concept of fundamental alteration under the Americans with Disabilities Act (ADA); specifically it considers when proposed modifications of public programs under Title II of the ADA will be considered to amount to the type of fundamental alteration that lies beyond judicial power to compel. The issue of when a program change constitutes a fundamental alteration is important in state community integration planning efforts, since these types of changes will require legislative action

An Evaluation of Agreements Between Managed Care Organizations and Community-Based Mental Illness and Addiction Disorder Treatment and Prevention Providers

This Issue Brief, prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), examines contracts between managed care organizations (MCOs) and community-based providers of mental illness and addiction disorder treatment and prevention services (MI/AD providers). Building upon initial research published in 1997, this brief explores in depth one of the most hidden aspects of managed care: the relationship between the managed care organizations and health care providers

U.S. Commission on Immigration Reform

The U.S. Commission on Immigration Reform was created by Congress to assess U.S. immigration policy and make recommendations regarding its implementation and effects. Mandated in the Immigration Act of 1990 to submit an interim report in 1994 and a final report in 1997, the Commission has undertaken public hearings, fact-finding missions, and expert consultations to identify the major immigration-related issues facing the United States today.LBJ School of Public Affair