Payer Roundup—CMS to decide on mental health waiver decision this week

Verma says waiver decisions coming this week

Medicaid head Seema Verma told reporters Monday that an Institutions for Mental Disease (IMD) waiver decision is coming soon. 

Such waivers allow states to finance certain mental health services through federal Medicaid spending, which has become more sought-after due to the ongoing opioid crisis. CMS administrator Verma said in a press meeting on Monday that one state's waiver will be decided this week.  

Currently, there are 11 approved waivers and 12 pending related to IMD payments. 

Medicare to reconsider coverage for depression treatment

The Centers for Medicare & Medicaid Services is taking another look at whether to cover a certain depression treatment.

LivaNova has announced that the agency is reconsidering coverage for Vagus Nerve Stimulation Therapy for treatment-resistant depression, which involves implantation of a device that stimulates a patient's vagus nerve. 

CMS last considered covering treatment in 2007, but declined to cover the treatment “insufficient evidence.”

"Over the last decade, a significant body of new evidence has emerged showing that the addition of VNS Therapy is effective in reducing symptoms in patients with TRD," LivaNova said in a release. "We look forward to working with CMS as they consider a change in Medicare coverage." (Release)

BCBS Texas delays drastic emergency room billing rule

Blue Cross and Blue Shield of Texas has decided to delay a controversial rule that would have cost some patients big bucks if they ended up in the emergency room.

The insurer delayed for two months a rule that would remove benefits for out-of-network ER visits unless a condition was deemed serious or life-threathening, according to KCBD. 

The policy was scheduled to start June 4, but it was halted after the Texas Department of Insurance voiced concern that the policy would deter patients with serious conditions from the ER over coverage concerns. (KCBD)