Payer Roundup–Mental health care is lacking; CMS approves New Mexico mobile crisis intervention team

Below is a roundup of payer-centric news for the week of Feb. 5, 2024.

Commercial insurance lags behind Medicaid for mental health care: report

An analysis by mental health policy nonprofit Inseparable and healthcare consulting company Milliman shows a lack of adequate mental health for people with insurance.

The two organizations released an overarching report and state-by-state scorecards revealing how each state fares.

Among the findings:

  • 2 in 3 people with health insurance do not receive specialty care. This includes individual therapy or psychiatric medication management.

  • 30.7% of people with commercial insurance with a mental health condition received specialty mental health care, whereas 44.3% of those with Medicaid received specialty care.

  • Only 1 in 3 people with a mental health or substance use disorder-related emergency department or hospital visit received follow-up care with a mental health specialist within 30 days.

CMS approves New Mexico crisis intervention team

New Mexico is the 15th state to be approved community-based mobile crisis intervention teams by the Centers for Medicare & Medicaid Services (CMS).

These teams connect individuals to behavioral health providers any time of the day. Teams are trained and equipped to de-escalate situations. They can also offer referrals for more support and will schedule check-ins with individuals with mental health or substance use disorders, according to a news release.

In July, CMS approved California and Kentucky for crisis intervention teams. Under the American Rescue Plan, states can create Medicaid crisis teams under a program that gives them an 85% federal match for three years.

Penn State Health agrees to settlement

A health system in Pennsylvania agreed to pay nearly $12 million in a settlement that claimed violation of Medicare rules and regulations, according to a news release by the U.S. attorney's office for the Middle District of Pennsylvania.

The agreement resolves allegations that the health system submitted claims to Medicare for annual wellness visit services not supported by the medical record. Penn State Health voluntarily disclosed the claims between December 2015 and November 2022 and took "corrective action" before telling the agency, the office said.