Coordinated Specialty Care (CSC) is an evidence-based practice that has been demonstrated to be effective in successfully engaging and serving individuals experiencing a first episode of psychosis. It involves the use of a multidisciplinary team that actively engages and serves clients and their families using a consumer-centered approach with shared decision making. However, the approach requires a certain amount of service flexibility that does not fit neatly into public or private insurance fee-for-service payment models. In this presentation, we will document the problems with current reimbursement methods and suggest strategies that can be used to address them.

The first strategy involves advancing an argument based on legally required parity in insurance coverage. In 2008, Congress passed and President George W. Bush signed the Mental Health Parity and Addiction Equity Act. This Act prohibits discrimination in insurance coverage for behavioral health services, requiring insurers to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer. The inability to fully cover the costs of CSC services by both commercial insurance and Medicaid / CHIP is arguably a violation of the Federal Parity Law. In this presentation, we will present this argument and suggest strategies and resources that advocates can use to push for equitable insurance coverage.

A second strategy for assuring equitable access to CSC services involves mandating that a bundled service model and reimbursement rate be used for CSC services in both public/Medicaid and commercial insurance. This is the strategy that Illinois successfully pursued. While Illinois' law excludes commercial insurance coverage of supported education and employment, the law requires that the CSC services be provided with fidelity (meaning providers must use public funds for education and employment components of the model). In this part of the panel, we will both discuss the multi-year process that was involved in the development of the enabling legislation and summarize the implementation process that has been ongoing this year.

Workgroups convened by the Illinois Department of Insurance including treatment providers, insurance companies and advocates have developed program eligibility requirements, continuing treatment and discharge guidelines. Work is underway to choose a reimbursement code and reimbursement rate for the program. Cost-based, bundled reimbursement will be available January 1, 2021. Presenters will also discuss how the Commercial and Medicaid legislation includes mandates for young adult team services beyond CSC, so that young people have services to transition to, and from, during their services journey based on their mental health needs. We will also discuss the challenges of supported employment and education inclusion in the legislation.

Finally, we will review some of the existing approaches that can be used in Medicaid to fully cover the cost of these services We will present data regarding cost effectiveness of CSC services as well as the potential for large public savings if CSC services are properly reimbursed, including significant reductions in severity of illness, physical health care costs, disability, unemployment, homelessness, and early mortality. Not only is coverage the right thing to do to enable access to treatment, but we will also demonstrate that full coverage of every incident case would result in negligible increases in insurance premiums using New York state population data and incidence estimates for both commercial and Medicaid populations.

Format

Recorded webinar, non-interactive, self-paced distance learning activity with post-test.

This presentation was recorded on November 12, 2020 at the virtual conference, Third National Conference on Advancing Early Psychosis Care in the United States: Addressing Inequities - Race, Culture, and COVID. 

Learning Objectives

• Describe the major features of the federal Mental Health Parity and Addiction Equity Act and how the law can be used to seek equitable coverage for CSC services.
• Explain the process of developing and implementing legislation that requires coverage for CSC services in both public and private insurance.
• Effectively argue that CSC services are affordable relative to other commonly reimbursed medical procedures and meet conventional standards for cost effectiveness.

Outline

• Mental Health Parity and Addiction Equity Law
• Cost based, bundled rates for CSC services
• Medicaid strategies to fund CSC services

Target Audience

Psychologists, Other Mental Health Professionals

Instructional Level

Intermediate

Estimate Time to Complete

Estimated Duration: 1.0 hour
Program Start Date: May 3, 2021 
Program End Date: May 3, 2024

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit™, CE credit for psychologists, or a certificate of participation may do so by completing all sections of the course, including viewing the full video (≥60 minutes) and submitting an evaluation. A multiple-choice quiz is provided based on the content. A passing score of 75% must be achieved. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians), CE certificate (psychologists), or certificate of participation (other disciplines) showing the completion date and hours/credits earned.

Continuing Education Credit

Physicians

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The APA designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Psychologists

The American Psychiatric Association is approved by the American Psychological Association to sponsor continuing education for psychologists. American Psychiatric Association maintains responsibility for this program and its content.

Continuing education requirements vary from state to state. Many state boards grant reciprocity with national accrediting organizations and other state boards. It is the responsibility of each professional to understand the requirements for license renewal or check with the state or national licensing board and/or professional organization to become more familiar with their policies for acceptable continuing education credit. Social workers and Psychologists should contact their regulatory board to determine course approval.

Faculty and Planner Disclosures

Instructors

• Heather O'Donnell, J.D., is Senior Vice President of Public Policy & Advocacy at Thresholds. Heather leads the legislative and public policy affairs at Thresholds, a Chicago-based community mental health and substance use treatment provider. She successfully led the passage of Illinois' Early Mental Health and Addictions Treatment Act, the Children and Young Adult Mental Health Crisis Act, and several other legislative efforts aimed at improving access to care. Her expertise extends to Medicaid and affordable housing. Heather also spearheads a statewide coalition of advocacy organizations. Prior to moving into public policy, Heather practiced law in Chicago for many years and also worked in Johannesburg, South Africa for Lawyers for Human Rights. Reports no financial relationships with commercial interests.

• David L. Shern, Ph.D., served as the President and CEO of Mental Health America (MHA) from 2006 to 2012, and on an interim basis in 2014 following the departure of his successor. After leaving MHA, Dr. Shern joined the staff of the National Association of State Mental Health Program Directors as a Senior Public Health Advisor. He also has an appointment in the Department of Mental Health at the Johns Hopkins. Prior to joining MHA, Dr. Shern served as dean of the Louis de la Parte Florida Mental Health Institute (FMHI) at the University of South Florida, one of the largest research and training institutes in behavioral health services in the United States. His work has spanned a variety of mental health services research topics including serving street dwelling individuals with SMI; epidemiological studies of the need for community services; the effects of differing organizational, financing and service delivery strategies on continuity of care and client outcome and the use of alternative service delivery strategies such as peer counseling and self-help on the outcomes of care. Disclosures - Grant/Research: Through my employment at NASMHPD, I co-chair the dissemination function of the Early Psychosis Intervention network as part of the national data coordinating center at Westat. Westat was awarded the coordinating center grant by NIMH Other: serve on the Board of Livanta

• Marc A. Fagan, Psy.D., is the Vice President of Clinical Operations, Youth and Young Adult Services at Thresholds. Marc has over 18 years of experience in developing, implementing, and sustaining comprehensive programs for youth and young adults, including youth with histories of trauma and system involvement, emerging serious mental health conditions, and at high risk for psychosis. These nationally recognized multidisciplinary programs are featured in several books and journal articles. Locally and nationally, Marc partners with policy makers, researchers, and practitioners to develop effective systems supporting the transition to adulthood. As a consultant and trainer in key evidence-informed practices for young people, including the Transition to Independence Process (TIP) Model, Marc conducts workshops for stakeholders across the country. Reports no financial relationships with commercial interests.

• Former U.S. Representative Patrick J. Kennedy was the lead author of the groundbreaking Mental Health Parity and Addiction Equity Act (Federal Parity Law), which requires insurers to cover treatment for mental health and substance use disorders no more restrictively than treatment for illnesses of the body, such as diabetes and cancer. In 2013, he founded The Kennedy Forum, a nonprofit that unites mental health advocates, business leaders, and government agencies in support of mental health equity and works to advance evidence-based practices, policies, and programming around treatment and recovery. In 2015, Kennedy co-authored the New York Times Bestseller, "A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction," which details a bold plan for the future of mental health care in America. In 2017, he was appointed to the President's Commission on Combating Drug Addiction and the Opioid Crisis. Kennedy is also the co-founder of One Mind, an organization that pushes for greater global investment in brain research; co-chair of Mental Health for U.S., a nonpartisan initiative designed to elevate mental health and addiction in policy conversations during the 2020 election cycle; and founder of DontDenyMe.org, an educational campaign that empowers consumers and providers to understand parity rights and connects them to essential appeals guidance and resources. Disclosures - Stock: DynamiCare Health, Health Pointe Solutions Consultant: Adaptive Testing Technologies, DynamiCare Health, PhRma Other: axial Healthcare - Member, Board of Directors, Braeburn Pharmaceuticals, Member Board of Directors, Interaxon (Muse) - Advisory Board Member, Kaden Health - Strategic Advisor, Integrated Life Sciences, LTD - Special Advisor, Owl Insights - Strategic Advisory, Pear Therapeutics - Chairman, Advisory Board.

Program Planners

• Steven Adelsheim, M.D. Reports no financial relationships with commercial interests.
• Catherine Adams, L.M.S.W., A.C.S.W., C.A.A.D.C. Reports no financial relationships with commercial interests.
• Susan T. Azrin, Ph.D.  Reports no financial relationships with commercial interests.
• Iruma Bello, Ph.D.  Reports no financial relationships with commercial interests.
• Gary Michael Blau, M.S., Ph.D.  Reports no financial relationships with commercial interests.
• Teri S. Brister, Ph.D., L.P.C.  Reports no financial relationships with commercial interests.
• Nybelle An-Vi Caruso, B.S.  Reports no financial relationships with commercial interests.
• Amy N. Cohen, Ph.D.  Reports no financial relationships with commercial interests.
• Robert O. Cotes, M.D.  Dr. Cotes discloses the following relationships: Consultant: Saladax Biomedical, American Psychiatric Association Grant/Research: Ostuka, Lundbeck, Roche, Alkermes
• Judith Dauberman, M.A., Ph.D.  Reports no financial relationships with commercial interests.
• Steven P. Dettwyler, Ph.D.  Reports no financial relationships with commercial interests.
• Lisa B. Dixon, M.D., M.P.H.  Reports no financial relationships with commercial interests.
• Melissa Edmondson Smith, Ph.D.  Reports no financial relationships with commercial interests.
• Chantel Garrett. Ms. Garrett discloses the following relationships: Stock: Invitae, stockholder Livongo, stockholder Color, private equity holder Consultant: Maine Health Northwell Health One Mind Grant/Research: One Mind National Institute of Health
• Tristan Gorrindo, M.D.  Reports no financial relationships with commercial interests.
• Kate Hardy, ClinPsych.D.  Ms. Hardy discloses the following relationships: Consultant: SME for Click Therapeutics
• Robert K. Heinssen, Ph.D., A.B.P.P. Reports no financial relationships with commercial interests.
• Brian Hepburn, M.D.  Reports no financial relationships with commercial interests.
• Patrick Kaufmann, B.S.  Reports no financial relationships with commercial interests.
• Sherin Khan, L.C.S.W. Reports no financial relationships with commercial interests.
• Steven R. Lopez, Ph.D. Reports no financial relationships with commercial interests.
• Ted Lutterman.  Reports no financial relationships with commercial interests.
• Tushita Mayanil, M.D.  Reports no financial relationships with commercial interests.
• Ryan Melton, Ph.D.  Reports no financial relationships with commercial interests.
• Oladunni Oluwoye , Ph.D.  Reports no financial relationships with commercial interests.
• Abram Rosenblatt, Ph.D.  Reports no financial relationships with commercial interests.
• David L. Shern, Ph.D.  Dr. Shern discloses the following relationships: Grant/Research: Through my employment at NASMHPD, I co-chair the dissemination function of the Early Psychosis Intervention network as part of the national data coordinating center at Westat. Westat was awarded the coordinating center grant by NIMH Other: serve on the Board of Livanta

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