INITIAL EXCERPTS FROM THE CMS LETTER ON Mental Health INNOVATION

I.  Strategies under Existing Authorities to Support Innovative Service Delivery Systems for Adults with SMI and Children with SED

  • Earlier Identification and Engagement in Treatment
  • ​​Integration of Mental Health Care and Primary Care 
  • Improved Access to Services Across the Continuum of Care Including Crisis Stabilization Services ​
  • Better Care Coordination and Transitions to Community-based Care  
  • ​Increased Access to Evidence-based Services that Address Social Risk Factors  

Assertive Community Treatment

​Additional opportunities to engage Medicaid beneficiaries in community-based treatment include increasing availability of assertive community treatment (ACT) programs.lxiii.

ACT programs include a multidisciplinary team of mental health professionals with low client to staff ratios allowing for multiple contacts for clients needing intensive support and the capacity to respond 24 hours a day seven days a week. 

ACT programs include frequent team meetings and offer integration of services instead of referring clients to other programs for other services. 

CMS has previously issued a State Medicaid Director letter that included information about covering ACT programs in Medicaid.lxiv 

Coverable services in ACT programs could include assessment, medication, medication management, therapy/counseling, and case management. 

[Orchid NOTE:  Remember a State's duties under Olmstead are NOT limited by what MEDICAID will cover -- & ACT is a common component of US Department of Justice MI Olmstead Settlement Agreements] 
Peer Support Services

​There is a strong role for peers as natural allies in the facilitation of person-centered planning processes, and self-direction for mental health is an emerging practice that is being developed in several states and shows promising outcomes.lxvii 

Innovative models of community recovery support, such as “clubhouse” programs and wrap-around recovery support services provided by community health workers, emphasize the use of peer support specialists and others to provide skills training, and assistance with educational and vocational needs. 

CMS has previously issued a State Medicaid Director letter on covering peer support services in Medicaid,lxviii as well as additional clarification that peer supports in some circumstances can include peer supports for the parents/legal guardians of Medicaid eligible children.lxix
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