CO's Medicaid Mental Health Alternative Services
This is really where the rubber meets the road on Medicaid & Parity: these "Medicaid Mental Health Alternative Services."
If designation of a Medicaid Mental Alternative Service in and of itself is allowed to defeat Parity -- what is the point in having Medicaid Parity in the first place?
CMS Parity Compliance Toolkit
Colorado's "Alternative Services" for Community Behavioral Health
8.212.4.B. Alternative services of the Community Behavioral Health Services program are:
1. Vocational -- Services designed to help adult and adolescent clients who are ineligible for state vocational rehabilitation services to gain employment skills and employment. Services are skill and support development interventions, educational services, vocational assessment, and job coaching.
2. Assertive Community Treatment (ACT) – Comprehensive, locally-based, individualized treatment for adults with serious behavioral health disorders, that is available 24 hours a day, 365 days a year.
Services include case management, initial and ongoing behavioral health assessment, psychiatric services, employment and housing assistance, family support and education, and substance use disorders services.
3. Intensive Case Management -- Community-based services averaging more than one hour per week, provided to adults with serious behavioral health disorders who are at risk of a more intensive 24 hour placement and who need extra support to live in the community.
Services are assessment, care plan development, multi-system referrals, assistance with wraparound and supportive living services, monitoring and follow-up. Intensive case management may be provided to children/youth under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program.
4. Clubhouse and drop-in center services – Peer support services for people who have behavioral health disorders, provided in a Clubhouse or Drop-In Center setting.
Clubhouse participants may use their skills for clerical work, data input, meal preparation, providing resource information and outreach to clients. Drop-in Centers offer planned activities and opportunities for individuals to interact socially, promoting and supporting recovery.
5. Recovery Services – Community-based services that promote self-management of behavioral health symptoms, relapse prevention, treatment choices, mutual support, enrichment, rights protection, social supports.
Services are peer counseling and support services, peer-run drop-in centers, peer-run employment services, peer mentoring, consumer and family support groups, warm lines, and advocacy services. CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.200 Medical Services Board 71
6. Residential Services – Twenty-four (24) hour care, excluding room and board, provided in a non-hospital, non-nursing home setting, appropriate for adults whose mental health issues and symptoms are severe enough to require a 24-hour structured program but do not require hospitalization.
Services are provided in the setting where the client is living, in real-time, with immediate interventions available as needed.
Clinical interventions are assessment and monitoring of mental and physical health status; assessment and monitoring of safety; assessment of/support for motivation for treatment; assessment of ability to provide for daily living needs; observation and assessment of group interactions; individual , group and family therapy; medication management; and behavioral interventions.
Residential services may be provided to children/youth under EPSDT.
7. Prevention/Early Intervention Services – Proactive efforts to educate and empower individuals to choose and maintain healthy life behaviors and lifestyles that promote positive behavioral health.
Services include behavioral health screenings; educational programs promoting safe and stable families; senior workshops related to aging disorders; and parenting skills classes.
8. Respite Care – Temporary or short-term care of a child, youth or adult client provided by adults other than the birth parents, foster/adoptive parents, family members or caregivers that the client normally resides with.
Respite is designed to give the caregivers some time away from the client to allow them to emotionally recharge and become better prepared to handle normal day-to-day challenges. Respite care providers are specially trained to serve individuals with behavioral health issues.
We Heard Back from the State on Parity.
We Would Like Additional Discussions with the State Before We Decide To Contact CMS Region 8 on What We Believe is Colorado Medicaid's Failure to Comply with Parity
Our Original Letter to the State re: Parity & Assertive Community Treatment.
Our Initial Response Back to the State
Hi Gretchen -- Thanks so much for the response. It was really helpful.
I'll look into the resources you mentioned. If there is something out that is better and cheaper, I'm not going to argue for something that is more expensive and less effective.
I think my take right now is that ACT is covered with regard to financial requirements or treatment limitations -- otherwise the whole non-qualitative [this should probably be non-quantative] [treatment limitation concept within parity becomes meaningless. Now maybe that's not going to be the majority view and this is all still pretty new.
42 CFR 438.920
(c) Scope. This subpart does not -
(1) Require a MCO, PIHP, or PAHP to provide any mental health benefits or substance use disorder benefits beyond what is specified in its contract, and the provision of benefits by a MCO, PIHP, or PAHP for one or more mental health conditions or substance use disorders does not require the MCO, PIHP or PAHP to provide benefits for any other mental health condition or substance use disorder;
(2) Require a MCO, PIHP, or PAHP that provides coverage for mental health or substance use disorder benefits only to the extent required under 1905(a)(4)(D) of the Act to provide additional mental health or substance use disorder benefits in any classification in accordance with this section; or
(3) Affect the terms and conditions relating to the amount, duration, or scope of mental health or substance use disorder benefits under the Medicaid MCO, PIHP, or PAHP contract except as specifically provided in §§ 438.905 and 438.910.
42 CFR 438.905 - Parity requirements for aggregate lifetime and annual dollar limits.
42 CFR 438.910 Parity requirements for financial requirements and treatment limitations.
I'll look at the resources and get back with you.
Thanks so much for your courtesy,
The final rule requires that all beneficiaries who receive services through managed care organizations, alternative benefit plans, or CHIP be provided access to mental health and substance use disorder benefits that comply with parity standards, regardless of whether these services are provided through the managed care organization or another service delivery system.
Response from the State
We have quoted from the CMS document below. The quote is to the left.
Mass. Ass. Of Mental Health: Comments on Parity
If Parity doesn't cover Assertive Community Treatment under Medicaid -- who are we really fooling & hurting?
"For example, all insurers cover inpatient mental services and crisis stabilization, but only Medicaid covers Programs of Assertive Community Treatment (PACT), considered by many experts to be a critical component of a comprehensive community mental health system and a significant safeguard against institutionalization."