On Monday, March 31, 2014, the efforts of the entire behavioral health community, spearheaded by the National Council for Behavioral Health, were rewarded when Congress passed the Protecting Access to Medicare Act (H.R. 4302), which included provisions of the Excellence in Mental Health Act. This groundbreaking legislation will increase access to community based mental health and substance use treatment services, while further improving Medicaid reimbursement for these services. The Act provides for the following:
- The Secretary of the Department of Health and Human Services is mandated to establish a two-year, eight state Medicaid demonstration project, through which participating states will receive 90% of Federal Medical Assistance Percentages (FMAP) for the range of health and behavioral health services delivered by Certified Community Behavioral Health Clinics.
- New criteria are created for Certified Community Behavioral Health Clinics, which are entities created specifically to serve individuals with serious mental illness (SMI) and substance use disorders (SUD) through intensive person-centered, evidence-based modalities within the community.
- $25 million will be available in planning grants for states that are interested in being a part of the 2-year pilot. Only states that have received a planning grant will be eligible to participate in the pilot. Planning grants are to be awarded to states no later than January 1, 2016.
- Participating states are required to develop a Prospective Payment System for reimbursing Certified Behavioral Health Clinics for required services provided by these entities.
Eight states will be selected to participate in the Demonstration program no later than September 1, 2017.
To learn more about the Excellence in Mental Health Act and its implications for behavioral health providers, visit the National Council’s website here.