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MATERNAL AND CHILD HEALTH STATE POLICY COLLABORATIVE
OCTOBER 3, 2019
MEDICAID STRATEGIES: MATERNAL BEHAVIORAL HEALTH
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Select Medicaid Levers to Address the Behavioral Health Needs of Pregnant
Women and Maternal Depression
Car r ie H anlon, P r o je ct Dir e ctor
chanlon@ nas hp.org
State Policy Collaborative on Improving Quality and Access to Care in Maternal and Child Health
About NASHP
Nonpartisan forum of policymakers throughout state governments, learning, leading, and implementing innovative solutions to health policy challenges
Key activities:
o Convening state leaders to solve problems and share solutions
o Conducting policy analyses and research
o Disseminating information on state policies and programs
o Providing technical assistance to states
www.nashp.org
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State Medicaid Quality Measurement Activities
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Managed care organization (MCO) or provider:
Performance measures
Performance-based incentives
Performance improvement projects (PIPs) or quality improvement initiatives
2019 NASHP research on women’s health examples:
50-state chart and map series
- Behavioral health - Prenatal care
- Chronic disease & general health - Reproductive health
- Delivery & postpartum care - Substance use
State Medicaid Quality Measurement Activities for Women’s Health – Behavioral Health Measures
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*As of July 2019
https://nashp.org/50-state-scan-of-medicaid-initiatives-to-improve-womens-health/
State Medicaid Quality Measurement Activities for Women’s Health – Substance Use Measures
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*As of July 2019
https://nashp.org/50-state-scan-of-medicaid-initiatives-to-improve-womens-health/
Maternal Depression Screening (MDS)
The American Academy of Pediatrics’ 4th edition of Bright Futures recommends MDS during the 1, 2, 4, and 6 month well-child visits.
A 2016 bulletin clarified that state Medicaid agencies may allow MDS to be claimed as a service for the child as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
2018 NASHP research about state Medicaid policies:
- Coverage for MDS in well-child visits - Distinguishing positive and negative screens
- Billing codes - Coverage for other caregivers
- Fee-for-service reimbursement rates - Tools required or recommended
- Maximum number of screenings allowed - Tracking outcomes and referrals
- Modifiers - Related state initiatives
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Policy Trends
37 states recommend, require, or allow MDS as part of a well-child visit.
The most common CPT code is 96161 and reimbursement ranges from $2.18-$29.68.
18 states require and 16 states recommend specific or standardized MDS tools.
14 states allow a primary caregiver to be screened for depression during a well-child visit.
State efforts to monitor referrals and health outcomes after a positive screening are still emerging. 11 states distinguish positive and negative screens with specific
codes or modifiers.
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*As of September 2018
Medicaid Fee for Service Policies for MDS in a Well-Child Visit
Require (5 states) – Georgia, Michigan, Mississippi, Pennsylvania, South Carolina, Washington
Recommend (25 states) – California, Delaware, District of Columbia, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Montana, New Mexico, North Carolina, North Dakota, Ohio, Rhode Island, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia
Allow (7 states) – Alabama, Colorado, Connecticut, Hawaii, Nevada, New York, Wisconsin
Sources: State Medicaid websites and direct communication with state Medicaid officials
*As of September 2018
9https://healthychild.nashp.org/resource-center/maternal-depression/
State Medicaid Recommendations and Requirements for MDS Tools
Requires specific tools (18 states) –Alabama, California, Connecticut, Delaware, Idaho, Illinois, Iowa, Maine, Massachusetts, Mississippi, Montana, North Carolina, North Dakota, Pennsylvania, South Carolina, South Dakota, Texas, Vermont
Recommends specific tools (16 states) – Colorado, District of Columbia, Georgia, Hawaii, Maryland, Michigan, Minnesota, Nevada, New Mexico, New York, Ohio, Rhode Island, Virginia, Washington, West Virginia
Does not require or recommend specific tools (3 states) – Kentucky, Tennessee, and Wisconsin
Sources: State Medicaid websites and direct communication with state Medicaid officials
*As of September 2018
10https://healthychild.nashp.org/resource-center/maternal-depression/
Virginia’s BabyCare Program fact sheet
State Options for Promoting Recovery among Pregnant or Parenting Women with Opioid or Substance Use Disorder (SUD) issue brief (CO, PA, TX) and webinar (CO)
State Strategies to Meet the Needs of Young Children and Families Affected by the Opioid Crisis issue brief (NH, KY, VA) and webinar (NH)
Healthy Child Development State Resource Center
Issue brief on Medicaid initiatives promoting pregnant women’s access to SUD treatment
Thank You + More NASHP Resources
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MATERNAL AND CHILD HEALTH STATE POLICY COLLABORATIVE
OCTOBER 3, 2019
MEDICAID STRATEGIES: MATERNAL BEHAVIORAL HEALTH
Emily BlanfordProgram PrincipalNCSL Health Program
MEDICAID POLICY OPTIONS - “LEVERS”
Eligibility levels
Who is covered by the program
Delivery systems
How services are coordinated
This Photo by Unknown Author is licensed under CC BY-NC-ND
MEDICAID ELIGIBILITY LEVELS: PREGNANT WOMEN
States are required to provide coverage up to 138% of the federal poverty level (FPL)
Many states choose to provide coverage at levels above 138% FPL
Source: National Academy for State Health Policy, 2017
CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) ELIGIBILITY: PREGNANT WOMEN
MEDICAID POSTPARTUM ELIGIBILITY AND COVERAGE
All states are required to provide coverage through 60 days after birth
The child is covered for at least one year
Most states do not provide Medicaid coverage past 60 days
Some new parents are eligible under the Medicaid expansion option
Pending 1115 waivers and legislation to extend coverage
South Carolina 1115 waiver proposal
Missouri HB 2280
DELIVERY SYSTEMS
Managed care organizations (MCOs) are the primary service delivery system in most states
33 states report 75% or more of Medicaid beneficiaries are enrolled in MCOs
Primary Care Case Management (PCCM) – primary care provider coordinates services
Source: Kaiser Family Foundation
DELIVERY SYSTEMS
Patient Centered Medical Homes (PCMH) Similar to Primary Care Case Management Model
Health Home Builds on the PCMH model and targets individuals with multiple chronic conditions
Accountable Care Organization (ACO) Generally includes primary and specialty care and one hospital
INTEGRATION OF PHYSICAL AND BEHAVIORAL HEALTH
Behavioral health services have often been “carved-out” from physical health services under Medicaid
More states are working to fully integrate behavioral and physical health as way to reduce costs and unnecessary utilization
According to the Medicaid and CHIP Payment and Access Commission (MACPAC), integrating physical and mental health has been shown to reduce fragmentation of services and promote patient-centered care for adults with depression and anxiety disorders
EXAMPLES OF RECENTLY ENACTED AND PROPOSED LEGISLATION
CaliforniaHealthy California for All Commission - SB 104
Maternal Mental Health Screening and Support -AB 2193
Hospital Maternal Mental Health - AB 3032
TexasPost Partum Depression Strategic Plan - HB 253
ConnecticutMedicaid In-Home Counseling - SB 895
COLORADO
The Accountable Care Collaborative & Programs for
Pregnant and Parenting Women
Susan Mathieu, Program Design Section Manager
Health Care Policy & Financing
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Oct-19
Our Mission
Improving health care access and outcomes
for the people we serve
while demonstrating sound stewardship of
financial resources
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Accountable Care Collaborative
Phase II (July 2018)
Regional Accountable Entities
o Care coordination of fee for service physical health activities (PMPM)
o Delivery and management of capitated behavioral health benefit
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Objectives:
1. Join physical and behavioral health under one accountable entity
2. Strengthen coordination of services by advancing team-based care and health neighborhoods
3. Promote member choice and engagement
4. Pay providers for the increased value they deliver
5. Ensure greater accountability and transparency
Short Term Behavioral Health Visits
• Policy objectives
o Increase access to behavioral health services
o Provide early intervention
o Increase member options on where to receive care
o Offer interventions for non-covered diagnoses
• Operations
o Six fee for service sessions within twelve months
o Outside of the cap
o Masters-level or higher licensed behavioral health provider
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Pay for Increased Value:
Pay for Performance
Key Performance Indicators (KPIs)
The Behavioral Health Incentive Program
Flexible Funding Pool
Public Reporting
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o Outpatient and residential substance use disorder (SUD) treatment for pregnant
and parenting women, up to one year postpartum
o Only adult residential benefit in the state
o Admissions between January 2017 and November 2018: 277
History
o Legislation for pregnant women -> 60 days postpartum (1992)
o Legislation to extend to one year postpartum (2002)
o Legislation to implement a residential and inpatient SUD benefit (2018)
o Legislation to expand enrollment to post-partum women (2019)
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Special Connections
Other Programs• Prenatal Plus
o Enhanced perinatal service program for high-risk, pregnant members
o Members receive services of a care coordinator, dietitian and behavioral health professional: 4
different levels of services
o From 2013-2016, 10 providers at 22 sites in 9 counties served 6,500 members
o 48% received the Full Plus package that lower inadequate weight gain and prematurity rates when compared to
the general Health First Colorado population
• Nurse Family Partnership (NFP)
o Available in 64 counties to women who are pregnant or recently had first child, <200% FPL
o Managed by CDHS, University of Colorado, NFP National Services offices and Invest in Kids
o Funded through Tobacco Master Settlement Agreement; Maternal, Infant and Early Childhood Home
Visiting Block Grant; and Medicaid
o Working on a pilot program to increase Medicaid billing
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Other Initiatives• Perinatal Mood and Anxiety Disorders
o Screening allowable under the child’s ID (2015)
o Three screens in the first year postpartum (2017)
o Contributed to a 78% increase in the number of women screened between 2015 and 2018
o Participating in the creation of a web-based toolkit for pediatric providers (est. 2020)
• Enhancing SUD Service
o In partnership with Office of Behavioral Health
o Bi-directional co-located services pilots grants [OB/GYN services in Treatment Centers (2), and behavioral
health services in OB/GYN clinics(4)]
o Child care pilots for parenting women seeking treatment
• Hospital Quality Incentive Program
o Incentivizes hospitals to pursue WHO approved Baby Friendly Designation (evidence-based maternity services)
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Thank You!
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QUESTIONS FOR THE PANEL
DISCUSS AT YOUR TABLES
