Medicare Compliance & Reimbursement

A number of states have come up with novel and successful Medicaid approaches to provide mental health care for children and young adults, according to child mental health expert and advocate Janice L. Cooper, PhD, in recent testimony to Congress. Cooper explains that the purpose of her testimony was to "point out to legislators and plead with them about the need to ensure that funding supports what works for children, youth and their families -- or at least what works to the best of our knowledge." Instead, however, "Medicaid policy is moving in the opposite direction," cautions Cooper, director of child health and mental health for the National Center for Children in Poverty and a public health professor at Columbia University. States using "out-of-the-box" thinking and approaches compared to traditional Medicaid programs include the following, according to Cooper: New York: The outgoing Pataki administration launched an initiative that represents one of the largest investments in community-based mental health services for children and youth, says Cooper. "ClinicPlus, a $33 million initiative, is designed to significantly increase the capacity of community mental health," she says. The initiative includes enhanced reimbursement rates for community mental health visits. It also includes a strong focus on early intervention and treatment, and on the delivery of school-based mental health services. Simultaneously, New York established an evidence-based treatment dissemination center funded by the National Institute of Mental Health (NIMH) and the State of New York. The center plans to train over 600 providers. More than 200 clinicians have already been trained in trauma-focused cognitive behavioral therapy, an evidence-based treatment. The idea of the center is to improve the capacity and competency of the workforce to deliver proven clinical strategies starting with trauma-based cognitive behavioral therapy, says Cooper. The center will then move on to other evidence-based practices until there is a "proliferation of clinicians trained in evidence-based treatment." Cooper notes that a lot of research shows that what is provided as "treatment as usual" lacks efficacy. Thus, there's a push by mental health experts to move to treatment modalities that have an empirical base and have been tested. There's always the cautionary note that some evidence-based treatments have not been tested for populations of color, the extremely poor or native cultures, Cooper concedes. "But there has been an adaptation of some practices to make them more culturally relevant, and trauma-focused cognitive-based therapy is one of these," she says. Oregon: In 2003, the State of Oregon passed legislation mandating that within five years, 75 percent of all state human services funding must support evidence-based programs, including those for children and youth in the mental health and juvenile systems. "The state and stakeholders in mental health have worked to [...]