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Special Report:
Policy Report: School-Based
Mental Health Services
Under Medicaid Managed Care
Executive Summary
This study sought to learn how schools and providers of
school-based mental health services work with Medicaid
managed care organizations. To that end, it observed
the experiences of several States and local communities in providing for
the inclusion of school-based mental health services in managed care
contracts. The study also explored options and models for including
school-based mental health services within managed care; examined
financing and reimbursement issues that might affect the viability and
expansion of such services; and assessed alternative ways to maintain
and expand school-based mental health services within the managed
care environment.
A multidisciplinary team with experience
in mental health, school health, and health
care financing conducted the study. Site visits
were conducted in three states: New Mexico,
Maryland, and Connecticut. The chosen sites
had well-established school-based mental
health programs and were actively implementing
managed care contracts with local
Medicaid managed care organizations
(MCOs).
The study revealed that providers of
school-based mental health services and
administrators of the programs struggle to
solve numerous logistical and administrative
problems that are inherent to the startup
of new business arrangements for service
delivery, service coordination, and reimbursement.
The partnerships between school-based
programs and managed care organizations
are relatively new. Many of the
problems associated with these new partnerships
are likely to be growing pains, which
will resolve over time. While study respondents had doubts about the feasibility and
value of contracting with managed care
organizations, they acknowledged that working
with these organizations brings school-based
mental health programs into the main-stream
of health care financing, establishes
credentials of school-based providers, and
improves accountability.
The main study conclusions are that
school-based mental health programs need
more support to effectively and efficiently
implement managed care contracts, and that
policy leaders should consider other options
for capturing third-party insurance revenue
in addition to traditional behavioral health
managed care network provider contracts.
Specific study findings include the following:
1. At the study sites, the sponsoring agencies
for school-based mental health services
successfully negotiated contracts with
Medicaid managed care plans. However,
these arrangements varied greatly in their
complexity, ease of implementation, and results regarding revenue generation
and barrier-free access to mental health
services.
2. Schools that had mental health clinicians
prior to managed care still had those
clinicians. Providers were not shifted into
other service venues because of managed
care network pressures or decisions to end
school-based health center (SBHC) services.
Barriers to care emerged from administrative
policies, not from a loss of mental
health clinicians providing services in the
schools.
3. Sponsoring agencies, State Medicaid
agencies, and MCOs lacked understanding
about the full scope and value of school-based
mental health services and the role
that such services can play within the
overall system of care for children. The
decision to collect third-party dollars
through MCOs was not grounded in carefully
thought-out strategic plans consistent
with the philosophical base and principles
supporting school-based mental health
services.
4. The implementation of managed care may
have changed access to community-based
mental health services and may also have
changed the mix of available community-based
services. This affected the demand
for mental health services within the
school and the level of care needed by
children attending school.
5. The study team observed a number of
missed opportunities for enhanced coordination
between school-based mental
health programs and other school health
services.
Study recommendations included exploring
ways to help school-based mental health
programs develop the needed skill and infrastructure
to implement viable managed care
contracts, defining other approaches to generate
Medicaid revenue for school-based
mental health care, and improving coordination
between school mental health programs
and other school health programs.
The evaluation team also identified the
need for further research to understand and
quantify the effects of managed care on the
availability and mix of community-based
mental health services, and, consequently,
on the demand for school-based mental
health services.
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