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Special Report:
Policy Report: School-Based
Mental Health Services
Under Medicaid Managed Care
Conclusions and
Recommendations
Four main conclusions can be drawn from the experiences of
the three study sites:
1. Better understanding of the interrelationship
between community-based mental
health services and school-based mental
health services is needed. Changes in the
organization and delivery of mental health
services, including implementation of
Medicaid managed behavioral health care,
are altering the availability of mental
health services in the community. Such
changes are affecting the demand for mental
health services in schools.
2. SBHCs may have difficulty implementing
managed care organization contract
requirements, primarily because of insufficient
on-site support. SBHCs, sponsoring
agencies, and school-based mental health
clinicians appear to need more support to
handle requirements for documenting credentials,
negotiating rates, claims processing,
and following prior authorization and
record-keeping procedures.
3. In only a few instances were SBHC prevention-
oriented mental health services
covered by managed care contracts.
Contracts generally covered only diagnosis
and treatment of acute mental illness.
Study respondents suggested that
Medicaid incentives, through contracting
or financing mechanisms, could encourage
the inclusion of prevention-oriented mental
health services in managed care contracts
with SBHCs.
4. Many opportunities exist for enhancing
coordination across the agencies and
constituency groups involved with school-based
mental health services. Better coordination
might better ensure a comprehensive
nonduplicated system of care
for children that works financially and
administratively.
Recommendations for Future Study
Based on study findings, the following
areas of inquiry appear to warrant further
examination:
The impact of managed care and provider
network changes on children’s access to
community-based mental health services,
and the extent to which intensive treatment
of severely ill children is being shifted
to school-based providers. The hypothesis
is that a reduction in the number of
inpatient and residential providers, coupled
with restrictive prior authorization
procedures that block admissions to facilities,
have resulted in increased barriers to
care. The impact of these apparent
changes on children and schools needs to
be described and quantified further, to foster
improvement in the system and to
ensure that children receive needed and
appropriate mental health services.
An audit of school-based mental health
programs’ managed care arrangements, to assess if the relative benefits of collecting
third-party revenue outweigh the administrative
investment. The third-party revenue
being generated by SBHCs is not
currently a significant source of funding,
and the centers do not predict that they
will be self-sustaining. This is partly
because implementation problems prevent
centers from successfully collecting payment
for legitimate claims. It is also due
to the fact that centers provide mental
health services not typically covered by
insurance, and because they serve uninsured
children. Such an audit might help
centers to design feasibility assessments
and develop business plans before
making the decision to move into a
managed care arrangement.
Methods and options designed to integrate
or coordinate school-based mental
health programs and EPSDT/special education
school arrangements. Such integrated
services are one way to build a system
that supports the full value of SBHC services without forcing centers into the
"medical model" prevalent in traditional
managed care contracting. A study could
identify benefits and drawbacks of such
options, and delineate the constraints to
implementation.
Possible development of support structures
for the implementation of school-based
mental health program managed
care arrangements. Ideas to be explored
include the creation of regional technical
assistance resource centers to help local
communities solve community-specific
implementation problems, and the development
of local problem-solving "user
groups" that can help local programs
identify and solve implementation problems.
Another idea for consideration is the
development of regional "management
services organizations (MSOs)" and networked
groups of SBHCs, which would
provide business services for SBHCs and
for sponsoring agencies that lack the
capacity to negotiate and implement managed
care contracts.
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