Hot Topics / Priority Issues

THURSDAY, SEP 27, 2018

National Council Publishes New Advocacy Guide on Managed Care Contracting

As states move more Medicaid services to managed care, the National Council for Behavioral Health has released Medicaid Managed Care Contracting, an advocacy guide to ensure mental health and addiction care is protected under managed care arrangements. Behavioral health providers are often subject to practices that restrict reimbursement and reduce patients’ options. The guide offers community behavioral health providers and associations talking points and sample contract language they can use with their state Medicaid agency to ensure Medicaid managed care will enhance behavioral health access.

Common contracting practices can pose difficulties for behavioral health providers aiming to serve Medicaid patients in managed care. For example, managed care organizations (MCOs) often refuse to contract with behavioral health providers who will not accept the proposed contract terms or require “All Products Clauses,” which can require providers to serve commercially-insured patients (in addition their Medicaid patients) at payment rates that may be lower than the Medicaid rate. There are also precedents for excluding certain services and reimbursing behavioral health providers at levels lower than Medicaid’s Fee-For-Service rates. These measures deprive providers of payment and limit patient choice.

While provider associations are not able to engage directly in contract negotiations between states and MCOs, they are able to influence state policies and regulations. To support state associations and behavioral health providers, the guide presents key challenges alongside example contract language to address common contracting issues. Talking points for state associations related to each issue are presented to strengthen advocacy efforts with state agencies. Since each state’s current legislation and regulations may differ, it is recommended that state associations understand current laws and regulations that may already exist to address these challenges.

The new Medicaid Managed Care Contracting guide contains thirteen chapters covering: refusal to contract, all product clauses, scope of services and covered services, prompt payment, payment rates, payment recoupments, medical necessity determinations, contract amendments, regulatory penalties, prohibitions on assignment, data reporting requirements and drug formularies and preferred drug lists.

Read the full guide here.