CMS to Mandate State Reporting of Behavioral Health Quality Data

The US Centers for Medicare & Medicaid Services (CMS) could require states to report additional health quality data, including more behavioral health quality data.

A proposed rule released late Thursday, if finalized, would require states to report behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid. States used to do this on a voluntary basis, but CMS is looking to make it mandatory in the future.

“Data reported in 2024 will reflect care provided in calendar year 2023,” a related CMS announcement reads. “National reporting of metrics packages will create opportunities to develop a national vision for quality in Medicaid and CHIP programs – a goal long sought after by public health advocates.”

Other measures affected by the proposed rule include the Children’s Health Care Quality Measure Set for Medicaid and CHIP, as well as the Home Care Quality Measure Sets for Medicaid.

“CMS will use all available levers to ensure a high quality of care for everyone with Medicaid and CHIP coverage,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “By requiring states to report key sets of quality metrics, we can ensure that our policies are underpinned by data representing all of our beneficiaries.”

The 60-day comment period for the proposed rule ends October 21, 2022. The rule in its entirety is available on the Federal Register.

CMS had identified a core set of 20 behavioral health measures for voluntary reporting by state agencies Medicaid and CHIP. Here are some examples :

— Management of antidepressants

— Depression screening and follow-up plan (with different measures depending on age)

— Follow-up after hospitalization for mental illness (again, with different measures depending on age)

— Adherence to antipsychotic medication for people with

— Concomitant use of opioids and benzodiazepines

Also note: The proposed rule is intended to better define “behavioral health” and “behavioral health measures,” as federal definitions currently vary depending on the source.

“We currently do not have a definition of behavioral health for use in the adult core set for self-reporting and not all measures relevant to behavioral health are included in the behavioral health domain of the basic set for adults, as these measures cover several areas. says the proposed 85-page rule. “For example, the measure ‘Depression screening and follow-up plan’ is in the ‘Access to primary care and preventive care’ domain on the adult core set because it is provided within the primary care setting. However, we believe it is clearly a behavioral health measure as well.

Children’s mental health

At the same time, CMS announced two new guidance documents for state Medicaid programs focused on youth mental health.

The two new documents for state Medicaid programs outline the requirement to cover youth behavioral health services. The CMS also included a guidance document on expanding school-based health care, particularly mental health services.

“As we begin the school year, one of the Biden administration’s top priorities is to ensure that all children have access to the full range of care and support they need to stay healthy. and thrive, including mental health services,” the US Department of Health and Human Affairs said. Services Secretary Xavier Becerra said in a press release. “For the millions of children covered by Medicaid and CHIP, this means working with states to ensure they pull every lever to strengthen and expand comprehensive access to mental health care for children.”

In late July, the White House pledged nearly $300 million to expand mental health services in schools.

Legislative efforts, including the bipartisan guns and mental health reform bill passed in June, also put in place several additional resources and programs to deepen mental health resources in schools.

About John Tuttle

Check Also

10 Keys to a Successful Pharmacy Audit Call | CP Oberheiden

Medicare, Medicaid, and Pharmacy Benefit Manager (PBM) audits can result in substantial losses for pharmacies. …