CMS Announces Opportunities to Expand Mental Health Treatment

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States have new opportunities available to expand their mental health services for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED), CMS announced this week. CMS reached out to state Medicaid directors to outline existing and new opportunities, including a new chance for states to receive authority to pay for short-term residential treatment services in an institution for mental disease for these patients.

Medicaid is the largest payer of behavioral health services, including mental health and substance abuse services, in the U.S. Approximately 10.4 million adults in the U.S. had an SMI in 2016, but only 65% received mental health services that year.

CMS currently offers states the flexibility to pursue similar demonstration projects under Section 1115 (a) of the Social Security Act, regarding substance use disorders, including opioid use disorder. CMS has so far approved this authority in 17 states, where it is already improving outcomes for beneficiaries. A CMS release cites early results in Virginia that show a 39% decrease in opioid-related emergency room (ER) visits, and a 31% decrease in substance use-related ER visits overall after implementation of the demonstration. CMS is now offering a way for the 12 states that have expressed interest in expanding access to community and residential treatment services for the full continuum of mental health and substance use disorders.

CMS also noted in its letter that existing resources can help address the following issues:

  • Earlier identification and engagement in treatment, including improved data-sharing between schools, hospitals, primary care, criminal justice, and specialized mental health providers to improve communications
  • Integration of mental healthcare and primary care that can help ensure early identification of individuals with SMI or SED and connection with the appropriate treatment sooner
  • Improved access to services for patients across the continuum of care, including crisis stabilization services and support to help transition from acute care back into their communities
  • Improved care coordination and transitions to community-based care
  • Increased access to evidence-based services that address social risk factors, including services designed to help individuals with SMI or SED maintain a job or stay in school

CMS has more information on the demonstration opportunity available online.