Health Law Daily CMS model responds to opioid crisis by improving behavioral health care for children
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Friday, August 24, 2018

CMS model responds to opioid crisis by improving behavioral health care for children

By Patricia K. Ruiz, J.D.

The Center for Medicare and Medicaid Innovation’s new Integrated Care for Kids Model aims to reduce expenditures and improve the quality of care for children covered Medicaid and the Children’s Health Insurance Program (CHIP). The interventions under this model will respond to the opioid crisis by supporting state Medicaid agencies and local health and community-based partners to increase access to behavioral health care for vulnerable children, improving the capacity in these communities to provide effective, efficient, and affordable care through home-and community-based services.

Treating behavioral health conditions in children and youth. According to a CMS fact sheet, behavioral health conditions in children and youth, including the use of opiates and other substances, result in significant morbidity, health care utilization, and premature death. Only one-third of children with behavioral health needs who rely on Medicaid and CHIP receive needed care. Adolescent deaths from drug overdose are increasing, with opiates causing more than half of drug-related overdoses.

Integrated Care for Kids Model. The model will support state and local providers in conducting early identification and treatment of children with health-related needs across settings. Participants will be required to integrate care coordination across physical and behavioral health. The model will also encourage shared accountability for cost outcomes over states and local providers through alternative payment models. These interventions should increase behavioral health access, respond to the opioid epidemic, and positively impact the health of the young generation.

The key participants in the model will be state Medicaid agencies and local "lead organizations," which will facilitate coordination and management of core child services (such as clinical care, schools, food, early care and education, housing, and child welfare) and take responsibility for improving population-level care quality and outcomes. Lead organizations will also develop service integration protocols and processes.

Implementation. CMS intends to award funding for up to eight states as early as spring 2019. The model includes a two-year pre-implementation period for CMS to collaborate with states and lead organizations to establish Medicaid and CHIP authorities and develop necessary infrastructure and procedures. Then, states and lead organizations will implement their models and report data to CMS over a five-year implementation period.

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