Final Rule | The Health Law Firm Blog

CMS Issues Conditions of Participation for Community Mental Health Centers

By Lance O. Leider, J.D., The Health Law Firm

On October 28, 2013, the Centers for Medicare and Medicaid Services (CMS) announced a Final Rule establishing conditions of participation (CoPs) for Medicare-certified community mental health centers (CMHCs). The Final Rule is CMS 3202-F. These conditions are the health and safety regulations Medicare providers must meet in order to participate in the Medicare program and receive reimbursements. The stated purpose of the CoPs is to improve client care, establish requirements for staff and provider operations, and encourage clients to participate in their own treatment. According to CMS, many CMHCs are currently not required to meet any health and safety standards.

To read the Final Rule from the CMS, click here.

A CMHC is a provider that meets applicable licensure and certification requirements in the state in which it is located and provides certain care and services.

Mental Health Centers Must Meet These New CoPs.

CMS finalized six new CoPs. All clients will have a treatment team, an active treatment plan, and coordination of services providing individualized client care. Clients must be provided with an initial evaluation, a comprehensive assessment, and a discharge or transfer plan that identifies each client’s needs and how those needs will be met on a timely basis. Also, CMHCs must use outcome and client satisfaction data to identify specific program needs and improve the quality of care provided. The regulations also promote continuity of care by emphasizing the need for communication with other service providers regarding client needs at the time of discharge or transfer.

In a press release, CMS stated that the new CoPs will help raise standards for the 100 CMHCs that participate in Medicare. The conditions will supposedly ensure a higher quality of care and safety for more than 13,000 Medicare beneficiaries being treated at mental health centers.

Click here to read the press release from the CMS.

Effective Date for New Requirements is October 29, 2014.

The regulations take effect on October 29, 2014. To verify CMHCs are meeting the new requirements, CMS will survey these centers at least once every five years. However, if CMS receives a complaint on a CMHC, surveys may occur more frequently. Considering the scrutiny that has been applied recently to the provision of mental health services, we expect surveys to be much more frequent.

Contact Health Law Attorneys Experienced in the Mental Health Counselors, Therapists and Facilities.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, social workers and family therapists in Department of Health (DOH) investigations, FBI investigations, audits and other types of investigations of health professionals and providers. Our attorneys also represent community mental health centers and other types of mental health facilities.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think of the new CoPs for CMHCs? How do you think these conditions will improve patient care? Please leave any thoughtful comments below.

Sources:

Centers for Medicare and Medicaid Services. “CMS Issues New Patient Safety Standards for Community Mental Health Centers.” CMS. (October 28, 2013). From: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-10-28.html

Bourque, Dianne. “CMS Finalizes Conditions of Participation for Community Mental Health Centers.” American Health Lawyers Association. (November 5, 2013).
About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

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Department of Health and Human Services Announces Mental Health Parity Final Rule

By Lance O. Leider, J.D., The Health Law Firm

On November 8, 2013, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the promulgation of the agency’s final rule related to parity of coverage of mental health and substance use treatment. According to Sebelius: “For way too long, the healthcare system has openly discriminated against Americans with behavioral health problems.”

The purpose of the regulations is to close the gaps in coverage that permit insurance carriers to treat mental and substance-abuse related treatment different from traditional medical and surgical benefits.

Among the key provisions of the regulations are the elimination of separate mental health deductibles, co-insurance, etc.; elimination of limits on lifetime benefits; as well as several other measures insuring that mental health benefits are treated on par with traditional medical and surgical benefits.

Compliance with the final rule will be required by group health plans and health insurance issuers offering group health insurance coverage on the first day of the first plan year beginning on or after July 1, 2014.

Click here to read the press release from the HHS.

Effects on Healthcare Providers.

From a business perspective, this final rule may change the type of coverage that is required to be offered by a practice to its employees. Likewise, employed practitioners may see changes in the way the coverage offered by their employers works.

Also, these rules may allow primary care providers to significantly limit their exposure to civil and administrative complaints resulting from the provision of basic mental health services. Often times patients who are unable to afford mental health coverage rely on their primary care physician for assistance. This sometimes leads to primary care doctors prescribing and managing medication for which they are inadequately trained or otherwise uncomfortable with.

By ensuring parity in coverage, primary care physicians should be able to make referrals to mental health providers with confidence that their patients will not face any artificial barriers to coverage.

Additionally, mental health providers will likely see an increase in patient volume and utilization. These increases will likely come from additional referrals from physicians as well as increased self-referrals from patients seeking to take advantage of their coverage.

Finally, with increased utilization comes increased revenue, and with increased revenue comes increased scrutiny. Private insurers have undertaken an auditing protocol that is remarkably similar to that of federal payors like Medicare, Medicaid, TRICARE, etc.

Considering the abuses that have been publicized in the mental health sector and the increased scrutiny coming from federal and state governments, we expect mental health providers will receive the same or similar audit treatment from private payors.

Be Prepared for Possible Change in Mental Healthcare Field.

Should the Affordable Care Act (ACA) ultimately serve to dramatically increase the number of Americans with insurance coverage, mental health providers may find themselves at the forefront of a rapidly expanding part of the healthcare field.

Be prepared for these changes by reviewing your processes and documentation. Consult with an experienced healthcare attorney or other similarly qualified expert to make sure your practice is ready.

The Health Law Firm Supports the Mental Health Parity Rule.

The Health Law Firm fully supports the Mental Health Parity Rule. The provision of mental health services for our citizens is long overdue.

Many fail to recognize the costs paid by our society to deal with those who have mental health issues outside of the healthcare system. Jails and prisons are often the final repository for those who should receive hospital treatment. Many individuals who are homeless, who are veterans, or who have serious mental health issues could lead constructive, productive lives if they receive proper mental health treatment.

Psychologists, psychiatrists, mental health counselors and social workers should be happy for the adoption of the regulation. In addition, law enforcement officials, judges and relatives of those with mental illness must also be thankful.

Contact Health Law Attorneys Experienced in the Representation of Mental Health Counselors, Psychologists, Social Workers, and Marital and Family Therapists.

The attorneys of The Health Law Firm provide legal representation to mental health counselors, psychologists, psychiatrists, social workers and family therapists in Department of Health (DOH) investigations, business transactions, contracts, structuring business ventures, clinical privileges actions, professional licensure matters, Board hearings, business litigation, Medicare and Medicaid audits, and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Were you familiar with the final mental health and substance use disorder parity rule? How do you think it will affect the mental healthcare field? Please leave any thoughtful comments below.

Source:

U.S. Department of Health and Human Services Press Office. “Administration Issues Final Mental Health and Substance Use Disorder Parity Rule.” U.S. Department of Health and Humans Services. (November 8, 2013). From: http://www.hhs.gov/news/press/2013pres/11/20131108b.html

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.