Trillium Health Resources, a local management entity (LME)-managed care organization (MCO) in North Carolina, is providing targeted 10-30% rate increases for behavioral health services that are likely to experience higher costs to deliver during the coronavirus pandemic. Included in the rate enhancement are instances when providers might have to pay staff overtime when other workers are unable to work because of COVID-19 as well as hazard pay for those programs delivering care in higher risk environments like crisis care. Tom Betlach, Arizona’s former Medicaid director and the new interim director of the state’s Department of Economic Security, applauds the approach. “As Medicaid contemplates the many issues providers navigate, we hope they look to the leadership provided by North Carolina as the type of proactive actions necessary in this time of great need.”
On March 23rd, Trillium identified the specific services and funding sources that fall under the rate enhancement, which include State, Medicaid, and Medicaid Innovations funds for group living, facility-based crisis care, supervised living, community living facilities and support, intensive alternative family treatment, intermediate care facilities, residential treatment, supported living, and residential supports.
Trillium’s boosted support of crisis services highlights the importance of a robust mental health crisis continuum during a public health disaster. Nearly one in five adults—roughly 46.6 million people in 2017—live with a mental illness. Young adults experience a higher prevalence at slightly more than one in four. Mental health crisis services are a safety net, providing vital care to people in the community as they face isolation, stress, unemployment, housing instability, illness, and domestic abuse and child abuse, with cases increasing even though coronavirus restrictions are making it harder for victims to reach out.
We are in a national emergency, and creative solutions are necessary to maintain critical mental health and substance use treatment resources during a time in which we are seeing dramatic changes in how our communities can access outpatient care. Trillium’s decision to increase Medicaid reimbursement for crisis service providers offers a path to solidify the human resources necessary to maintain access to services that divert individuals from our justice system and emergency departments—locations that are not equipped to deliver needed behavioral health services and represent a higher risk of COVID-19 transmission.
As we explored in our recent article Amidst the Coronavirus Pandemic, States and Hospitals Turn to Telehealth, doctors in Italy have warned leaders in the United States that critical countermeasures must take place to combat COVID-19. They include mass quarantine, social distancing, and telehealth. On Friday, March 13th, in a live address in the White House rose garden, President Trump declared a national emergency. During his speech, he announced that he was giving Alex Azar, Health and Human Services secretary, broad authority to “waive provisions of applicable laws and regulations to give doctors, hospitals—all hospitals—and healthcare providers maximum flexibility to respond to the virus.” A week before, the president signed an $8.3 billion funding bill to combat the COVID-19 crisis and waived telehealth restrictions for Medicare beneficiaries. The language includes a provision to lift restrictions on telehealth services for Medicare beneficiaries so that Americans—especially people at higher risk of experiencing complications if infected with COVID-19—are aware of accessible, easy-to-use benefits that can keep them healthy “while helping to contain the community spread” of the virus. The Centers for Medicare & Medicaid Services (CMS) released a fact sheet, reviewing expanded Medicare telehealth services and payment for virtual services. The agency stated that the changes will allow beneficiaries to “receive a wider range of services from their doctors without having to travel to a healthcare facility.”
Simultaneously, governors, state by state, are using emergency declaration to further increase telehealth access, including relaxing both physician licensure and Medicaid telehealth requirements.
As more mental health care services shift to telehealth, there will likely be an increase in the number of people served at the essential crisis facilities that remain open. Among the waived regulations highlighted by President Trump on March 13th are restrictions on hospital bed limits, inpatient length of stay, new physician hiring, office space, and caring for patients within the facility to “ensure that the emergency care can be quickly established.” Service providers are continuing to prepare to serve more people in their crisis receiving and stabilization centers. There are already increases in some communities, though precisely what this will look like is unknown. At the same time, COVID-19 restrictions have resulted in reduced outpatient treatment options and, to maintain social distancing, shifts in how providers work.
As a nation, we continue to monitor the advancing 1135 waivers approved by CMS for states that position communities with far greater flexibility to meet the needs of their residents. Trillium Health Resources has taken the vital step of advancing funding to address the staffing challenges that are quickly creating fiscal strains on organizations dedicated to offering face-to-face care during this national emergency.
What’s happening in your community regarding emergency declarations and mental healthcare? Let us know at firstname.lastname@example.org.