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States allowing ACT teams to be funded by Medicaid?

  • 1.  States allowing ACT teams to be funded by Medicaid?

    National Council Staff
    Posted 01-24-2020 17:40
    Dear Association Executives - An Association Executive from a state with Medicaid managed care has asked us to inquire about other states that allow Assertive Community Treatment (ACT) teams to be funded by Medicaid.

    Specifically, does Medicaid managed care pay a monthly capitation rate for the teams?  Are there arrangements like this in Kentucky and Arizona?  Other states?

    Thank you for your help with this.

     



    ------------------------------
    Neal Comstock
    Director of Membership
    National Council
    NealC@TheNationalCouncil.org
    202 748-8793
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  • 2.  RE: States allowing ACT teams to be funded by Medicaid?

    National Council Staff
    Posted 01-27-2020 09:27

    I'm not aware of any. Look forward to hearing from others.

     

    Joe Parks
    Medical Director
    National Council for Behavioral Health
    1400 K Street NW Suite 400, Washington, DC 20005
    Direct: (202) 629-5791
    Email: JoeP@TheNationalCouncil.org
           
    www.TheNationalCouncil.org  
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  • 3.  RE: States allowing ACT teams to be funded by Medicaid?

    Posted 01-27-2020 10:43
    We had a good ACT rate at one time in Indiana.  When the state changed our Medicaid rehabilitation program in 2011, they eliminated the rate in support of ACT.  The ACT fidelity model requirements necessitate a rate that covers costs, including the prescriber on the team.   The issues due to elimination of the program continues to linger. Some of our CMHCS still maintain "ACT light" teams, however they have to cobble together reimbursements to cover costs. 

    Matt Brooks
    Indiana Council





  • 4.  RE: States allowing ACT teams to be funded by Medicaid?

    Posted 01-27-2020 11:23

    ACT is part of Medicaid Managed Care in NY. Billing codes and rates are available here: https://omh.ny.gov/omhweb/medicaid_reimbursement/

     

    Nadia Chait

    Associate Director of Policy & Advocacy

    The Coalition for Behavioral Health

    212-742-1600 x 206

     



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  • 5.  RE: States allowing ACT teams to be funded by Medicaid?

    Posted 01-27-2020 13:37

    Ohio has taken a hybrid approach that "approximates" a monthly case rate.  There are 4 payments available monthly:  1) prescriber; 2) licensed clinician and 2 additional payments for case management and/or peer services.  It's a bit complicated and works for some providers, but not all.  We are still advocating for a true case rate.

     

    The Ohio Medicaid rule governing the service can be found here:  http://codes.ohio.gov/oac/5160-27-04v1

     

    Payment information can be found on page 74:   https://bh.medicaid.ohio.gov/Portals/0/Providers/Manual/11-27-19%20BH%20Manual%20FV%201_10.pdf?ver=2019-11-27-105620-353

     

     

    Teresa Lampl, LISW-S, CEO 

    The Ohio Council of Behavioral Health & Family Services Providers

    35 E. Gay Street, Suite 401, Columbus, OH  43215 

    lampl@theohiocouncil.org   614-228-0747  |  www.theohiocouncil.org     

     

    Advocating Today for a Healthy Tomorrow

     

     






  • 6.  RE: States allowing ACT teams to be funded by Medicaid?

    Posted 01-27-2020 15:19
    In Massachusetts, our state Department of Mental Health has been a key payer for ACT (called PACT here), but we have for many years paid for PACT services under our PIHP.   As of 1/1/20, the state will be paying through our Medicaid managed care plans.  The rates (day rate) can be found here: https://www.mass.gov/regulations/101-CMR-43000-rates-for-program-of-assertive-community-treatment-services.    

    --

    Lydia Conley

    President/CEO

    251 West Central Street, Suite 21

    Natick, MA 01760

    Tel: 508.647.8385, x 11

    Email: lconley@abhmass.org


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