What GAO Discovered
The Defending Entry to Medicare Act of 2014 (PAMA) established the Licensed Neighborhood Behavioral Well being Clinics (CCBHC) demonstration and tasked the Division of Well being and Human Companies (HHS) with its implementation. CCBHCs goal to enhance the behavioral well being companies they supply, significantly for Medicaid beneficiaries. Initially established for a 2-year interval, the demonstration has been prolonged by regulation plenty of occasions; most not too long ago, it was prolonged to September 2023. States collaborating within the demonstration can obtain Medicaid funds, in keeping with federal necessities, for CCBHC companies supplied to beneficiaries.
PAMA additionally required HHS to evaluate the impact of the demonstration on service entry, prices, and high quality. HHS’s preliminary assessments of the demonstration in eight states, with 66 collaborating CCBHCs, discovered the next:
- Entry. CCBHCs generally added companies associated to psychological and behavioral well being, akin to medication-assisted therapy, and took actions to offer companies exterior the clinic setting, akin to by telehealth.
- Prices. States’ common funds to CCBHCs usually exceeded CCBHC prices for the primary 2 years of the demonstration. CCBHC funds and prices have been extra carefully aligned within the second yr for many states, higher reflecting the fee strategies prescribed below the demonstration.
- High quality. States and CCBHCs took steps, akin to implementing digital well being information methods, to report efficiency on 21 high quality measures.
GAO discovered information limitations sophisticated—and can proceed to have an effect on—HHS’s efforts to evaluate the effectiveness of the demonstration. For instance:
- Lack of baseline information. PAMA requires HHS to evaluate the standard of companies supplied by CCBHCs in contrast with non-participating areas or states. The demonstration marked the primary time these clinics reported efficiency on high quality measures, so no historic baseline information exist. HHS officers famous that with time, extra information could present perception on the standard of companies.
- Lack of comparability teams. PAMA requires HHS to check CCBHCs’ efforts to extend entry and enhance high quality with non-participating clinics and states. HHS was unable to determine comparable clinics or states as a result of vital variations among the many communities.
- Lack of element on Medicaid encounters. PAMA requires HHS to evaluate the impact of the demonstration on federal and state prices and on Medicaid beneficiaries’ entry to companies. HHS plans to make use of Medicaid claims and encounter information to evaluate such adjustments. Nonetheless, GAO has beforehand recognized issues with the accuracy and completeness of Medicaid information and has made quite a few suggestions aimed toward bettering their high quality.
HHS’s selections in implementing the demonstration additionally sophisticated its evaluation efforts. HHS allowed states to determine totally different program targets and goal populations, and to cowl totally different companies. HHS additionally didn’t require states to make use of normal billing codes and billing code modifiers it developed. The shortage of standardization throughout states restricted HHS’s capability to evaluate adjustments in a uniform method.
Why GAO Did This Examine
Behavioral well being situations—psychological well being points and substance use problems—have an effect on thousands and thousands of individuals. HHS estimates that 61 million adults had not less than one behavioral well being situation in 2019—41 million of whom didn’t obtain any associated therapy within the prior yr.
Many people with behavioral well being situations depend on group psychological well being facilities for therapy, however the scope and high quality of those companies differ. To enhance community-based behavioral well being companies, PAMA created the CCBHC demonstration and supplied HHS with $25 million to help its implementation.
PAMA directed HHS to evaluate the demonstration and to offer suggestions for its continuation, modification, or termination. To this point, HHS has issued three annual studies assessing the preliminary demonstration interval, which ran from 2017 to 2019. HHS plans to situation a fourth annual report and a closing report by December 2021.
This report describes HHS’s evaluation of the demonstration concerning entry, prices, and high quality. Underneath the CARES Act, GAO is to situation one other report on states’ experiences by September 2021.
GAO reviewed federal legal guidelines and laws; HHS steerage; and HHS’s assessments of the demonstration, together with three issued studies, interim studies, and the evaluation plan for future studies. GAO additionally interviewed HHS officers and officers from organizations conversant in group well being clinics.
HHS supplied technical feedback, which GAO included as applicable.
For extra info, contact Carolyn L. Yocom (202) 512-7114 or firstname.lastname@example.org.