How to Negotiate Managed Medicaid Contracts to Improve Mental Health Care Access
When it comes to the issue of mental health care and substance use treatment, it’s imperative that states properly negotiate mental health and addiction parity protections into contracts with managed care organizations (MCOs) administering Medicaid plans. This includes empowering providers to challenge denials of medically necessary care.
To help promote timely and appropriate care for Medicaid recipients, the National Council for Behavioral Health has released an article outlining suggested contractual language that state Medicaid directors should consider when they negotiate managed care contracts. The primer is co-authored by Psych-Appeal’s Meiram Bendat.
“The potential confusion regarding the Mental Health Parity and Addiction Equity Act compliance requirements for Managed Care Organizations (‘MCOs’) in the Medicaid sector, as well as the often complicated medical necessity determination and appeal procedures may jeopardize an individual’s ability to obtain medically necessary care,” write the authors. “It is imperative that states negotiating Medicaid contracts with MCOs make use of new safeguards and mental health and addiction parity protections to ensure access to essential services for vulnerable populations. This includes empowering providers to effectively challenge adverse benefit determinations impacting their patients’ access to medically necessary care.”
In “Protecting Consumer Access to Mental Health and Addiction Care in Managed Medicaid Plans,” Bendat and the National Council for Behavioral Health outline eight points of discussion, along with proposed contract terms, that are focused on the appeals process and plan disclosure requirements:
- Communications,
- Standing,
- Access to plan documents,
- Access to clinical criteria,
- Network access,
- Negotiated coverage modifications,
- Access to claims data, and
- Denials implicating mental health and addiction parity.
These recommendations serve as a useful guide in clarifying the rights, expectations and responsibilities of all parties, including states, MCOs, patients and providers.
Psych-Appeal and the National Council for Behavioral Health have also compiled tips on how providers can negotiate contracts with MCOs.
NOTE: “Protecting Consumer Access to Mental Health and Addiction Care in Managed Medicaid Plans” is for educational purposes only. The incorporation of any of these recommendations into managed care contracts should be decided upon after consultation with qualified legal counsel.