How Providers Can Negotiate Managed Care Contracts
A common question we’re asked by providers is to how to negotiate mental health and addiction parity protections into managed care contracts. The inclusion of specific, contractual language into contracts with managed care organizations (MCOs) that administer both commercial and Medicaid plans offers multiple benefits. These provisions can help providers act on behalf of patients, obtain relevant claims data, and access plan documents, including criteria used by plans in determining medical necessity.
Psych-Appeal’s Meiram Bendat, in collaboration with the National Council for Behavioral Health, has written “Tips for Providers on Negotiating Managed Care Contracts to Improve Access to Mental Health and Addiction Care.” This toolkit outlines suggested language that can enable providers to represent clients in a streamlined appeals process, with a focus on:
- Standing,
- Access to plan documents,
- Access to clinical criteria,
- Access to claims data, and
- Denials implicating mental health and addiction parity.
By learning how to negotiate and incorporate protections into managed care contracts, mental health and addiction providers can further advocate for their patients.
“It is imperative that mental health and addiction providers make use of new safeguards to advocate on behalf of their vulnerable patients to ensure patients receive timely and appropriate care,” write Bendat and the National Council for Behavioral Health. “While all of the provisions outlined are important to ensure adequate protection for providers and consumers, if all of them cannot be inserted, the inclusion of any of them will better enable providers to assist patients to access medically appropriate care.”
Psych-Appeal and the National Council for Behavioral Health have also compiled tips for state Medicaid directors negotiating contracts with MCOs.
NOTE: “Tips for Providers on Negotiating Managed Care Contracts to Improve Access to Mental Health and Addiction Care” 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.