Behavioral Health Delivery Workgroup

In accordance with House Bill 413, Medicaid Amendments (2022 GS, Representative Dunnigan), the Department of Health and Human Services, Division of Integrated Healthcare has been tasked with forming a behavioral health working group to address specific issues identified in the bill.¹ Specifically, the legislation requires:

 “On or before May 31, 2022, the department shall convene a working group to collaborate with the department on: (a) establishing specific and measurable metrics regarding:(i) compliance of managed care organizations in the state with federal Medicaid managed care requirements; (ii) timeliness and accuracy of authorization and claims processing in accordance with Medicaid policy and contract requirements; reimbursement by managed care organizations in the state to providers to maintain adequacy of access to care; (iv) availability of care management services to meet the needs of Medicaid-eligible individuals enrolled in the plans of managed care organizations in the state; and (v) timeliness of resolution for disputes between a managed care organization and the managed care organization's providers and enrollees; (b) improving the delivery of behavioral health services in the Medicaid program; (c) proposals to implement the delivery system adjustments authorized under Subsection 26-18-428(3); and (d) issues that are identified by managed care organizations, behavioral health service providers, and the department.”

The working group will recommend to the Department specific and measurable metrics, including:

• How physical and behavioral health services may be integrated for the targeted adult Medicaid programs
• Ways to improve the delivery of behavioral health services to enrollees including changes to statute or administrative rule
• Wraparound service coverage for enrollees who need specific, nonclinical services to ensure a path to success

To accomplish this directive, HB 413 specifies that this working group will meet quarterly, at a minimum.