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Mental Health Service Reimbursement
How have changes in reimbursement and medications been a major driver in these policy and treatment changes?
As a Chief Nursing Officer, one must be at once informed of the practical, day-to-day challenges of nursing in the field and of the administrative realities shaping the occupation. With respect to the latter, it is important to understand the implications of insurance, Medicare and coverage terms and conditions. These frequently complex terms will have a direct impact on the experience of providing treatment. This is well demonstrated in a discussion on coverage vagaries relating to mental health treatment reimbursement. Especially with so many changes now taking place in the healthcare field, there is practical value in understanding the emergent conditions of mental health coverage.
The most immediate and impactful change in mental health coverage relates to the historical limitations placed...
Insurance companies first and, consequently, Medicare and Medicaid, placed caps on the amount of coverage that could be received for extended treatment on individual conditions This model persisted well into the 1990s and was an extension of the fee for service approach driving the healthcare reimbursement system on the whole. (Williams & Torrens, p. 9)
A troubling consequence of this system was the burden placed on individual system users, who would be required to pay high deductibles, co-payments and other cost-containment-based fees. A major transition would come with the adoption of managed healthcare, where more individualized plans would allow for a broader array of coverage options for patients. For those of us in the nursing profession, this change would result in a great deal more latitude in prescribing mental health treatment options. This is because the managed care approach relies on an…
Works Cited:
Centers for Medicare & Medicaid Services (CMS). (2013). Medicare and Your Mental Health Benefits. Medicare.gov.
Geriatric Mental Health Foundation (GMHF). (2012). Paying for Mental Health Services Under Medicare. GMHFonline.org.
Williams, S.J. & Torrens, P.R. (2007). Introduction to Health Services. Cengage Learning.
097 United States 0.109 0.093808 0.036112 0.068 Utah 0.1071 0.1401 0.035696 0.073 Vermont 0.1326 0.0988 0.040851 0.114 Virgin Islands NA NA NA Virginia 0.1048 0.0829 0.080009 0.092 Washington 0.1229 0.0669 0.027831 0.068 West Virginia 0.1293 0.0774 0.036499 0.055 Wisconsin 0.0954 0.0357 0.032367 0.097 Wyoming 0.1251 0.1453 0.053867 0.075 Notes All spending includes state and federal expenditures. Growth figures reflect increases in benefit payments and disproportionate share hospital payments; growth figures do not include administrative costs, accounting adjustments, or costs for the U.S. Territories. Definitions Federal Fiscal Year: Unless otherwise noted, years preceded by "FY" on statehealthfacts.org refer to the Federal Fiscal Year, which runs from October 1 through September 30. for example, FY 2009 refers to the period
Access to Health Services is one of the main objectives of Healthy People 2020. As the Office of Disease Prevention and Health Promotion (ODPHP, 2017) notes, acces to quality health care services is essential for sustaining and promoting healthy communities, preventing the spread of disease, and eliminating unnecessary disabilities and deaths for Amerircans. While insurance coverage has been expanded thanks to the ACA (Somanader, 2016), timeliness of care and access
Utilization of the data and collection of the data should be one of the main aims of the policy makers. The data can be used by the policymakers in order to develop the policies and implement these in order to make sure that improvement can be ensured (Basch, 2011, p. 9). 3. One of the main roles that can be played by the policy makers includes reviewing the policies that
Fault: An Alternative to the Current Tort-Based System in England and Wales The United Kingdom statistics regarding claims THE NATIONAL HEALTH SYSTEM OBSTACLES TO DUE PROCESS THE CASE FOR REFORM THE REGULATORY ENVIRONMENT THE RISING COST OF LITIGATION LORD WOOLF'S REFORMS MORE COST CONTROLS THE UNITED STATES PAUL'S PULLOUT THE INSURANCE INDUSTRY TORT REFORM IN AMERICA FLEEING PHYSICIANS STATISTICS FOR ERROR, INJURY AND DEATH THE CALL FOR REFORM IN 2003: A FAMILIAR REFRAIN THE UNITED STATES SITUATION, IN SUMMARY NEW ZEALAND CASE STUDIES THE SWEDISH SCHEME COMPARISON: WHICH SYSTEM IS
……Pre-diabetes and Diabetes Early Awareness Education and Its Effects on BMISubmitted by:Nancy L. Gee Comment by Pamela Love: Looks like an interesting project, Nancy.Very good start! Be sure whenever you submit your manuscript that you change wording from �study� to �project� and avoid referring to the project as research. Review carefully for grammar, punctuation, sentence structure, format, or APA errors. Pay close attention to the reviewer�s comments as you continue
(Feldman & Greenberg, 2005, p. 67) Staffing coordinators, often nurse leaders must seek to give priority to educational needs as a reason for adjusting and/or making schedules for staff, including offering incentives to staff not currently seeking educational goals for assisting in this priority regardless of the implementation of a tuition reimbursement program. (Feldman & Greenberg, 2005, p. 233) Nurse Leaders as Academic Theorists The fact that many nurse leaders serve