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…
