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style="width:100%;height:90px;text-align:center;margin: 0 auto;"> <div id='div-gpt-behavioralhealth_adunitb'> <script> window.addEventListener('gpt-slots-ready', () => { googletag.cmd.push(function() { googletag.display('div-gpt-behavioralhealth_adunitb'); }); }); </script> </div> </div></div> <div class="grid-container"> <div class="grid-col single-content-column "> <header class="page-header archive-header"> <h1 class="page-title archive-title heading-with-border">Category: <span>Medicare</span></h1> </header> <div class="posts-feed"> <article id="post-8501" class="entry-block entry-block-with-excerpt post-8501 post type-post status-publish format-standard has-post-thumbnail hentry category-bhb-plus category-commercial category-featured category-finance category-medicaid category-medicare category-original-story category-reimbursement tag-elevance-health tag-learn-behavioral tag-molina tag-ophelia tag-optum tag-the-cigna-group tag-unitedhealthcare amn_content_type-featured amn_word_count-over-1200"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/featured/" class="post-category post-category-tag"><span>Featured</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/11/14/medicaid-elevated-behavioral-health-utilization-had-payers-talking-in-q3/">Medicaid, Elevated Behavioral Health Utilization Had Payers Talking in Q3</a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/mgonzales/">Morgan Gonzales</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-11-14T11:40:42-06:00">November 14, 2024</time><time class="updated" datetime="2024-11-14T11:40:45-06:00">November 14, 2024</time></span> </div> </div>  <div class="thumbnail-holder"> <a href="https://bhbusiness.com/2024/11/14/medicaid-elevated-behavioral-health-utilization-had-payers-talking-in-q3/"> <img width="150" height="115" src="data:image/svg+xml,%3Csvg%20xmlns='http://www.w3.org/2000/svg'%20viewBox='0%200%20150%20115'%3E%3C/svg%3E" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="A person's hands are interlaced on a table. In front of them is a laptop with financial graphs, a yellow mug, and a calculator." decoding="async" data-lazy-src="https://bhbusiness.com/wp-content/uploads/sites/7/2024/11/pexels-anna-nekrashevich-6801647-150x115.jpg" /><noscript><img width="150" height="115" src="https://bhbusiness.com/wp-content/uploads/sites/7/2024/11/pexels-anna-nekrashevich-6801647-150x115.jpg" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="A person's hands are interlaced on a table. In front of them is a laptop with financial graphs, a yellow mug, and a calculator." decoding="async" /></noscript> </a> </div>  </header> <div class="entry-content"> <p>The ongoing need for behavioral health services will be no surprise to anyone involved in the industry. Patients continue to have high rates of need and often present with greater acuity. This demand for behavioral health services was reflected across payers’ Q3 earnings calls. The result? Sky-high utilization levels. For example, David Cordani, the CEO […]</p> </div> </article> <article id="post-8469" class="entry-block entry-block-with-excerpt post-8469 post type-post status-publish format-standard hentry category-commercial category-medicaid category-medicare category-operations category-outpatient category-psychiatric-care category-reimbursement tag-lifestance-health amn_content_type-news amn_word_count-350-700"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/facility-type/outpatient/" class="post-category post-category-tag"><span>Outpatient</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/11/07/lifestance-surpasses-2024-forecasts-but-predicts-rockier-waters-ahead/">Lifestance Surpasses 2024 Forecasts But Predicts Rockier Waters Ahead </a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/mgonzales/">Morgan Gonzales</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-11-07T15:24:41-06:00">November 7, 2024</time><time class="updated" datetime="2024-11-07T15:24:44-06:00">November 7, 2024</time></span> </div> </div>  </header> <div class="entry-content"> <p>LifeStance Health (Nasdaq: LFST) is overhauling its facilities with a new operating model — one that it hopes will strengthen its position ahead of what executives expect to be a rocky 2025. The outpatient mental health giant’s executives project that federal reimbursement rate cuts will challenge the company’s financial progress. LifeStance is banking on momentum […]</p> </div> </article> <article id="post-8452" class="entry-block entry-block-with-excerpt post-8452 post type-post status-publish format-standard hentry category-commercial category-depression category-medicaid category-medicare category-original-story category-reimbursement tag-headway tag-the-national-quality-forum amn_content_type-news amn_word_count-701-1200"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/reimbursement/" class="post-category post-category-tag"><span>Reimbursement</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/11/05/major-insurance-companies-back-new-behavioral-health-measurement-standards-program/">Major Insurance Companies Back New Behavioral Health Measurement Standards Program</a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/mgonzales/">Morgan Gonzales</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-11-05T07:00:00-06:00">November 5, 2024</time><time class="updated" datetime="2024-11-05T08:03:17-06:00">November 5, 2024</time></span> </div> </div>  </header> <div class="entry-content"> <p>The National Quality Forum (NQF) has partnered with a coalition of health plans and the national digital therapy enablement platform Headway to create a new assessment tool that standardizes how behavioral health clinicians measure the progress of care. The behavioral health industry, across specialties, has struggled with a lack of a standardized data measurement set. […]</p> </div> </article> <article id="post-8371" class="entry-block entry-block-with-excerpt post-8371 post type-post status-publish format-standard hentry category-bhb-plus category-compliance category-fraud category-medicaid category-medicare category-regulation tag-polsinelli amn_content_type-news amn_word_count-701-1200"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/regulation/compliance/" class="post-category post-category-tag"><span>Compliance</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/10/18/court-ruling-could-massively-curb-health-care-litigation-what-behavioral-health-operators-should-know/">Court Ruling Could Massively Curb Health Care Litigation: What Behavioral Health Operators Should Know</a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/matthewblake/">Matthew Blake</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-10-18T09:31:52-05:00">October 18, 2024</time><time class="updated" datetime="2024-10-18T09:31:54-05:00">October 18, 2024</time></span> </div> </div>  </header> <div class="entry-content"> <p>A Florida federal court ruling issued last month could lead to a “massive sea change” in what lawsuits can be brought against behavioral health companies. That is the interpretation of Gregory Jones, a principal at the law firm Polsinelli’s Los Angeles office, who represents health care companies, including in False Claims Act (FCA) cases. FCA […]</p> </div> </article> <article id="post-8301" class="entry-block entry-block-with-excerpt post-8301 post type-post status-publish format-standard has-post-thumbnail hentry category-addiction-treatment-business category-medicare category-regulation category-substance-abuse tag-baymark-health-services amn_word_count-350-700"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/addiction-treatment-business/" class="post-category post-category-tag"><span>Addiction Treatment Business</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/10/16/baymark-calls-for-incentives-to-serve-rural-areas-changes-in-medicare-advantage/">BayMark Calls for Incentives to Serve Rural Areas, Changes in Medicare Advantage</a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/matthewblake/">Matthew Blake</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-10-16T15:20:42-05:00">October 16, 2024</time><time class="updated" datetime="2024-10-16T15:20:44-05:00">October 16, 2024</time></span> </div> </div>  <div class="thumbnail-holder"> <a href="https://bhbusiness.com/2024/10/16/baymark-calls-for-incentives-to-serve-rural-areas-changes-in-medicare-advantage/"> <img width="150" height="115" src="data:image/svg+xml,%3Csvg%20xmlns='http://www.w3.org/2000/svg'%20viewBox='0%200%20150%20115'%3E%3C/svg%3E" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="Addiction Treatment Business logo illustrates Bradford Health Services M&A" decoding="async" data-lazy-src="https://bhbusiness.com/wp-content/uploads/sites/7/2023/10/2023-Addiction-WP-assets_featuredImg-posts-150x115.png" /><noscript><img width="150" height="115" src="https://bhbusiness.com/wp-content/uploads/sites/7/2023/10/2023-Addiction-WP-assets_featuredImg-posts-150x115.png" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="Addiction Treatment Business logo illustrates Bradford Health Services M&A" decoding="async" /></noscript> </a> </div>  </header> <div class="entry-content"> <p>Companies that treat opioid use disorder could commend themselves last month when the federal government reported overdose deaths were down nearly 11% for the first eight months of 2024, marking the second-straight year of decline. “It’s fantastic news,” Jason Kletter, president of BayMark Health Services, told Addiction Treatment Business. “It’s something to celebrate.” But the […]</p> </div> </article> <article id="post-8272" class="entry-block entry-block-with-excerpt post-8272 post type-post status-publish format-standard hentry category-compliance category-fraud category-hospitals-and-health-systems category-medicaid category-medicare category-regulation tag-acadia-healthcare amn_content_type-news amn_word_count-350-700"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/regulation/" class="post-category post-category-tag"><span>Regulation</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/09/26/acadia-to-pay-19-85m-to-settle-whistleblower-allegations-relating-to-medically-unnecessary-inpatient-behavioral-health-services/">Acadia to Pay $19.85M to Settle Whistleblower Allegations Relating to Medically Unnecessary Inpatient Behavioral Health Services</a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/mgonzales/">Morgan Gonzales</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-09-26T22:36:43-05:00">September 26, 2024</time><time class="updated" datetime="2024-09-27T08:43:45-05:00">September 27, 2024</time></span> </div> </div>  </header> <div class="entry-content"> <p>Behavioral health care giant Acadia Healthcare (Nasdaq: ACHC) will pay $19.85 million to the U.S. and several states’ governments to resolve allegations that it knowingly billed for medically unnecessary behavioral health services and endangered patients. The U.S. Department of Justice (DOJ) alleged that Acadia falsely billed Medicare, Medicaid and TRICARE for inpatient behavioral health services […]</p> </div> </article> <article id="post-8271" class="entry-block entry-block-with-excerpt post-8271 post type-post status-publish format-standard has-post-thumbnail hentry category-addiction-treatment-business category-medicaid category-medicare category-substance-abuse tag-hhs tag-oig amn_content_type-news amn_word_count-350-700"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/addiction-treatment-business/" class="post-category post-category-tag"><span>Addiction Treatment Business</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/09/26/oig-audit-reveals-gaps-in-opioid-medication-access/">OIG Audit Reveals Gaps in Opioid Medication Access</a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/matthewblake/">Matthew Blake</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-09-26T15:29:22-05:00">September 26, 2024</time><time class="updated" datetime="2024-09-26T15:29:25-05:00">September 26, 2024</time></span> </div> </div>  <div class="thumbnail-holder"> <a href="https://bhbusiness.com/2024/09/26/oig-audit-reveals-gaps-in-opioid-medication-access/"> <img width="150" height="115" src="data:image/svg+xml,%3Csvg%20xmlns='http://www.w3.org/2000/svg'%20viewBox='0%200%20150%20115'%3E%3C/svg%3E" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="Addiction Treatment Business logo illustrates Bradford Health Services M&A" decoding="async" data-lazy-src="https://bhbusiness.com/wp-content/uploads/sites/7/2023/10/2023-Addiction-WP-assets_featuredImg-posts-150x115.png" /><noscript><img width="150" height="115" src="https://bhbusiness.com/wp-content/uploads/sites/7/2023/10/2023-Addiction-WP-assets_featuredImg-posts-150x115.png" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="Addiction Treatment Business logo illustrates Bradford Health Services M&A" decoding="async" /></noscript> </a> </div>  </header> <div class="entry-content"> <p>A federal audit released last week found that, despite changes in the law, Medicare and Medicaid enrollees may not have access to medications for opioid use disorder (OUD). In assessing why swaths of the country have spotty or nonexistent access to the federally approved medications methadone and buprenorphine, the U.S. Department of Health and Human […]</p> </div> </article> <article id="post-8222" class="entry-block entry-block-with-excerpt post-8222 post type-post status-publish format-standard hentry category-commercial category-depression category-medicaid category-medicare category-outpatient category-psychiatric-care category-reimbursement tag-brightside-health amn_content_type-news amn_word_count-350-700"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/facility-type/outpatient/" class="post-category post-category-tag"><span>Outpatient</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/09/17/citing-increased-payer-and-health-system-demand-brightside-health-expands-into-teen-mental-health-services/">Citing Increased Payer and Health System Demand, Brightside Health Expands into Teen Mental Health Services</a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/mgonzales/">Morgan Gonzales</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-09-17T06:00:00-05:00">September 17, 2024</time><time class="updated" datetime="2024-09-16T15:36:44-05:00">September 16, 2024</time></span> </div> </div>  </header> <div class="entry-content"> <p>Behavioral health providers are increasingly expanding care continuums to include teenagers and meet the growing need for age-specific care. Virtual behavioral health provider Brightside Health is the latest to do so. Announced Tuesday, its expansion into care options for teens aims to address what Brad Kittredge, founder and CEO of Brightside, calls a “teen mental […]</p> </div> </article> <article id="post-8172" class="entry-block entry-block-with-excerpt post-8172 post type-post status-publish format-standard has-post-thumbnail hentry category-addiction-treatment-business category-compliance category-medicare category-outpatient category-regulation category-substance-abuse amn_content_type-news amn_word_count-350-700"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/addiction-treatment-business/" class="post-category post-category-tag"><span>Addiction Treatment Business</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/09/10/73-of-sampled-otps-in-massachusetts-fall-short-of-federal-state-requirements/">73% of Sampled OTPs in Massachusetts Fall Short of Federal, State Requirements</a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/mgonzales/">Morgan Gonzales</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-09-10T14:36:30-05:00">September 10, 2024</time><time class="updated" datetime="2024-09-10T14:36:40-05:00">September 10, 2024</time></span> </div> </div>  <div class="thumbnail-holder"> <a href="https://bhbusiness.com/2024/09/10/73-of-sampled-otps-in-massachusetts-fall-short-of-federal-state-requirements/"> <img width="150" height="115" src="data:image/svg+xml,%3Csvg%20xmlns='http://www.w3.org/2000/svg'%20viewBox='0%200%20150%20115'%3E%3C/svg%3E" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="Addiction Treatment Business logo illustrates Bradford Health Services M&A" decoding="async" data-lazy-src="https://bhbusiness.com/wp-content/uploads/sites/7/2023/10/2023-Addiction-WP-assets_featuredImg-posts-150x115.png" /><noscript><img width="150" height="115" src="https://bhbusiness.com/wp-content/uploads/sites/7/2023/10/2023-Addiction-WP-assets_featuredImg-posts-150x115.png" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="Addiction Treatment Business logo illustrates Bradford Health Services M&A" decoding="async" /></noscript> </a> </div>  </header> <div class="entry-content"> <p>Opioid treatment programs (OTPs) are the door to evidence-based medication for patients with opioid use disorder (OUD). Current regulations may not be strong enough to keep these facilities in compliance with requirements that prevent overpayment for services and ensure that patients receive the most appropriate treatment. An audit conducted by the Department of Health and […]</p> </div> </article> <article id="post-8137" class="entry-block entry-block-with-excerpt post-8137 post type-post status-publish format-standard has-post-thumbnail hentry category-bhb-plus category-commercial category-medicaid category-medicare category-reimbursement tag-i-am-boundless tag-magellan-healthcare amn_content_type-news amn_word_count-over-1200"> <header class="entry-header"> <div class="entry-header-content"> <div class="category-tag-holder"> <a href="https://bhbusiness.com/category/reimbursement/" class="post-category post-category-tag"><span>Reimbursement</span></a> </div>  <h2 class="entry-title"><a href="https://bhbusiness.com/2024/09/03/shared-savings-in-behavioral-health-a-realistic-approach-to-value-based-care/">Shared Savings in Behavioral Health: A Realistic Approach to Value-Based Care</a></h2> <div class="entry-meta"> <span class="byline"> By <span class="author vcard"><a class="url fn n" href="https://bhbusiness.com/author/mgonzales/">Morgan Gonzales</a></span></span> | <span class="posted-on"><time class="entry-date published" datetime="2024-09-03T15:35:57-05:00">September 3, 2024</time><time class="updated" datetime="2024-09-03T15:36:01-05:00">September 3, 2024</time></span> </div> </div>  <div class="thumbnail-holder"> <a href="https://bhbusiness.com/2024/09/03/shared-savings-in-behavioral-health-a-realistic-approach-to-value-based-care/"> <img width="150" height="115" src="data:image/svg+xml,%3Csvg%20xmlns='http://www.w3.org/2000/svg'%20viewBox='0%200%20150%20115'%3E%3C/svg%3E" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="One person hands a $2 bill to another person. Only the hands and the bill are in frame." decoding="async" data-lazy-src="https://bhbusiness.com/wp-content/uploads/sites/7/2024/09/pexels-tima-miroshnichenko-6694574-150x115.jpg" /><noscript><img width="150" height="115" src="https://bhbusiness.com/wp-content/uploads/sites/7/2024/09/pexels-tima-miroshnichenko-6694574-150x115.jpg" class="attachment-agingmedia-thumb-medium size-agingmedia-thumb-medium wp-post-image" alt="One person hands a $2 bill to another person. Only the hands and the bill are in frame." decoding="async" /></noscript> </a> </div>  </header> <div class="entry-content"> <p>Fee-for-service reimbursement models incentivize behavioral health providers to deliver more services – in some instances, even when medically unnecessary, some would point out. Value-based care – paying for quality and outcomes instead of volume – has been heralded as the behavioral health industry’s path away from fee-for-service models. Challenges, including tension between health plans and […]</p> </div> </article> <div class="pagination"> <span aria-current="page" class="page-numbers current">1</span> <a class="page-numbers" href="https://bhbusiness.com/category/reimbursement/medicare/page/2/">2</a> <a class="page-numbers" href="https://bhbusiness.com/category/reimbursement/medicare/page/3/">3</a> <span class="page-numbers dots">…</span> <a class="page-numbers" href="https://bhbusiness.com/category/reimbursement/medicare/page/14/">14</a> <a class="next page-numbers" href="https://bhbusiness.com/category/reimbursement/medicare/page/2/"><span>Next</span></a> </div>  </div>  </div>  <div class="grid-col grid-col-1-of-3"> <div class="primary-sidebar-holder widget-area desktop-only" role="complementary"> <section id="custom_html-2" class="widget_text widget widget_custom_html"><div class="textwidget custom-html-widget"><div style="width:300px;height:600px;">  <div id='div-gpt-behavioralhealth_adunitc'> <script> 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