State Medicaid and MCO-CBO contracting. The George Washington University studies.
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TL;DR
In two studies supported by the Substance Abuse and Mental Health and Services Administration (SAMHSA), contracts for behavioral healthcare services between Medicaid agencies and MCOs, and between M COs and community-based mental health and substance abuse organizations were examined.
Abstract
The web of contracts between purchasers, plans, and providers will ultimately shape the American healthcare system. Managed care contracts represent a marked departure from common law principles which allowed healthcare providers to decide when and under what circumstances they would enter into a provider/patient relationship. In two studies supported by the Substance Abuse and Mental Health and Services Administration (SAMHSA), contracts for behavioral healthcare services between Medicaid agencies and MCOs, and between MCOs and community-based mental health and substance abuse organizations were examined. Contracts typically cover both mental health and substance abuse treatment services, but state-to-state variation in procedures and specific services covered is the hallmark of behavioral healthcare contracts across the board.