Sep 07, 2023
MHR NCQA Policy Change

Word count:  598

Estimated time to read:   3 minutes

One of NCQA’s latest Policy Changes brings to the forefront the importance of access and treatment for behavioral health. With the 2023 Health Plan Accreditation (HPA) standards, health plans who do not cover adult members are no longer exempted from reporting on all members with Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED). What this means is that any organization that previously did not collect data and report on all members with SMI or SED (previously referred to as severe and persistent mental illness) must do so now to help improve Coordination and Continuity Between Medical Care and Behavioral Healthcare (QI 4, Element A, Factor 6).

What organizations are most impacted?

Organizations most impacted are those with children and adolescents covered by Medicaid and the Children’s Health Insurance Program (CHIP).

Keep this timeframe in mind

Organizations undergoing  First and Renewal surveys  must have a report once during the prior year for Factor 6.

Why is this important?

Here are just some of the facts.

  • The Medicaid program provides coverage to an estimated 27 million children under age 18 in the United States. While 11 percent of the youth have been diagnosed with a mental illness, two-thirds of youth who have a condition have not been identified and do not receive mental health services. Further, the rate of current illicit drug use (Medicaid and non-Medicaid) aged 12-17 years is 12.1 percent. Children and Youth | Medicaid
  • Survey data from the Centers for Disease Control and Prevention (CDC) showed that mental, behavioral, and developmental disorders begin in early childhood, affecting 1 in 6 U.S. children aged 2-8 years.
  • Children and adolescents under age 18 also experience Long COVID, affecting mood, sleep disorders, fatigue, and cognitive symptoms. SAMHSA

These are the children, up until now, that may not have been prioritized in collaborative care activities.

Your Process

Since collaborative activities implemented as a result of data collected and analyzed and identifying two opportunities for five other factors from QI 4, Element A to meet Element B, there is no mandate for taking collaborative action nor measuring effectiveness (baseline measurement) for Factor 6 in the first year of this Policy Change.

You probably can identify two opportunities and take action on the five other factors from Element A. However, you can certainly do so if you started collecting and analyzing data for Factor 6 when the 2023 standards were published a year ago.

  • Use multiple data sources to identify opportunities, such as:
  • Population Assessment (PHM 2, Element B)
  • HEDIS measure APM (Metabolic Monitoring for Children and Adolescents on Antipsychotics)
  • Conduct a comprehensive qualitative and quantitative (Q&Q) analysis
  • Discuss and document collaborative opportunities with primary care and behavioral healthcare practitioners. Tie activities directly to special needs of members with SMI or SED.

Implement a Range of Activities

Improving collaboration can be done with new developments involving people, process, and technology, depending upon your identified opportunities. For example,

  • Improve access by co-locating BH practitioners with pediatricians and a patient-centered medical home.
  • Improve availability with developing online networks connecting primary care and BH providers while also addressing cultural needs of members.
  • Promote early diagnosis of SMI and SED by engaging BH providers to train primary care practitioners on screening and referring for depression, anxiety, ADHD, behavior problems, substance use, obesity, and anorexia.

Call to Action:    

  • Contact MHR for training on Q&Q analysis.
  • Ensure your Population Assessment addresses the needs of children and adolescents with SMI and SED.
  • Email Susan K. Moore

Stay connected with news and updates!

Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.

We hate SPAM. We will never sell your information, for any reason.