Defining ‘Mental Illness’ In Mental Health Policy

Goldman, Howard H.; Grob, Gerald N.

doi:10.1377/hlthaff.25.3.737

Cited by 82 publications

(22 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The national population (regardless of diagnosis) living in nursing facilities and other personal care homes had grown from 568,560 to 1,406,778 during that same decade (Toff & Scallet, 1986). Community mental health centers (CMHCs), which also came into existence during this time, attempted to take credit for the reduction in psychiatric hospitalizations, but there was not a direct relationship between the growth of the CMHCs and the reduction in the size of the state hospital population (Goldman & Grob, 2006). Instead, the general consensus at the time was that the ready availability of nursing home coverage under Medicaid had made it possible for many psychiatric facilities to reduce their census by transferring individuals from psychiatric facilities to nursing facilities (Toff & Scallet, 1986).…”

Section: Older Adults With Mental Illness In the United Statesmentioning

confidence: 99%

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

O'Connor

Little

McManus

2009

Journal of Aging & Social Policy

View full text Add to dashboard Cite

This article reviews key federal Medicaid policies affecting older adults with serious, long-term mental illness: (a) the Medicaid exclusion of coverage for Institutions for Mental Diseases, (b) the Preadmission Screening and Resident Review Process, and (c) the Medicaid Home and Community Based Services waiver policy. Documenting the incentives and restrictions in these policies provides an historical context for understanding the current gaps in treatment for elders with mental illness. New federal options under the Deficit Reduction Act may provide opportunities for reducing the institutional bias for older adults with mental illness and for improving mental health services for elders under Medicaid.

show abstract

Section: Older Adults With Mental Illness In the United Statesmentioning

confidence: 99%

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

O'Connor

Little

McManus

2009

Journal of Aging & Social Policy

View full text Add to dashboard Cite

show abstract

“…Relative to most acute care payment systems, which have hundreds to thousands of DRGs, 6 the MH clustering system, we consider is simple and limited. However, the criteria upon which clustering is undertaken, seem a priori to be subject to clinician discretion, which in turn may be an inherent characteristic of care for mental illness (Goldman & Grob, 2006;Bellows & Halpin, 2008). Hence, our analysis of the extent of provider discretion within this emerging system is of importance to health policy makers in framing the development of mental health care payment systems.…”

Section: Related Literaturementioning

confidence: 99%

Prospective payment systems and discretionary coding—Evidence from English mental health providers

et al. 2018

View full text Add to dashboard Cite

Reimbursement of English mental health hospitals is moving away from block contracts and towards activity and outcome‐based payments. Under the new model, patients are categorised into 20 groups with similar levels of need, called clusters, to which prices may be assigned prospectively. Clinicians, who make clustering decisions, have substantial discretion and can, in principle, directly influence the level of reimbursement the hospital receives. This may create incentives for upcoding. Clinicians are supported in their allocation decision by a clinical clustering algorithm, the Mental Health Clustering Tool, which provides an external reference against which clustering behaviour can be benchmarked. The aims of this study are to investigate the degree of mismatch between predicted and actual clustering and to test whether there are systematic differences amongst providers in their clustering behaviour. We use administrative data for all mental health patients in England who were clustered for the first time during the financial year 2014/15 and estimate multinomial multilevel models of over, under, or matching clustering. Results suggest that hospitals vary systematically in their probability of mismatch but this variation is not consistently associated with observed hospital characteristics.

show abstract

“…However, state and local “safety net” financing for public mental health care could in many cases offset the impacts of losing Medicaid coverage (11, 12). Many uninsured and even some privately insured low income young adults who meet state or local need criteria can qualify for receipt of public mental health services at minimal out-of-pocket expense.…”

Section: Introductionmentioning

confidence: 99%

Medicaid Lapses and Low-Income Young Adults’ Receipt of Outpatient Mental Health Care After an Inpatient Stay

Slade¹,

Wissow

Davis

et al. 2014

View full text Add to dashboard Cite

Objective This study examines low-income young adults' use of outpatient mental health services following an inpatient mental health stay, with a focus on Medicaid enrollment lapses and public mental health safety net coverage. Methods The sample included (N=1174) young adults ages 18 to 26 years who had been discharged from inpatient care in a mid-Atlantic state. All were Medicaid enrolled at the time of discharge and all were eligible for continued public mental health services regardless of Medicaid enrollment. Administrative claims data were used to examine outpatient mental health clinic use, psychotropic medication possession, inpatient readmission, and emergency department admission during the 365-day period following the index discharge. The main independent variable was a lapse in Medicaid enrollment. An instrumental variables regression model was used to minimize estimation bias due to unmeasured confounding between lapses and service use. Results Nearly a third (345 or 30%) of the young adults had an enrollment lapse. In instrumental variables analysis, those whose coverage lapsed were less likely to have had at least 2 clinic visits (38% versus 80%) and had a lower average psychotropic medication possession ratio (25% versus 55%) compared with persons who had continuous Medicaid. Conclusion Age-related Medicaid enrollment lapses are common and are associated with receipt of less clinical care post-discharge despite continued eligibility for public services. States should examine opportunities to assist young adults with serious mental health problems who are aging out of Medicaid enrollment categories for children.

show abstract

Defining ‘Mental Illness’ In Mental Health Policy

Cited by 82 publications

References 14 publications

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

Prospective payment systems and discretionary coding—Evidence from English mental health providers

Medicaid Lapses and Low-Income Young Adults’ Receipt of Outpatient Mental Health Care After an Inpatient Stay

Contact Info

Product

Resources

About