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Medicaid to Cover New Treatment for First Episode Psychosis

Medicaid to Cover New Treatment for First Episode Psychosis

Medicaid to Cover New Treatment for First Episode Psychosis Based on NIMH-Funded Research

Coordinated specialty care may become more readily available

Science Update

NIMH is the world’s leader in mental health research, yet it’s rare for that research to have an immediate impact on clinical practice. However, the NIMH-funded RAISE initiative is an exception.

On October 16, 2015, the Centers for Medicare & Medicaid Services (CMS) posted an informational bulletin  to State Medicaid Directors about covering treatment for first episode psychosis. A key feature of this bulletin is CMS’ support for coordinated specialty care (CSC), the evidence-based treatment approach tested in the Recovery After an Initial Schizophrenia Episode (RAISE) initiative.

The bulletin says that the two RAISE studies, as well as the Specialized Treatment in Early Psychosis (STEP) study from Yale University, “demonstrate convincingly (1) the feasibility of first episode psychosis specialty care programs in U.S. community mental health settings, (2) that young people with psychosis and their family members accept these services, and (3) that CSC results in better clinical and functional outcomes than typical treatment.”

The rest of the bulletin goes on to explain how states can use the federal Medicaid program to pay for evidence-based first episode psychosis services, such as those tested in RAISE.

Why is this important? The RAISE initiative has shown that coordinated specialty care for first episode psychosis is better than the standard care offered in community clinics. However, covering the cost of coordinated specialty care can be challenging. When Medicaid agrees to pay for effective treatment programs, patients in need benefit. With CMS’ informational bulletin on first episode psychosis treatment, more clinics may be able to offer coordinated specialty care and the treatment may become more readily available. Decisions made by Medicaid can influence private insurance companies and the services they cover. Ultimately, this will help people experiencing first episode psychosis get effective treatment, which is important for recovery.

The bulletin represents a joint effort by several agencies: NIMH, CMS’ Center for Medicaid and Children’s Health Insurance Program, and the Substance Abuse and Mental Health Services Administration