Medicaid Reimbursement For Psychiatric Services: Comparisons Across States And With Medicare.
Medicaid Reimbursement For Psychiatric Services: Comparisons Across States And With Medicare.
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DOI：
10.1377/hlthaff.2022.00805
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发表时间：
2023-04
期刊：
影响因子：
9.7
通讯作者：
McConnell, K. John
中科院分区：
文献类型：
--
作者：
Zhu, Jane M.;Renfro, Stephanie;Watson, Kelsey;Deshmukh, Ashmira;McConnell, K. John
医疗补助的特点是提供者参与率低，通常归因于报销率低于商业保险或医疗保险。了解医疗补助对精神卫生服务的报销在多大程度上因州而异，可能有助于阐明增加精神科医生参与医疗补助的一个杠杆。我们使用2022年州医疗补助机构网站上公开的医疗补助服务收费表，为精神科医生提供的一组常见心理健康服务构建了两个指数：一个医疗补助到医疗保险指数，以基准每个国家的医疗补助报销与医疗保险的同一套服务，以及一个州到国家的医疗补助指数，将每个州的医疗补助报销与注册加权全国平均值进行比较。平均而言，医疗补助支付精神科医生的医疗保险费率为81.0%，大多数州的医疗补助与医疗保险指数小于1.0（中位数为0.76）。精神科医生心理健康服务的州与国家医疗补助指数范围从0.46（宾夕法尼亚州）到2.34（内布拉斯加州），但与参与医疗补助的精神科医生的供应无关。由于政策制定者将报销率视为解决持续的心理健康劳动力短缺的一项战略，比较各州的医疗补助支付可能有助于衡量正在进行的州和联邦提案。
Medicaid is characterized by low rates of provider participation, often attributed to reimbursement rates below those of commercial insurance or Medicare. Understanding the extent to which Medicaid reimbursement for mental health services varies across states may help illuminate one lever for increasing Medicaid participation among psychiatrists. We used publicly available Medicaid fee-for-service schedules from state Medicaid agency websites in 2022 to construct two indices for a common set of mental health services provided by psychiatrists: a Medicaid-to-Medicare index to benchmark each state’s Medicaid reimbursement with that of Medicare for the same set of services, and a state-to-national Medicaid index comparing each state’s Medicaid reimbursement with an enrollment-weighted national average. On average, Medicaid paid psychiatrists at 81.0 percent of Medicare rates, and a majority of states had a Medicaid-to-Medicare index that was less than 1.0 (median, 0.76). State-to-national Medicaid indices for psychiatrists’ mental health services ranged from 0.46 (Pennsylvania) to 2.34 (Nebraska) but did not correlate with the supply of Medicaid-participating psychiatrists. As policy makers look to reimbursement rates as one strategy to address ongoing mental health workforce shortages, comparing Medicaid payment across states may help benchmark ongoing state and federal proposals.
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