Unit Four: Systems Oriented Practice
Chapter 17: Healthcare benefits, coverage limits, & reimbursement
Unit Four: Class Two
Learning Objectives
4.2.1. Explain how changes to policy allow for sustainable business models through reimbursement: fee-for-service, per patient per month, capitation, and outcome based incentives.
4.2.2. List three resources available to help providers with questions about benefits, coverage limitations, and reimbursement.
4.2.3. Explain how medical and non-ACS mental health services are administered in the state of Washington and the North Sound RSN/BHO.
4.2.4. List four examples of community mental health services that can be administered.
Reading Assignments
Online Articles:
-
MENTAL HEALTH SERVICES – Provider Guide [PDF] October 1, 2015; WA State Apple Health
- A Closer Look at Alternative Payment Models; prepared by Breakaway Policy Strategies for FasterCures (2nd in a series)
- “At a Glance” Guide to Federal Medicaid Authorities Useful in Restructuring Medicaid Health Care Delivery or Payment; Centers for Medicare and Medicaid Services, Technical Assistance Tool, 4/2012
Optional Articles:
- Financing of Behavioral Health Services within Federally Qualified Health Centers, Contracted Behavioral Health Financing Studies for SAMHSA; 2012
- Reimbursement of Mental Health Services in Primary Care Settings; SAMHSA, U.S. Department of Health and Human Services (DHHS); 2/2008
- Washington State Health Homes Billing Tiers [PDF]. WA State Health Home Training Manual, 7/2014.