The providers achieve the payment gains when the health of behavior is increased

For more than a decade, qualified care providers have been exploding behavioral health requirements among their residents – with hardly any additional financial support for the changes in personnel and infrastructure that often require these conditions.

In the past few months, however, the providers in 10 states have won new or significantly higher installment add-ons for patients with health needs, are about to secure them from the legislator, or have permission to start new state-funded pilots to improve the care of such patients.

A program with up to 125 inhabitants is to be initiated in Kansas on July 1st. It offers qualified nursing operators an additional 175 US dollars every day to enable Medicaid patients with behavioral health needs “special staff training and improved nursing services”.

In Utah, the add-on rates for behavioral residents have been set for residents with an intellectual disability diagnosis and behavioral challenges at 7.52 USD per patient and 21.88 USD per patient and everyday.

In July, these tariffs will record a “modest” increase in 2026, although the final figures do not yet have to be determined by the state, said Spangler. She added that providers endeavor to take care of such residents, but have long been faced with obstacles.

“The boss among them is the need for proper reimbursement. The residents with behavioral health challenges often have disruptive behaviors and require individual programs, specialized providers and creative care planning,” she told to McKnights long -term paw news this week. “This support is of crucial importance for quality provision, but are both time -consuming and expensive.”

Partnership for payment

Some of the recent victories came through a partnership between Behavioral Health Solutions, a group for mental health. State associations; And the American Health Care Association, which helped to finance the efforts, to clarify the legislator about how today's nursing home population has changed.

A 2023 study that was published in which Journal of American Geritrics Society It found that 30% of the country's 1.1 million nursing home residents have a psychiatric diagnosis such as depression or anxiety. However, they have also taken up more patients with psychiatric diagnoses, including bipolar disorders and schizophrenia, after the country's psychiatric institutions were closed.

The proportion of residents of nursing homes with serious mental illnesses doubled to 19%for almost a decade by 2017, reported researchers from the University of Michigan.

This is done in addition to patients with significant cognitive impairment, dementia or Alzheimer's disease, diseases that also require additional surveillance, care planning and sometimes expensive measures to prevent elopements.

“We see that 70% of the population in long -term care either have neurocognitive disorders with potentially associated behavior, at the same time occurring psychiatric diseases, depression, all types of diagnoses throughout the spectrum,” said Kristina Kovacs, PhD, co -founder and Chief Clinical Officer of Beharich Health Solutions Solutions.

Unaffected

“Nursing homes are not equipped and have never been trained to look after these types of residents,” added Kovacs, whose group offers nursing homes in nine states of wreck-around services, clinical services and therapy support. “If the models change and do not always have qualified patients, many nursing homes go more towards long -term care and more medicaid. They get more of them [behavioral] Residents. “

BHS offers regular training courses for the managers and the direct nursing staff of its customers, who may have never learned how to work with patients with behavioral health, or may not have an understanding of behaviors that are associated with certain diseases or how trigger can be avoided.

De-escalation and security skills are particularly important for the high quality, since medicaid patients with health needs in behavioral activity were referred to a historical extent in nursing homes of less quality.

Nursing homes that serve patients with complex needs of behavior – including several diagnoses, and often simultaneously with disorders of substance consumption – require employees who are particularly trained in mental healthcare. With younger, outpatient patients, more activities and programs also require to employ patients.

Larger needs

Depending on the care planning, residents who have serious needs can also require individual support. And patients with behavioral health who receive treatment for drug abuse disorders can require medication that can only be administered by a nurse or a doctor.

The use of antipsychotics and other medication can also require additional surveillance, as well as more work to ensure that it does not give over -control to them. In Nevada, where behavioral health solutions are based, the providers were actually able to reduce the use of antipsychotics, although the population becomes more psychiatric due to the use of non -pharmacological interventions and activity support workers.

But all this care of care increases the costs, and providers have not always managed to get the legislator to recognize the rapidly changing landscape.

Spangler admitted that the attitude, training and storage of specialized personnel “increases additional financial pressure on facilities”. Behavioral health has used existing models to show legislation and political decision-makers of health in order to cope with the financial needs of the providers and ensure that add-ons are good money.

In some states, add-ons are granted for certain diagnoses or reviews. In other cases, payments are only made for patients in safe units to support the costs for adding and operating them.

And innovation continues: Kansas' pilot must require the participating institutions for the development and implementation of individual behavioral support plans, carry out monthly psychopharmacological checks and work with a contractual provider of behavioral support in order to pursue and report the awards for the success of state officials.

Future growth

Linda Mowbray, President of the Kansas Health Care Association, said she was confident that the pilot, who was signed by Governor Laura Kelly (D) at the beginning of this month, will lead to a more permanent payment reform. According to the state's current case mix formula, patients with complex medical needs easily receive $ 200 to $ 250 more per day than patients with considerable challenges for behavioral health.

“The [current] The prices do not take into account the extraordinary amount of time that people with behavioral health need McKnight's. “Conclusion is the pilot creative and innovative and offers the urgently needed financial support to those who need residents with behavioral health.”

Spangler also looks into the future. After resetting add-ons, it encourages the state to be more long-term to overcome the unique challenges, such as the development of specialized nursing facilities for behavioral authorities that are regulated separately by traditional nursing homes.

“Current regulations are often suitable for institutions that accept a higher number of behavioral complex residents,” she said. In addition, it is important to take into account that residents with serious behavioral problems may not always be appropriate for security reasons in order to improve the population of general nursing homes. “