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What Are Section 1115 Waivers and How Do They Affect Behavioral Health?

One main goal of the Affordable Care Act (ACA) is increased insurance coverage for low-income Americans. The ACA aimed to achieve this goal partly through the expansion of Medicaid to most U.S. adults at 138 percent of the federal poverty level.

Although there are financial incentives for adopting the Medicaid expansion, the decision is still up to individual states. As of April 2019, 36 states and the District of Columbia have adopted the Medicaid expansion. This leaves 14 states that have not expanded their Medicaid program coverage.

What Are Section 1115 Waivers?

Federal law gives individual states some flexibility in how they implement and operate their Medicaid programs. States may also apply for a Section 1115 waiver, granted by the Centers for Medicare & Medicaid Services.

Section 1115 waivers give states additional leeway to deviate from federal Medicaid guidelines and laws. States also can use the waivers to test different ways to deliver or fund Medicaid services.

Behavioral Health and Section 1115 Waivers

Many people who are currently uninsured and living at or below the federal poverty level also struggle with mental illness, addiction, or other behavioral health issues. Federal law requires all state Medicaid programs to provide some mental health services. Some state Medicaid programs provide beneficiaries with addiction treatment services.
By expanding Medicare coverage, more individuals may gain access to services to help address their behavioral health needs.
Even states that have not formally expanded Medicaid can use Section 1115 waivers to expand coverage to additional low-income residents. The mental-health organization NAMI has officially called on every state to expand Medicaid and apply for Section 1115 waivers to ensure that Medicaid programs provide “adequate mental health services and supports.”

One use for Section 1115 waivers is to improve service systems for behavioral health and addiction treatment. As of September 2017, 12 states had approved Section 1115 Medicaid waivers related to behavioral health.

How Are States Using Section 1115 Waivers?

Under new legislation, the Idaho Department of Health and Welfare has been directed to seek a Section 1115 waiver for multiple changes to the state Medicaid program. If the waivers are not approved by January 1, 2020, then all individuals at or below the federal poverty line will be enrolled in Medicaid.

One change involves adding questions about substance use disorder to the initial Health Assessment to direct beneficiaries to services early. Another change is the use of Medicaid funds directly for inpatient behavioral health and addiction treatment services.

Arizona used a waiver approved in 2016 to better integrate physical and behavioral health, including payment incentives to providers. In Delaware, a waiver allowed the state in 2015 to implement a voluntary program that provides enhanced behavioral health services for certain Medicaid beneficiaries.

Prepare for Expanded Behavioral Health Services

Behavioral health and addiction treatment providers could see an increase in demand in states that have expanded Medicaid coverage or received Section 1115 waivers. Adopting a comprehensive EHR solution can help you keep up with demand while streamlining services.

Created specifically for behavioral health professionals, BestNotes EHR offers the features you need to improve patient care, increase practice revenue, and reduce staff frustration. Contact us today to learn more about our solutions, or to schedule a free demonstration.

date:  May 02, 2019
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Curious About Telemedicine for Behavioral Health? Here Are Some Things to Know:

The early adoption of telemedicine, a term often used interchangeably with telehealth, has surpassed the early adoption of electronic health records (EHRs), survey results show. Telehealth is even finding favor with specialists who experience significant burnout.

Telehealth platform company American Well reported at the ATA19 telehealth conference that physician adoption of telehealth increased 340 percent between 2015 and 2018. Even among providers who have not used telehealth, more of them are willing to try it.

Why is Telemedicine Becoming More Appealing?

Telemedicine has already been found to have numerous benefits to behavioral health and addiction treatment providers and their patients.

Closing care gaps: Specialists, including behavioral health clinicians, tend to practice in higher-population areas, creating fewer options for small towns and rural areas. Telemedicine could help bridge some of the care gaps found in behavioral health and addiction treatment.

Reducing care shortages: Although mental health needs are growing across the United States, there is also an increasing shortage of care providers. As addiction, suicide, and other behavioral health concerns increase, telemedicine may mean a difference between life and death.

Improving patient results: Experts note that telemedicine can make counseling and other types of substance abuse treatment more accessible to clients. This expanded accessibility can help individuals get support and make better decisions when faced with the option to use addictive substances.

Improving practice revenue: Telemedicine can be more convenient for patients than in-office visits. It reduces the risk of canceled appointments and no-shows. Faster check-ins can streamline the practice and improve billable hours.

What Are Some Concerns in Implementing Telemedicine?

Telemedicine is a growing technology, and the healthcare field overall is always changing. Researchers, clinicians, and administrators are working to resolve several issues associated with telemedicine. Some of these include:
Fragmented Care: Telemedicine offers a convenient source of care for many patients. At the same time, it could also lead to increased healthcare fragmentation if telemedicine providers do not coordinate with other members of a patient’s healthcare team.

Interoperability: Much like with EHRs, providers have many options for telehealth solutions. Unfortunately, the wide variety of solutions and software may limit interoperability. Behavioral health providers should be aware of this when entering the telemedicine space.

Measuring Value and Effectiveness: As U.S. healthcare moves to a value-based model, efforts to measure value and effectiveness should not exclude telemedicine. Experts at the American Telemedicine Association’s 2019 conference in New Orleans suggest that providers focus on building relationships with patients and asking telehealth users if they feel their needs were met.

Staff Effectiveness: All clinicians and support staff must be thoroughly prepared and trained for the adoption. Take time to address any questions and concerns. Be sure that remote workers have all the information, training, and equipment they need, and are aware of expectations.

Support Your Telemedicine Practice With Specialized EHR

BestNotes EHR was developed specifically to serve behavioral health and addiction treatment practices. Whether you’ve already invested in a telehealth program, you are just starting the process, or simply considering adding it to your practice, BestNotes can help you stay streamlined and cost-effective.

Contact us today to learn more about how BestNotes EHR can help you improve care, track patient outcomes, and increase practice revenue.

date:  Apr 25, 2019
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California Addiction Treatment News

While it has not seen the devastating levels of opioid addiction as other states, California still faces the challenges of opioids and other addictions. Here are the behavioral health issues and solutions making headlines in the state.

California Expands Addiction Treatment Program

The “Hub and Spoke” system of addiction treatment involves regional treatment centers connected to supporting facilities, creating a network that resembles the hub and spokes of a wheel. This helps patients get appropriate help close to home, with individualized treatment plans.
This system was first launched in Vermont in 2012, and since 2017 has been implemented on a larger scale in California. Funded by $90 million in federal grants, California began with 18 hubs and 57 spokes. It has expanded to more than 200 spokes across the state.

San Francisco-Based Insurer Reduces Members’ Opioid Use

Blue Shield of California reports that members with chronic, non-cancer pain have reduced their overall opioid use by 56 percent compared to 2014 levels. The organization in 2015 launched the Narcotic Safety Initiative to reduce members’ opioid use by 50 percent.

The initiative focused on both preventing patients from being prescribed high levels opioids and reducing the number of patients currently using long-term, high levels of opioids. This includes targeting extended-release opioids, which can contribute to opioid tolerance, and reducing opioid misuse and promoting alternative pain management.

University of California Grad Students Offer Solutions to Persistent Issues

Kate Linker, a grad student in anatomy and neurobiology at UC Irvine, has uncovered data on why adolescents are at such high risk of addiction. Teenage addiction may be connected to the brain’s immune system, Linker suggests. She is currently working with the California-based company Plexxikon to develop a new treatment that suppresses drug motivation without affecting other behaviors.

Many Providers Limited in Treating Opioid Abuse

Research from UC San Francisco has found that at least six states with high rates of opioid abuse also have tighter restrictions on the ability of nurse practitioners (NPs) to prescribe medication that could can help treat addiction. The study, published in JAMA, recommends reforms to relax restrictions and help health providers better address the opioid crisis.

California is one state that more severely restricts NP scopes of practice. However, lawmakers have introduced a bill to eliminate the physician collaboration requirement, a recommendation from the California Future Health Workforce Commission. Study corresponding author Joanne Spetz, Ph.D., suggests that, even without changes in current regulations, states might develop programs that connect NPs with physicians who are willing to supervise them in offering buprenorphine.

Medication May Reduce Arrests in People With Opioid Use Disorder

Research indicates that people with opioid use disorder who are prescribed buprenorphine or methadone may be less likely likely to be arrested and incarcerated compared to those not taking the medication. The study, published in the journal Addiction, included 303 individuals who had entered three opioid treatment programs in California over a period of five years.

Addiction Treatment and Behavioral Health Solutions

BestNotes EHR, created for behavioral health and addiction treatment organizations, can help you improve care, track patient outcomes, and increase practice revenue. Contact us today to learn more.

date:  Apr 18, 2019
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Behavioral Health Practice Management Solutions That Therapists Need

What practice management solutions are essential for behavioral health therapists and addiction treatment professionals? Here are the options that can help streamline your organization, increase your revenue, reduce your workload, and improve your patient care.

Electronic Health Record (EHR)

An EHR is more than just a digital version of a patient’s chart. It also allows you to incorporate data from all clinicians and facilities involved in a patient’s care. With the proper interoperability, all authorized providers and staff should be able to access this information. A behavioral health and addiction treatment EHR can include:

Diagnoses and allergies
Medications and other treatment plans
Immunization dates
Recent hospitalizations
Test results and radiology images
Provider contact information

Therapy Notes

Rather than scribbling paper notes or using a separate program, like Word, to keep additional patient information, behavioral health practice management solutions should include an application for therapy notes. This helps clinicians manage intake forms, create and edit progress notes and goals, develop treatment plans, and create discharge summaries.

Keeping this information in one place saves time and improves communication within a practice and with other providers. This not only streamlines your practice, but it also helps you track patient outcomes, a vital task for value-based care.


Whether you have regular follow-ups with a longtime patient, or new referrals, behavioral health scheduling can become overwhelming fast. The best scheduling software allows therapists and administrative staff to set up appointments and events for patients and schedule staff hours and vacations.

Scheduling solutions also can notify users of upcoming events, including cancellations and no-shows. With a mobile option, therapists and other clinicians can access their calendars anywhere, and create, change, or cancel appointments at any time.

Billing Software

There’s no doubt that billing gets complicated in the healthcare industry, whether physical or behavioral, and can take up a lot of your staff members’ time. The appropriate billing software should allow users to verify insurance, ensure proper claims coding, create invoices, post payments, and generate financial reports. This helps keep staff more efficient and increase practice revenue.

Customer Relationship Management (CRM)

Small or mid-sized behavioral health practices may dismiss the need for a CRM system, but they can provide enormous value to therapists. Your CRM solution should help you understand what emails, ads, website content, and other marketing strategies led new patients to your practice.

Behavioral health CRM can help you set up a system for communicating with both prospective and current patients. The right CRM solution not only offers lead management, but strengthens patient relationships and improves revenue.

Messaging and Communication

The phrase “No man is an island” certainly applies to behavioral health therapists and addiction treatment professionals. Whether you’re sharing data with other providers, sending orders to a pharmacy, or giving updates to patient family members, the right messaging solution is essential for your practice. Communication channels and portals should be fast, easy, and HIPAA-compliant.

An EHR for All Behavioral Health Practice Needs

BestNotes EHR solutions helps streamline your behavioral health practice or addiction treatment organization, saving you time, boosting your revenue, and improving your patients’ lives.

Take advantage of our EHR, CRM, messaging, prescription management, and other features. Contact us today (you can even request a live demo) to learn more about what we can do for you!

date:  Apr 12, 2019
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Selecting Surveys to Measure Treatment Impact

Laura Mills, Ph.D. (QM, Psych) Director, Research & Evaluation, Pine River Institute

When you are about to start measuring the impact of your work, you might first ask, ‘What measurement instrument is the best?’. Asking this question first, however, might result in your measuring factors that don’t resonate with your practice, or omitting factors that are important outcome indicators. The resources and culture shift required to implement evaluation are too costly for this. It’s vital to start right, which means a little bit of ground work. This article outlines some steps to start right, and ultimately, optimize your evaluation efforts.

Step One. Decide Why.

Why are you doing evaluation? Do you want to demonstrate your impact to clients, families, staff, accreditation, state, county or payor? Do you want to validate your treatment approach? Understand where to invest in professional development or make program changes? Engage a university research partner? Maybe you want to do all of this, and evaluation makes that possible, but write down your reasons for evaluation. This will be your guide and will keep you in scope.

Step Two. Get Curious!

‘Success’ is what you want to measure, and ‘success’ means something different for each of your stakeholders. Engage them! Ask clients (lots of them!), ‘if in a year you can say that treatment worked for you, what does that mean?’ Try not to prompt responses; you’ll be surprised with the indicators that are important to your clients. If they really don’t know, you might ask if success means they are working, schooling, medication-free, handling stress, relating to family, social, etc. But keep your input minimal.
Ask your staff what they work on with their clients. In what areas do they foster change? If they see a ‘success’ client in a year, what does that mean? Ask your executive team, ‘why are we here?’ ‘in what ways are we having an impact?’
If you plan to use your evaluation to broaden knowledge, you may want to explore ‘mechanisms of change’- why do you work, or what fosters treatment success. Ask clients ‘what was a moment of change for you?’; ask clinicians ‘what is your magic?’; ask executives ‘where do we expect treatment fidelity?’.

Step Three. List Key Indicators.

Using information from your environmental scan, list the common outcome indicators, and if applicable, process indicators. Outcome indicators are your success markers such as substance use, mental health, criminality, hospitalization, vocation, etc. Process indicators are the mechanisms of change such as treatment completion or progression, therapeutic alliance, family engagement, fidelity to a manualized approach, etc.

Step Four. Be a Journalist.

Who will complete the instrument (client, parent, clinician, referrer)? Where will it be completed (online, on-site)? How will it be administered (paper, device, in a group)? If there is a user cost, do you have the resources? Do you need quantitative responses or qualitative? When will it be administered (before, during, after)? Importantly, if you want to measure change, you measure indicators before and after treatment!

Step Five. Find Your Instruments!

You can explore many sources, such as university libraries and google scholar to see the thousands of measurement tools available. Your ground work will help you narrow the options, thankfully! OutcomeTools has several dozen instruments available to view.
Read every question! Have your stakeholders review different instruments. The tool must align with your language and your purpose. Look for problems such as double-barreled questions (asks two questions in one), hard to remember items (dosage of alcohol or substances), too much jargon, difficult time anchors, assumptive questions (e.g., does your child think about suicide), no ‘other’ or ‘don’t know’ option where it’s needed.

Step Six. Implement!

This is where the work gets real! Implementation is a huge undertaking, requiring a working culture shift, huge leadership support, and all-hands-on-deck. For some, evaluation will seem like just another task in their already overburdened day; demonstrate the benefits to them! Show clinicians the scores of one of their clients. Ask them if the scores resonate with their experience. Ask them about the client, the treatment approach, challenges, surprises, successes. Most often, clinicians are so happy to share their experience and see the results of their hard work.
One way to really engage all stakeholders in evaluation is to implement Feedback Informed Treatment, which is periodic measurements of key indicators that are used to inform and guide treatment. This is a powerful way to close the gap between research and practice. Feedback Informed Treatment is also a way to increase your post-treatment survey response rates. When clients see the results of evaluation during treatment, they are more likely to respond to requests for contribution after treatment.
If we can help you get started with these steps or have questions, please reach out to our expert staff at OutcomeTools – or 866-543-6646.


For more information on this topic, please see our recent webinar here!

date:  Apr 09, 2019
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