The National Guidelines for Behavioral Health Crisis Care from the Substance Abuse and Mental Health Services Administration (SAMHSA) call for a sustainable infrastructure to respond to behavioral health crises, through crisis services that are accessible to anyone, anywhere, at any time. States and communities use a variety of funding sources to support crisis services, such as public and commercial insurance, federal and state grants, and other state and local funds. Having all health insurers cover crisis services can help promote more adequate, stable funding for a full continuum of these services. The National Guidelines for Behavioral Health Crisis Care recommend Medicaid, Medicare, and commercial insurers adopt universal billing codes for crisis services. According to the national guidelines, establishing crisis service codes that every insurer should reimburse is important to fostering parity between coverage for medical and behavioral health care services.
Although some national and state codes exist to reimburse crisis services, not much is known about how providers use them in practice and the types of providers who use them. As of July 2022, 11 states and Washington, DC, covered three core crisis services (crisis call centers, mobile crisis teams, and crisis receiving and stabilization services) in their Medicaid fee-for-service plans, but the scope of crisis services coverage and Medicaid billing requirements vary across states. Medicaid managed care plans, Medicare, and commercial insurance also reimburse crisis services, but coverage and billing guidelines vary across these payors. These exploratory analyses examined the extent to which commercial payors, Medicaid, and Medicare reimburse services using specific national and state crisis services billing codes. Further, this research explores opportunities to enhance reimbursement through insurers as the continuum continues to evolve.
This research was conducted under contract between HHS/ASPE’s Office of Behavioral Health, Disability, and Aging Policy (BHDAP) and Mathematica Policy Research, with funding from the Substance Abuse and Mental Health Services Administration (SAMHSA). Additional research in this area is available at the ASPE Behavioral Health page.
*This content is in the process of Section 508 review. If you need immediate assistance accessing this content, please submit a request to POC Name, brenda.veazey@hhs.gov. Content will be updated pending the outcome of the Section 508 review.
Available Reports:
- Financing Crisis Services Through Public and Commercial Insurance: Current Landscape and Future Opportunities
- The Role of the Outpatient Behavioral Health Provider in Crisis Services: Opportunities and Existing Reimbursement Pathways
- Crisis Services Billed to Medicaid: Lessons Learned from Eight States and Considerations for Future Analyses Issue Brief
- Financing Crisis Services Using Public and Commercial Insurance: Key Takeaways for State and Local Agencies Issue Brief
- Behavioral Health Crisis Services Billed to Commercial Insurance, Medicaid, and Medicare Issue Brief