This paper used Social Security Administration program data from 2005 to 2019 to examine national- and state-level changes in the number of new adult supplemental security income (SSI) awardees on the autism spectrum relative to awardees with intellectual disability and other mental health disorders. We identified three main findings: the number of autistic awards increased between 2005 and 2019 when awards for all other mental health disorders declined; roughly nine out of every 10 autistic adult awardees were between ages 18–25 years; there was variation in the growth of autistic awards across states. These findings support the need to consider geographic and age differences in SSI program participation among autistic adults and determine the underlying causes.

OBJECTIVE:In this study, the authors assessed the long-term impact of the Mental Health Treatment Study (MHTS), a randomized controlled trial testing the effects of providing 2 years of employment services based on the evidence-based individualized placement and support model to Social Security Disability Insurance (SSDI) recipients with serious mental illness. Treatment recipients also received systematic medication management, supplemental health care supports, and short-term relief from medical continuing disability review by the Social Security Administration (SSA).METHODS:MHTS site data for 2,160 participants were linked to SSA administrative data from 2011 to 2015, 1 to 5 years after the original study concluded. Univariate and multivariate models were used to assess the MHTS effects on employment, earnings, and disability benefit suspension-termination up to 7 years after services ended.RESULTS:The analyses showed that the treatment group was more likely than the control group to work, and average earnings among the treatment group increased more over time than earnings among the control group. Disability benefit suspension/termination did not differ between groups.CONCLUSIONS:Providing the demonstration's package of services and support to SSDI beneficiaries with psychiatric disabilities for up to 2 years may have a long-term impact on employment and earnings. Under the SSDI program as currently structured, however, even after receiving 2 years of evidence-based supported employment and high-quality mental health services, SSDI beneficiaries with psychiatric conditions are unlikely to achieve economic independence within 5 years.

States face considerable challenges addressing the needs of Medicaid beneficiaries with behavioral health conditions. Historical fragmentation of health care providers, funding streams, benefits, and regulatory functions for behavioral health have resulted in unmet health care needs and poor health outcomes for many beneficiaries with behavioral health conditions. To lower total costs, increase access to high quality care, and improve beneficiary outcomes, many states are testing approaches to promote physical and behavioral health integration (PBHI), a range of clinical and policy strategies that seek to bring together physical and behavioral health care service providers, payment systems, and administrative and oversight functions to address all aspects of a patient’s wellbeing. This brief systematically examines how nine states are supporting PBHI at the clinical level through their section 1115 delivery system reform demonstrations. Drawing on state documentation and key informant interviews with policymakers and provider representatives, we find that states primarily use financial incentives, requirements for provider collaborations, changes to managed care program design, and technical assistance to promote PBHI through their section 1115 demonstrations. Qualitative findings point to the importance of using multiple policy strategies that target the delivery system, provider payment mechanisms, and covered benefits to promote PBHI. Although section 1115 demonstrations with elements addressing PBHI have shown some early signs of progress, persistent challenges related to health information technology, rules governing patient datasharing, and workforce gaps affect the advancement of PBHI.

Delivery System Reform Incentive Payment (DSRIP) programs, authorized as Medicaid section 1115 demonstrations, provide incentive funding to safety net hospitals and other providers, such as physicians and community clinics, for infrastructure investments, quality improvement, and population health advancement. To receive these incentive payments, providers must implement projects that achieve specified milestones and metrics. The projects, milestones, and metrics are broadly designed to build infrastructure and workforce capacity among safety net providers, transform the way services are delivered, and improve the health of Medicaid beneficiaries and the uninsured. In this brief, we focus on the largest DSRIP demonstration programs approved by January 1, 2016 including California, Massachusetts, New Jersey, New York, and Texas. For California, we examine the state’s first DSRIP program and its new DSRIP program, the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program. For Massachusetts, we include the state’s initial Delivery System Transformation Initiatives (DSTI) program and its renewed DSTI program.

Delivery System Reform Incentive Payment (DSRIP) programs, authorized as Medicaid section 1115 demonstrations, provide incentive payments to safety net hospitals and other providers, such as physicians and community clinics. Participating providers conduct improvement projects to earn incentive payments, which are tied to their achievement of specified milestones and metrics. The projects are broadly designed to build capacity among safety net providers, transform the way services are delivered, and improve the health of Medicaid beneficiaries and the uninsured. This brief focuses on the largest DSRIP demonstrations as of July 2015, which were in California, Massachusetts, New Jersey, New York, and Texas.1

OBJECTIVE:Opioid analgesic abuse is a complex and relatively new public health problem, and to date little is known about how the news media frame the issue.METHODS:To better understand how this issue has been framed in public discourse, an analysis was conducted of the volume and content of news media coverage of opioid analgesic abuse over a 15-year period from 1998 to 2012 (N=673 news stories). A 70-item structured coding instrument was used to measure items in four domains that prior research suggests can influence public attitudes about health and social issues: causes, solutions, and consequences of the problem and individual depictions of persons who abuse opioid analgesics.RESULTS:Although experts have deemed opioid analgesic abuse a public health crisis, results of our study suggest that the news media more often frame the problem as a criminal justice issue. The most frequently mentioned cause of the problem was illegal drug dealing, and the most frequently mentioned solutions were law enforcement solutions designed to arrest and prosecute the individuals responsible for diverting opioid analgesics onto the illegal market. Prevention-oriented approaches, such as prescription drug-monitoring programs, were mentioned more frequently in the latter years of the study period, but less than 5% of news stories overall mentioned expanding substance abuse treatment, and even fewer mentioned expanding access to evidence-based medication-assisted treatments, such as buprenorphine.CONCLUSIONS:Findings underscore the need for a concerted effort to reframe opioid analgesic abuse as a treatable condition addressable via well-established public and behavioral health approaches.

To understand the role of Medicaid in financing health services delivered through special education, program characteristics and covered services were compared from all 50 states and Washington, D.C. Data were collected from school-based fee schedules and policy manuals available through state Medicaid or education agencies. Except Wyoming, all states bill Medicaid for school-based health services, but there is substantive variation across states in services covered. The service categories most often covered by states’ Medicaid special education programs are speech–language/audiology, occupational/physical therapy, and behavioral health. Almost all states use a fee-for-service payment methodology to reimburse for services. Implications for the delivery of care to and health outcomes of students with disabilities are discussed.

People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.

This report lays out the general design and approach Mathematica will use to evaluate four types of Medicaid section 1115 demonstration waivers: (1) Delivery System Reform Incentive Payments (DSRIP), (2) Premium Assistance Medicaid expansions, (3) Beneficiary Engagement/Premium Payment demonstrations, and (4) Managed Long-Term Services and Supports (MLTSS) programs. This plan focuses on the research questions that will guide the work and discusses relevant outcome measures, data sources, and general methodological approaches.

Objectives: This paper examines trends in the experience of students with autism spectrum disorder (ASD) in special education across states during the period of 2004-2012. Methods: Information based upon Individuals with Disabilities Education Act (IDEA) data reported by states during 2004-2012 were used to calculate the percentage of children with ASD, number of special education personnel, and percentage of children with ASD in a regular classroom for 80% or more of the day. Results: The proportion of special education students with ASD nearly tripled between 2004 and 2012. Results indicate considerable inter-state variation in each of the outcomes. Conclusions: The variation in outcomes across states suggests that lessons may be learned from individual states about how to address the increase in the number students with ASD.

In the United States, health insurance coverage for autism spectrum disorder treatments has been historically limited. In response, as of 2015, 40 states and Washington, DC, have passed state autism insurance mandates requiring many health plans in the private insurance market to cover autism diagnostic and treatment services. This study examined five states' experiences implementing autism insurance mandates. Semi-structured, key-informant interviews were conducted with 17 participants representing consumer advocacy organizations, provider organizations, and health insurance companies. Overall, participants thought that the mandates substantially affected the delivery of autism services. While access to autism treatment services has increased as a result of implementation of state mandates, states have struggled to keep up with the demand for services. Participants provided specific information about barriers and facilitators to meeting this demand. Understanding of key informants' perceptions about states' experiences implementing autism insurance mandates is useful for other states considering adopting or expanding mandates or other policies to expand access to autism treatment services.

BACKGROUND:Adults with serious mental illness have a mortality rate two to three times higher than the overall US population, much of which is due to somatic conditions, especially cardiovascular disease. Given the disproportionately high prevalence of cardiovascular risk factors in the population with SMI, screening for these conditions is an important first step for timely diagnosis and appropriate treatment. This comprehensive literature review summarizes screening rates for cardiovascular risk factors in the population with serious mental illness.METHODS:Relevant articles published between 2000 and 2013 were identified using the EMBASE, PsychInfo, PubMed, SCOPUS and Web of Science databases. We reviewed 10 studies measuring screening rates for obesity, diabetes, dyslipidemia, and hypertension in the population with serious mental illness. Two reviewers independently extracted information on screening rates, study population, and study setting.RESULTS:Rates of screening varied considerably by time period, study population, and data source for all medical conditions. For example, rates of lipid testing for antipsychotic users ranged from 6% to 85%. For some conditions, rates of screening were consistently high. For example, screening rates for hypertension ranged from 79% - 88%.CONCLUSIONS:There is considerable variation in screening of cardiovascular risk factors in the population with serious mental illness, with significant need for improvement in some study populations and settings. Implementation of standard screening protocols triggered by diagnosis of serious mental illness or antipsychotic use may be promising avenues for ensuring timely diagnosis and treatment of cardiovascular risk factors in this population.

Some disparities in access to care related to family immigration status have lessened over time among children in low-income families, although large disparities still exist.

Objectives: Prior studies suggest variation in the quality of medical care for somatic conditions such as cardiovascular disease and diabetes provided to persons with SMI, but to date no comprehensive review of the literature has been conducted. The goals of this review were to summarize the prior research on quality of medical care for the United States population with SMI; identify potential sources of variation in quality of care; and identify priorities for future research.Methods: Peer-reviewed studies were identified by searching four major research databases and subsequent reference searches of retrieved articles. All studies assessing quality of care for cardiovascular disease, diabetes, dyslipidemia, and HIV/AIDs among persons with schizophrenia and bipolar disorder published between January 2000 and December 2013 were included. Quality indicators and information about the study population and setting were abstracted by two trained reviewers.Results: Quality of medical care in the population with SMI varied by study population, time period, and setting. Rates of guideline-concordant care tended to be higher among veterans and lower among Medicaid beneficiaries. In many study samples with SMI, rates of guideline adherence were considerably lower than estimated rates for the overall US population.Conclusions: Future research should identify and address modifiable provider, insurer, and delivery system factors that contribute to poor quality of medical care among persons with SMI and examine whether adherence to clinical guidelines leads to improved health and disability outcomes in this vulnerable group. (C) 2015 Elsevier B.V. All rights reserved.