CMS, NIMH, SAMHSA discuss coverage of early intervention services for first-episode psychosis

CMS recently released an informational bulletin intended to assist states in designing a benefit package for early treatment intervention options for youth experiencing first-episode psychosis.

The bulletin was a collaborative effort between the NIMH, CMS’s Center for Medicaid and CHIP Services and Substance Abuse and Mental Health Services Administration (SAMHSA).

In 2008, the NIMH launched the Recovery After an Initial Schizophrenia Episode (RAISE) research initiative to develop, test and implement Coordinated Specialty Care (CSC) programs for first episode psychosis in “real world” community clinics.

One NIMH-funded randomized controlled trial, RAISE-Early Treatment Program, included 404 youth with first-episode psychosis across 34 community clinics. Community-based clinicians were trained to deliver a team-based approach to CSC that included resilience-focused individual therapy, family psychoeducation and support, supported education and employment and personalized medication management.

Study participants who received CSC exhibited significantly greater improvements in total symptoms, social functioning, work or school involvement and overall quality of life, according to the bulletin.

Youth with a shorter duration of untreated psychosis exhibited the greatest improvements following CSC treatment, suggesting that receiving care early in the course of first-episode psychosis leads to better outcomes.

In addition to RAISE-ETP results, findings from the RAISE-Implementation and Evaluation Study and the Specialized Treatment in Early Psychosis (STEP) indicated the feasibility of implementing first episode psychosis specialty care programs in U.S. community mental health settings, acceptance of these programs among youth with psychosis and family members, and that CSC leads to better clinical and functional outcomes compared with usual care.

As a result, CMS, SAMHSA and the NIMH outline various components of early intervention services for individuals experiencing first-episode psychosis in the bulletin, including team-based care, recovery-oriented psychotherapy, family psychoeducation and support, supported employment services, supported education services, pharmacotherapy and primary care coordination and case management.

In addition, the bulletin discusses how comprehensive approaches to early intervention services for first-episode psychosis can be funded or reimbursed by federal sources through SAMHSA’s Mental Health Block Grants and Medicaid.

“In designing an early intervention services program for individuals experiencing first-episode psychosis, state agencies should work together to develop an appropriate package of services to be provided to their beneficiaries. Coordination and a focus on consumer-centered care are critically important if outcomes are to improve for this very vulnerable population,” the organizations wrote in the bulletin. “CMS, SAMHSA and NIH are available to provide additional technical assistance as states approach funding of specialty programs and early intervention services for individuals experiencing first episode psychosis.” – by Amanda Oldt

For more information:

Visit http://medicaid.gov/federal-policy-guidance/downloads/CIB-10-16-2015.pdf for the full informational bulletin.