![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/06\/HHCN_Members_Icon_v2-1024x1024.jpg\"){kind=icon}
<\/p>\n<\/p>\n
\nThis article is a part of your HHCN+ Membership\n<\/p>\n
Offering behavioral health services in patients\u2019 homes can make services more effective and patients more comfortable, but an already complex regulatory and reimbursement landscape for these services is set to get even more challenging. <\/p>\n
With major Medicaid cuts under consideration in the Senate, states are increasingly likely to slash funding for home- and community-based services \u2013 further jeopardizing reimbursement for in-home behavioral health care. Home-based care advocates are pushing for sweeping regulatory reforms to safeguard access and ensure critical services keep pace with rising demand.<\/p>\n
\u201cBehavioral health needs are escalating nationwide \u2013 especially among Medicaid and dually eligible populations \u2013 yet reimbursement and policy frameworks have not kept pace with the demands of home-based delivery,\u201d Kristen Palumbo, chief operating officer and chief compliance officer at Innovive Health, told Home Health Care News in an email. <\/p>\n
Medford, Massachusetts-based Innovive provides in-home health care services for patients with multiple medical comorbidities with a behavioral health condition. Innovive offers skilled nursing designed to support mental and physical health, wound care, behavioral health care and care coordination, among other services. <\/p>\n
Annually, one in five<\/a> Americans experiences a behavioral health condition. Among Medicare beneficiaries, the rate is even higher, affecting one in four<\/a> individuals. <\/p>\n Despite how common behavioral health concerns are, even large home health care organizations may not be fully equipped to deal with the behavioral health needs of their patients. In a recent HHCN survey, none of the five respondents reported being 100% confident that their organization could connect or provide patients with necessary behavioral health care. <\/p>\n In-home behavioral health care availability has fluctuated over time, according to Dallas Star, regional director of behavioral health at Bayada Home Health Care. Currently, the availability of applied behavior analysis (ABA) services has shifted in favor of in-clinic care. <\/p>\n \u201cWhile clinic-based care offers its own benefits, a multi-setting approach, as supported by standards like those from the Council of Autism Service Providers (CASP), is crucial to meet diverse client needs,\u201d Star said. \u201cOrganizations like BAYADA aim to bridge this gap by offering services across various settings, including homes, communities, schools, and clinics, to ensure care is delivered wherever the client needs it most.\u201d<\/p>\n Pennsauken Township, New Jersey-based Bayada is a nonprofit home health care provider that offers adult skilled and non-skilled home care services, pediatric home health, hospice home care, rehabilitation at home and assistive care.<\/p>\n Shifts to in-clinic behavioral health care severely restrict access to care for people with profound autism, who often require home-based care or care in residential settings. <\/p>\n The regulations and policies home-based providers of behavioral health must follow<\/strong><\/p>\n Organizations that do offer behavioral health care must comply with both federal regulations and state-specific policies \u2013 which can vary significantly from one state to another.<\/p>\n For instance, Innovive operates in Massachusetts, Colorado and Iowa, and each state has a \u201cdistinct\u201d regulatory environment, according to Palumbo. To maintain compliance, Innovive maintains localized and centralized compliance and clinical teams in each state. <\/p>\n Some of the regulations Innovive must abide by include CMS Conditions of Participation, state licensure rules, Medicaid regulations, and privacy standards under HIPAA and 42 CFR Part 2.<\/p>\n Some states have additional requirements for home-based settings, according to Star, like an electronic visit verification (EVV).\u00a0<\/p>\n \u201cThere is a lack of consistency across state Medicaid programs, which complicates operations for providers serving multiple states,\u201d Star said. <\/p>\n Regulations vary by payer, as well as state-by-state variations. Medicaid coverage for ABA care is typically limited to individuals aged 21 and younger, Star said, and Medicare does not currently cover ABA services, limiting access to care for these beneficiaries.<\/p>\n The future of behavioral health in the home<\/strong><\/p>\n Medicaid\u2019s funding of home- and community-based services for people with mental illnesses is \u201clagging,\u201d according to an article<\/a> published in Health Affairs by Dennis Heaphy, researcher and policy analyst at Disability Policy Consortium in Boston, and Ellen Breslin, a principal at national health care consulting firm Health Management Associates (HMA).<\/p>\n Funding for home- and community-based behavioral health services is lagging because of institutional bias, Heaphy told HHCN. <\/p>\n \u201cInstitutional bias requires states to provide funding to institutionalization, whether it\u2019s a nursing home or some other institution, but home- and community-based services are optional, even though it\u2019s less expensive,\u201d Heaphy said. \u201cIn most cases, states still opt for institutionalization because it\u2019s basically simple or easy to do.\u201d<\/p>\n![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/06\/AD_4nXeu8i4qtOMlRWGDrQhB4mUVAi7PbnmomXF9Z49ekcOtnIQYw-k9gZ_IHSBbJCjxX0-zmP2L1SB3iaoh75vvDE8pnXu4ERux.png\" "\\"Chart\\"\/")
<\/p>\n