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Maryland providers seek 3% raise as state eyes behavioral health cut
Maryland behavioral health providers asked the House Appropriations Subcommittee on Health and Social Services for a 3% rate adjustment, saying current Medicaid and Public Behavioral Health System rates cannot retain staff (Becker's: https://www.beckersbehavioralhealth.com/behavioral-health-government-policies/5-state-behavioral-health-policy-updates/). The ask is the mirror image of Gov. Wes Moore's fiscal 2027 proposal: a $155.8 million cut to the Behavioral Health Administ
CMS provider-tax rule goes beyond H.R. 1 requirements
Comments close tomorrow on the CMS provider-tax proposal (https://www.cbpp.org/research/federal-budget/executive-action-watch?item=30628) released July 21. Nearly every state uses those taxes to fund its Medicaid share and support rate increases. The draft would extend the limits to non-Medicaid insurers and phase the hold-harmless threshold from 6 percent to 3.5 percent in expansion states from 2028 to 2032.
Experian's Patient Access Curator protected $50.4M in revenue
Forrester's August 2026 study (https://hitconsultant.net/2026/09/21/experian-health-patient-access-curator-forrester-tei-study-50m-denial-prevention/), commissioned by Experian Health and modeled from five customer interviews, pins the win on pre-service clearance: validating demographics, active coverage, coordination of benefits, and Medicare Beneficiary Identifier records before the encounter. Coordination-of-benefits denials fell 40% and eligibility denials 35% at the mod
Private practices would bear 80% of CMS's nearly $1B Modifier 25 impact
Jiro Health ran CMS's proposed same-day formula, pay the top-valued service in full and cut each other service by 50%, across claims from October 2024 through September 2025 (analysis: https://lifestyle.baretnews.com/story/361523/private-practices-would-bear-80-of-the-nearly-1b-impact-of-cmss-modifier-25-proposal/). The cut falls hardest on private practices and solo physicians at 81.5% of the total. CMS is expected to issue the final 2027 fee schedule this fall for a January
CMS swaps fee-for-service for outcome pay in behavioral health pilot
The next ACCESS entry point is October 1, 2026, and behavioral health participants bill only model G-codes for aligned Original Medicare beneficiaries during the 12-month care period instead of fee-for-service (Lexology: https://www.lexology.com/library/detail.aspx?g=eb97b506-6fb9-49ff-b3f5-651f76b0aadf). Payment is outcome-aligned, scaling with the share of patients hitting PHQ-9 and GAD-7 improvement targets against a 50% threshold in year one (McDonald Hopkins: https://www
LEARN Behavioral sues to stop MassHealth recoupment
Autism Spectrum Therapies, a LEARN Behavioral unit, filed suit September 23 against MassHealth and its managed care partners to halt a $943,000 recoupment of 2024 autism therapy payments (Behavioral Health Business: https://bhbusiness.com/2026/09/28/learn-behavioral-entity-sues-to-stop-masshealth-medicaid-recoupment/). The recoupment rests on a 1-to-10 supervision ratio, one hour of master-level oversight for every ten hours of therapy, that the suit says lived in guidance do
Illinois lawmakers host HB1085 webinars for behavioral health providers
Beginning January 2027, most private insurance plans in Illinois must pay more for behavioral health care under HB1085. The bill's sponsors are running two provider webinars, September 25 and October 2, on implementation and what to do if a plan doesn't comply. The sessions (https://www.replapointe.com/2026/09/14/rep-lapointe-sen-villa-to-host-webinars-for-behavioral-health-providers-on-hb1085/) cover the same material, will be recorded, and the announcement points providers
DOL makes therapy reimbursement methods a parity enforcement priority
The Labor Department's benefits enforcement arm named three parity priorities: blanket exclusions aimed at mental health benefits, medical necessity reviews as prior authorization and concurrent review, and network adequacy including provider pay. It will not enforce the portions of the 2024 final rule that go beyond the 2013 rule, but the comparative-analysis duties Congress added in 2021 remain in force, per Spencer Fane's analysis (https://www.spencerfane.com/insight/guidi
CMS proposes coaching reimbursement pathway
Practices you serve could add a newly billable adjacent line if CMS finalizes its July 14 proposed rule creating the first federal reimbursement pathway for health and wellness coaching, the National Board for Health & Wellness Coaching reports (https://nbhwc.org/cms-proposed-rule-health-wellness-coaching-coverage/). The pathway builds on Category III codes 0591T, 0592T and 0593T for assessment, follow-up and group coaching. With comments closed September 14 and final rulemak
Behavioral health spared from 2026 Medicare efficiency cut
CMS finalized the 2026 fee schedule with conversion factors above the 2025 rate. Psychotherapy codes are shielded from the new 2.5 percent efficiency cut to work RVUs, according to the September 16 analysis (https://insights.wchsb.com/2026/09/16/your-2026-medicare-revenue-may-depend-more-on-where-you-practice-than-what-you-bill/). A reshuffle of indirect practice expense between facility and non-facility settings means pay per code can still shift by site of service.
