Monitoring change in behavioral health care. The role of the Center for Mental Health Services.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the federal agency charged with improving the quality and availability of prevention, treatment, and rehabilitation services to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses. SAMHSA was established by the US Congress on October 1, 1992, in Public Law 102-321. Congress took this action to strengthen the nation's delivery system for prevention and treatment services for addictive and mental disorders. SAMHSA is the successor to the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), which since 1974 had encompassed the major research and services activities of the federal government aimed at reducing and controlling substance abuse and mental health problems. Under PL 102-321, the three former ADAMHA research institutes—the National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and National Institute of Mental Health—were transferred to the National Institutes of Health. SAMHSA is organized into four major components: the Office of the Administrator (OA); Center for Mental Health Services (CMHS); Center for Substance Abuse Treatment (CSAT); and Center for Substance Abuse Prevention (CSAP). One of SAMHSA's basic strategic goals is improving managed care outcomes. In 1995, an Office of Managed Care was established in the OA and in each of the Centers for the purpose of monitoring the development and impact of managed care reforms on people with mental illnesses and addictive disorders. These four offices are responsible for tracking changes in the organization and financing of behavioral health services throughout the country and for conducting studies of alternative service systems and their effects on access, quality, and costs. Each office conducts its own activities and studies; however, a substantial proportion of the projects are collaborative efforts. The report that follows summarizes the results of six projects in which the CMHS Office of Managed Care participates. Some of these studies are specific to managed care, whereas others examine broader issues of mental health and substance abuse (MH/SA) organization and financing. These specific projects were selected for discussion because they have already yielded substantive findings. They are (1) an in-depth evaluation of managed behavioral health care contracts; (2) an ongoing surveillance system for public managed care MH/SA services; (3) a project to develop national spending estimates for MH/SA on an annual basis; (4) a study on the costs and effects of parity in insurance coverage for MH/SA services; (5) a newly developed profile of MH/SA services in 10 state Medicaid programs; and (6) an annual survey examining trends in behavioral health benefits offered by employer-sponsored health plans. CMHS has the lead role for several of these studies; the two larger projects (the evaluation of contracts and the surveillance system) are collaborative efforts involving SAMHSA's four Offices of Managed Care. Information from these and other CMHS and SAMHSA studies is currently helping to guide public officials, consumers, families, and service providers in making the best possible use of managed care tools.