| 1. Direct Provision |
New Hampshire public mental health system, New Hampshire Hospital |
State owns psychiatric inpatient facility |
| 2. Direct Purchase, No Risk |
Medicare arrangements for professional services |
Centers for Medicare and Medicaid Services (CMS) pays unrelated (i.e.,
not federally employed) providers according to fee schedule |
| 3. Direct Purchase, Risk |
Medicare arrangements for inpatient services in general hospitals |
Centers for Medicare and Medicaid Services pay hospitals a prospectively
set rate per discharge (Diagnosis-Related Group [DRG] payment) |
| 4. Integrated Third-Party Purchasing, No Risk |
Self-insured employer |
Employer contracts on an Administrative Services Only (ASO) basis for
integrated health care benefit (managed or unmanaged); health plan purchases
both somatic health services and behavioral health services |
| 5. Integrated Third-Party Purchasing, Risk |
Lubbock County Service Area, Texas Medicaid program |
Texas Department of Health contracts with competing Health Maintenance
Organizations (HMOs) for integrated benefit provided under capitation
arrangement |
| 6. Carve-Out Third-Party Purchasing, No Risk |
West Virginia Medicaid program |
State Medicaid Agency carves out benefit to managed behavioral health
care organization (MBHO); pays MBHO fee-for-service |
| 7. Carve-Out Third-Party Purchasing, Risk |
Massachusetts Group Insurance Commission |
Employer group carves out benefit to MBHO, pays MBHO administrative
fee, and shares cost risk inside a fixed region (risk corridor) |
| 8. Carve-In, No Risk |
Self-insured employer |
Employer contracts with health plan on ASO basis; health plan subcontracts
with MBHO for behavioral health services on ASO basis |
| 9. Carve-In, Risk |
Federal Employees Benefit program |
Federal employees may choose, for example, an HMO, which carves in to
its own behavioral health subsidiary with a subcapitation arrangement
for behavioral health |
