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acute administration ADRGs alternative American Psychiatric Association antitrust benefits California chains changes chiatric clinical CMHCs Committee community mental health competition contract copayments cost containment coverage day hospital decision deinstitutionalization diagnosis discharge DRG system DRG-PPS economic effect employers expenditures facilities federal fee-for-service for-profit funding health care costs health insurance health maintenance organizations health plan Hosp Community Psychiatry impact incentives increased inpatient Institute issues legislation length of stay limited major major diagnostic categories Medicaid medical record Medicare Medicare program ment mental disorders mental health professionals mental health services mentally ill National nonphysicians operated outpatient participate patients peer review percent physicians pital practice preferred provider preferred provider organization prepaid problems procedures prospective payment system provider organization psychiatric hospitals psychiatric services rates reduce referrals reimbursement revenue sector Senate SMHA SMHS third-party payers treatment utilization review