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As efforts to address mental healthcare access and pay parity are bogged down in Congress, the Biden Administration and the Department of Health and Human Services have established a roadmap for increasing access to behavioral health services, in addition to other healthcare system improvements.
As part of the move toward access, the administration is suggesting reforms to the way behavioral health is financed, particularly through programs such as Medicaid.
The Centers for Medicare and Medicaid Services, for instance, has been directed to authorize Medicaid coverage and reimbursement of “inter-professional consultations.” For a longer-term strategy, CMS will test payment models “that leverage behavioral health integration to support the delivery of whole-person care.”
Among other components of the roadmap are incentives for psychologists and social workers to integrate into primary care, with CMS set to create billing codes that account for monthly care integration.
CMS will also tweak requirements for therapists and licensed mental health professionals, who currently only receive payment if they deliver services under the supervision of the billing physician. In the agency’s Physician Fee Schedule proposed rule, reimbursement would be tied to more “general” supervision, ostensibly increasing access.
WHAT’S THE IMPACT
Key to the roadmap is the idea of integrated care. While integration often refers to inclusion of behavioral health services in primary care settings, HHS said it approaches it more broadly, to also include integration of physical healthcare into behavioral health settings, and integration of behavioral healthcare with other specialty areas such as OB/GYN care, as well as in social service and other settings.
What inspired the roadmap’s creation are some sobering numbers. In 2020, more than 52 million Americans were affected by mental illness – about 21% of the adult population, according to government data. Substance use disorders affected 15% (37.9 million) of U.S. adults, including 6.7% (17 million) of adults who were affected by both mental illness and substance use disorders.
This high prevalence of mental and substance use disorders in the U.S. has been a major concern to policymakers even before the COVID-19 pandemic. The concern has only increased. During the public health emergency, self-reported symptoms of anxiety have increased, as has the rate of overdose deaths, data from the American Hospital Association shows.
The roadmap hinges on a number of pillars: “Strengthen System Capacity” will develop “a diverse workforce prepared to practice in integrated settings and investing in infrastructure for integrated care.” The “Connect Americans to Care” pillar will leverage health financing arrangements, including efforts to fully realize the potential of parity; and the ” Support Americans by Creating Healthy Environments” pillar will invest in behavioral health promotion, upstream prevention and recovery.
THE LARGER TREND
CMS, as part of its Behavioral Health Strategy, is proposing to bundle certain chronic pain management and treatment services into new monthly payments; and is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for people who are homeless or live in rural areas.
Mental health concerns keep rising among Americans of all backgrounds, especially those who are Black, young adults, older than 65 or who identify as LGBTQIA+, according to a recent CVS Health/Morning Consult Poll.
A majority of respondents, 59%, have experienced concerns about either their own mental health or that of family and friends. That’s a 9% increase since April 2020. Another majority, 53%, agree that hearing about other people’s challenges makes them more comfortable seeking out resources and care for themselves.
And since the pandemic began, most people agree that society has become more comfortable engaging in mental health discussions (56%), using digital tools to improve mental health (58%) and using telemedicine for therapy (63%).
A 2021 study showed that mental health services accounted for the most common use of telehealth during the early days of the pandemic. In the midst of skyrocketing depression rates, the findings show that more patients used telehealth for behavioral rather than physical conditions.