Alignment for Progress: A National Strategy for Mental Health and Substance Use Disorders
It’s time for a meaningful national conversation about mental health and substance use care. We must remove the barriers to equitable and available coverage for these conditions so people can get the help they need.
Welcome To The National Strategy
Want to understand more about the importance of building a National Strategy for Mental Health & Substance Use Disorders?
How Content Is Organized and How Best to Search/Sort the Recommendations
The National Strategy recommendations are organized by category, with impacted populations and topical areas providing additional nuance and the ability to narrow a search. We have also included the option to search recommendations by the relevant House and Senate committees of jurisdiction.
Recommendation Selection Methodologies and Criteria
After conducting a thorough review of the federal policy landscape, The Kennedy Forum team created this first-of-its-kind compilation of policy recommendations needed to transform our mental health and substance use systems. The recommendations have been sourced and vetted from numerous organizations, advocates, and experts across the country in order to capture a robust set of recommendations for lawmakers and federal agencies to act on.
All National Strategy Recommendations
These featured recommendations are highlighted based on their importance in beginning the national movement towards better care for everyone.
Create HCPCS codes for tech-based treatments
The Centers for Medicare and Medicaid Services (CMS) should fast-track the creation of Healthcare Common Procedure Coding System (HCPCS) codes for Food and Drug Administration (FDA)-approved technology-based treatments, digital interventions, and biomarker-based interventions. The National Institutes of Health (NIH) should develop a means to evaluate behavior modification apps for effectiveness.[1]
Digital tools such as software-driven applications, wearable devices, as well as detective or biomarker-based interventions can be leveraged to identify needs, assess care, and deploy substance use disorder (SUD) treatments.[1][2][3] An example of such a technology are “devices that transmit findings from smartphones directly into the medical record.”[1]
No independent regulatory agency, such as the Food and Drug Administration (FDA), is charged with consistently examining all mental health and substance use technology or applications. While the FDA may review certain apps (e.g., those that may require a prescription or function as a medical device), the agency uses its enforcement discretion with respect to many other mental health and substance use applications. The Federal Trade Commission (FTC) can also investigate potential false claims that an app developer may make.
While Congress should designate a regulatory body to oversee these emerging technologies, patients and providers would benefit from foundational research on how best to evaluate behavior modification apps to ensure they are effective. This information would support the development of a new regulatory framework for this technology, including how the FDA currently may review mobile health applications for the treatment of mental health and substance use disorders.
Once a technology or product is deemed safe and effective, it is critical for payers, including Medicare and Medicaid, to ensure the timely creation of reimbursement codes so that consumers can access emerging technology that helps meet their needs.[2]
Topics
Forbid same-day billing restrictions in Medicaid
Congress should prohibit same-day billing restrictions in state Medicaid programs as a condition of receiving federal funding, as recommended by a bipartisan group of Senate Finance Committee members.[1][2]
Despite the demonstrated efficacy of increased integration between physical and mental health and substance use disorder (MH/SUD) care, several states currently restrict billing for MH/SUD and physical health services on the same day to avoid duplicative billing.[3][4] This has restricted the ability to receive MH/SUD and physical health services on the same day, limiting the ability to meaningfully integrate care for individuals needing MH/SUD and physical health services.[5] Additionally, these restrictions present an undue burden on low-income individuals enrolled in Medicaid who are less likely to have sufficient access to time off and transportation for multiple office visits to accommodate their physical and MH/SUD needs separately.[5] The current reality for both patients and practitioners in states with same-day billing restrictions is antithetical to expanding integrated care.[1][2]
Topics
Expand value-based payments to encourage care integration
Congress should require the Centers for Medicare and Medicaid Services (CMS) to conduct an analysis of integration models in Medicaid and publish guidance describing state options for adopting or expanding value-based payment arrangements that integrate mental health or substance use disorder (MH/SUD) care within the primary care setting and best practices.[1][2][3]
Value-based payment systems are designed to improve patient care with financial incentives to providers, and such programs have been successfully implemented by the Centers for Medicare and Medicaid Services (CMS) for several programs aimed at reducing hospital-acquired illnesses and readmissions.[4] By incorporating mental health and substance use disorder (MH/SUD) care within primary care settings and expanding value-based payment models that tie quality metrics to payment, it can align incentives to improve the quality of care and outcomes.[3] In its 2022 Mental Health Care Integration Discussion Draft, the Senate Finance Committee proposed requiring CMS to analyze Medicaid integration models and deliver guidelines for states to incorporate value-based payment arrangements integrating MH/SUD and primary care.[1][2][3]
Topics
Pass the Stop Copay Overpay Act
Congress should pass the Stop Copay Overpay Act, which would prohibit the Department of Defense (DOD) from charging TRICARE enrollees a co-pay exceeding a certain rate for an outpatient visit for mental health and substance use disorders (MH/SUD). Specifically, the co-payment amount should not exceed a co-pay charged under the TRICARE program for an outpatient visit for primary care services.[1][2]
Over nine million people use TRICARE to provide for their healthcare needs, which includes coverage for MH/SUD services.[2] Copays under TRICARE have been increasing[3] and are higher than those under the Federal Employee Health Benefits (FEHB) program and some commercial plans.[3] The current lack of parity between copayments for outpatient MH/SUD visits and primary care outpatient visits must be addressed. Discriminatory cost barriers should not be a reason why someone does not receive the MH/SUD care they need.[2] To address reduce these costs on active military families, Congress should pass the Stop Copy Overpay Act.[1][2]
Topics
Ban SOGI change efforts
Congress should end harmful and ineffective sexual orientation and gender identity (SOGI) change efforts by passing legislation that bans SOGI change efforts or provides supportive resources. Additionally, licensed mental health and substance use disorder (MH/SUD) providers should be banned from engaging in SOGI change efforts, federal funds should be restricted, and SOGI change efforts should be defined as consumer fraud.[1]
According to the Substance Abuse and Mental Health Services Administration, “SOGI change efforts, commonly referred to as ‘conversion therapy’ or ‘reparative therapy,’ are practices that aim to suppress or alter an individual’s sexual orientation or gender to align with heterosexual orientation, cisgender identity, and/or stereotypical gender expression.”[1] SOGI change efforts have been linked to increased risk for psychological distress, suicidality, and depression.[1] About 698,000 LGBTQ+ adults have been subject to SOGI change efforts, with about half subject to the efforts in adolescence.[2] SOGI change efforts have been performed by licensed mental health providers as well as unlicensed providers and faith leaders.[3]
The Biden Administration has called on the Department of Health and Human Services (HHS) to ensure that federally funded health services are not used for SOGI change efforts.[4] The Therapeutic Fraud Prevention Act, as introduced in the 118th Congress, would ban SOGI change efforts and identify it as a fraudulent practice.[5][6] While several states have banned SOGI change efforts, federal legislation should be passed to ban the harmful practice, restrict federal funding, and define the efforts as consumer fraud.[1][3]
Topics
Create new payment models to further care integration
The Centers for Medicare and Medicaid (CMS) should create novel payment models and build on existing models that allow primary care providers to cover the full range of primary care and mild to moderate mental health and substance use disorder (MH/SUD) services.[1]
Over the past two decades, there has been increasing interest and movement towards value-based healthcare models, including the implementation of new payment reforms and demonstration programs. One of the main goals of value-based care is to move away from a fragmented fee-for-service model of delivering and paying for care to a more holistic system focused on health outcomes, including quality and cost.
New value-based care models can be used to drive further integration of primary care and MH/SUD services. Specifically, Congress should authorize CMS to create and offer the Integrated Health Model as a voluntary option for primary care providers currently in traditional fee-for-service Medicare.[1] Under such a program, risk-adjustment payments would be made to healthcare providers for primary care and integrated MH/SUD services, including preventive physical care, prevention, and management of mild to moderate MH/SUDs, and stress-related physical symptoms.[1]
While new value-based payment models are needed to help speed integration, building on existing models should also be considered. Medicare’s Merit-based Incentive Payment System (MIPS) is designed to improve care and health outcomes by tying payments to a provider's performance.[2] Healthcare providers can have their reimbursements adjusted upwards or downwards based on their performance in four categories: quality, cost, promoting interoperability, and improvement activities.[1] MIPS already includes some MH/SUD measures under the category of improvement activities, including activities related to integration (e.g., completion of a collaborative care management training program). To accelerate further integration, CMS should include additional MH/SUD integration measures in the MIPS mental/behavioral health measure and improvement activity set.[1]