Ensure FQHCs offer medication-assisted treatment
Recommendation
The Health Resources and Services Administration (HRSA) should ensure all Federally Qualified Health Centers (FQHCs) offer Medications for Opioid Use Disorder (MOUD) and Medications for Alcohol Use Disorder (MAUD), as well as wraparound and counseling services (together with medications often referred to as Medication-Assisted Treatment, or MAT).[1] Additionally, Congress should pass the Better Mental Health Care for Americans Act, to award planning grants to States to support the development of State infrastructure, such as technology and the physical structures necessary to physically co-locate integrated mental health and substance use disorder (MH/SUD) care services, including prevention and early intervention services.[2][3]
Background/summary
Health centers conduct more than 1.7 million substance use disorder (SUD) visits and over 15 million mental health visits.[4] Unfortunately, despite providing indispensable integrated health care services for individuals enrolled in Medicaid and Medicare, a significant percentage of FQHCs have historically not provided core evidence-based treatments for SUDs, including opioid use disorder. One survey showed that, in 2019, 36 percent of community health centers did not offer MAT.[5] While the percentage of FQHCs providing MAT has improved over time, no FQHC should be permitted to not provide this life-saving treatment. Particularly now that Congress has eliminated the requirement that buprenorphine (a key MOUD) prescribers have a separate waiver (X-Waiver), there can be no excuse for an FQHC failing to provide MOUD and wraparound and counseling services.[1] FQHCs can be particularly important in increasing access to needed SUD treatment in rural communities.[6]
Additionally, there is a gap in coverage and treatment facilities across most states. More than 163 million people live in a mental health Health Professional Shortage Areas (HPSAs), meaning they do not have access to MH/SUD health professionals or treatment and support services.[7] Co-location of primary care and MH/SUD services has been shown to improve access to care and health outcomes.[8] This type of care entails providers using similar technologies, such as electronic health records, and being in the same physical location.[8] By providing funding to states, they can develop the necessary infrastructure to provide MH/SUD care services at the same physical location.[2][3]
citations
1. The Kennedy Forum. Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Last Updated October 2017.
2. Better Mental Health Care for Americans Act. S. 923 (Bennet-Wyden), 118th Congress (2023-2024). Last Updated March 22, 2023.
3. Michael Bennet, U.S. Senate, Colorado. Bennet, Wyden Introduce Bill to Increase Access to Mental and Behavioral Health Care for Kids, Seniors, and Low-Income Americans (Press Release). Last Updated March 22, 2023.
4. U.S. Department of Health and Human Services, Health Resources and Services Administration. Behavioral Health and Primary Care Integration. Last Updated April 2023.
5. Corallo, Bradley, Jennifer Tolbert, Jessica Sharac, Anne Markus, and Sarah Rosenbaum. "Community Health Centers and Medication-Assisted Treatment for Opioid Use Disorder." Kaiser Family Foundation Issue Brief, (2020). Last Updated August 14, 2020.
6. Emily B. Jones, Ph.D. "Medication-Assisted Opioid Treatment Prescribers in Federally Qualified Health Centers: Capacity Lags in Rural Areas." The Journal of Rural Health 34, no. 1 (2017). Last Accessed July 16, 2023.
7. U.S. Department of Health and Human Services, Health Resources and Services Administration. Health Workforce Shortage Areas. Last Updated July 25, 2023.
8. Karen Monaghan and Travis Cos. Integrating physical and mental healthcare: Facilitators and barriers to success. National Institutes of Health, National Library of Medicine, Med Access Point Care. Last Updated October 11, 2021.