Establish a single global payment for mobile crisis response
Recommendation
Congress should require the Centers for Medicare and Medicaid Services (CMS) to establish a single global payment under the Physician Fee Schedule for mobile crisis response team services for Medicare beneficiaries experiencing a mental health or substance use disorder (MH/SUD) crisis. A bipartisan group of Senate Finance Committee members has supported this important step.[1]
Background/summary
Mobile crisis teams are a critical part of the MH/SUD crisis care continuum. The components of these teams can vary but generally involve response coordinators and social workers who can respond to MH/SUD crises. Research examining the impact of mobile crisis programs has shown they are effective in diverting individuals from emergency departments, reducing the need for hospitalization, and lowering law enforcement involvement for individuals experiencing an MH/SUDcrisis.[2]
Approximately 20 percent of older adults will experience an MH/SUD and access to services may be limited by mobility and transportation.[3] Additionally, many individuals with disabilities under the age of 65 are also eligible for Medicare. Mobile crisis teams are an indispensable part of the 988 Suicide Prevention and Crisis Lifeline, and access to mobile crisis teams is critical for Medicare beneficiaries experiencing an MH/SUD crisis.
Medicare currently covers psychiatric evaluation and depression screenings, which can be delivered in-office or through primary care integration, but does not explicitly cover mobile crisis teams.[4] Given that Medicare Part B has always covered emergency department and ambulance transportation services for physical health emergencies, Medicare should cover mobile crisis teams to ensure these important services are reimbursed and can be scaled to meet rising needs. Advancing parity for MH/SUD crisis services will reduce unnecessary emergency department visits, hospitalization, and law enforcement involvement. Congress should direct CMS to establish a global payment under the Physician Fee Schedule for mobile response team services for Medicare beneficiaries.[1]
citations
1. U.S. Senate Committee on Finance. “SFC Bipartisan Mental Health Care Provisions.” Last Updated May 26, 2022.
2. Saunders, Heather, Madeline Guth, Nirmita Panchal. “Behavioral Health Crisis Response: Findings from a Survey of State Medicaid Programs.” Kaiser Family Foundation. Last Updated May 25, 2023.
3. U.S. Department of Health and Human ServicesSubstance Abuse and Mental Health Services Administration. OLDER ADULTS LIVING WITH SERIOUS MENTAL ILLNESS: The State of the Behavioral Health Workforce. Last Updated 2019.
4. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare & Mental Health Coverage. Last Updated May 2023.