Forbid same-day billing restrictions in Medicaid
Recommendation
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]
Background/summary
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]
citations
1. U.S. Senate Committee on Finance. “Bipartisan Mental Health Care Provisions.” Last Updated November 10, 2022.
2. CEO Alliance. A Unified Vision for Transforming Mental Health and Substance Use Care. Last Updated August, 2022.
3. University of Washington AIMS Center. COLLABORATIVE CARE. (n.d.).
4. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. 2008. Reimbursement of Mental Health Services in Primary Care Settings. Last Updated February, 2008.
5. Roby, Dylan and Jones, Erynne. 2016. “Limits on same-day billing in Medicaid hinders integration of behavioral health into the medical home model.” National Institutes of Health, National Center for Biotechnology Information. Last Updated February 2016.