Increase Medicare payment rates for care integration
Recommendation
Congress should increase Medicare payment rates for mental health and substance use disorder (MH/SUD) integration services to help defray a portion of the startup costs that providers incur when they begin delivering care through models that integrate MH/SUD and primary care.[1]
Background/summary
Despite effective MH/SUD treatments being available for a wide range of conditions, many Americans remain untreated or undertreated due to historically siloed MH/SUD and physical health systems.[2] Integrating MH/SUD and physical health services can increase access to MH/SUD care and improve patient outcomes.[2]
In 2017, the Centers for Medicare and Medicaid Services (CMS) began paying physicians and non-physician providers separately for supplying patients with Behavioral Health Integrated Services (BHI).[3] These services involve a closer partnership between primary care and MH/SUD providers providers, which has proven beneficial to patients and has evolved into the Collaborative Care Model (CoCM). This model has been demonstrated effective by more than 90 randomized-controlled trials and can help to more effectively utilize limited MH/SUD provider capacity.[4]
However, critical infrastructure is required to effectively implement BHI services.[4][5] Insufficient compensation for training and technical support has effectively contributed to continued payment silos between behavioral health and primary care.[5] Therefore, as proposed by the Senate Finance Committee in its November 2022 Mental Health Care Integration Discussion Draft, Congress should increase Medicare payment rates for BHI services.[1][6]
citations
1. U.S. Senate Committee on Finance. Bipartisan Mental Health Care Provisions. Last Accessed November 10, 2022.
2. The Kennedy Forum. Vision: Integration. (n.d.)
3. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Behavioral Health Integration Services. Last Updated March 2021.
4. The University of Washington AIMS Center. Collaborative care. (n.d.)
5. Bipartisan Policy Center. Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration. Last Updated March 2021.
6. U.S. Senate Committee on Finance. Finance Committee Unveils Mental Health Care Integration Discussion Draft (Press Release). Last Updated November 10, 2022.