Provide technical assistance for care integration
Recommendation
The Centers for Medicare and Medicaid Services (CMS) should provide technical assistance to provider practices for integrating behavioral health and primary care services. Congress should fund the Primary Care Extension Program (PCEP) at $110 million over ten years, and establish grant funding for technical assistance for the implementation and ongoing delivery of integrated care.[1]
Background/summary
Despite effective mental health treatments being available for a wide range of conditions, many Americans remain untreated or undertreated due to historically siloed mental health and substance use disorder (MH/SUD) and physical health systems.[2] Integrating MH/SUDs and physical health services can bridge the gap to accessing sufficient MH/SUDs treatment, improving patient outcomes.[2]
In 2017, the Centers for Medicare and Medicaid Services (CMS) began paying physicians and non-physician practitioners for supplying patients with Behavioral Health Integrated Services (BHI).[3] These services involve a closer partnership between treating physicians and mental or MH/SUD health professionals, which has proven beneficial to patients and has evolved into the Collaborative Care Model (CoCM).[4] 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.[5]
However, critical infrastructure is required to effectively implement BHI services.[4] Technical support is also vital to successful implementation, especially for smaller practices who may not have the resources to undertake it alone, but whose patient population would most benefit. Technical support grants can provide staff training, billing, financing, and EHR implementation.[1] Insufficient technical support resource allocation has effectively contributed to continued operational silos between MH/SUD health and primary care.[1] Through the Affordable Care Act (ACA), Congress directed the Agency for Healthcare Research and Quality to establish the Primary Care Extension Program (PCEP) to improve and integrate community-based health programs, and authorized $120 million over two years for the program.[1] However, funding was never appropriated.[1][6][7] Congress should appropriate $110 million over ten years for the PCEP to empower primary care practices to implement the technical and administrative changes needed for effective integration of MH/SUD services.
citations
1. Bipartisan Policy Center. “Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration”. Last Updated March 2021.
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. U.S. Senate Committee on Finance. “Bipartisan Mental Health Care Provisions.” Last Updated September 22, 2022.
5. University of Washington, Advancing Integrated Mental Health Solutions Center. “Collaborative care.” (n.d.)
6. U.S. House of Representatives, Office of the Law Revision Counsel, United States Code. “42 USC 280g-12: Primary Care Extension Program.” Last Accessed July 25, 2023.
7. Cohen, Deborah J., Kevin Grumbach, and Robert L. Phillips Jr. 2023. “The Value of Funding a Primary Care Extension Program in the United States.” JAMA Health Forum 4(2). Last Updated February 2023.