Require GAO report on MH/SUD reimbursement rates
Recommendation
Congress should require the Government Accountability Office (GAO) to report to Congress on current reimbursement rates paid for mental health and substance use disorder (MH/SUD) services by Medicare, Medicaid, individual and group health plans, and other types of health coverage, both in and out of network. Rates should be assessed for their sufficiency to increase in the supply of participating providers and pipeline for clinicians entering MH/SUD fields, as well as compared to physical health reimbursement.[1]
Background/summary
Millions of individuals with MH/SUDs are unable to access the services they need. A significant part of the problem is that reimbursement rates for MH/SUD services are often lower than those for physical health services, which can discourage providers from participating in certain insurance networks or accepting insured patients.[2] Conversely, higher reimbursement rates can incentivize providers to join insurer networks and encourage more people to become MH/SUD clinicians, increasing access to care.[3] Reimbursement rates also vary widely across payers and markets.[4] This variation can create challenges for providers to navigate complex billing and payment systems and for patients to afford and access quality care. The GAO can play an important role in increasing transparency of reimbursement rates paid and disparities that exist that inhibit access to care.
citations
1. Giliberti, Mary. Fix the Foundation: Unfair Rate Setting Leads to Inaccessible Mental Health Care. Mental Health America. Last Updated February 10, 2023.
2. Melek, Steve, Stoddard Davenport, and T.J. Gray. Addiction and Mental Health vs. Physical Health: Widening Disparities in Network Use and Provider Reimbursement. Milliman Research Report. Last Updated November 19, 2019.
3. U.S. Government Accountability Office. Access Challenges for Covered Consumers and Relevant Federal Efforts. Last Updated March 2022.
4. Mann, Cindy and Adam Striar. How Differences in Medicaid, Medicare, and Commercial Health Insurance Payment Rates Impact Access, Health Equity, and Cost. The Commonwealth Fund. Last Updated August 17, 2022.