Year-end US Congress activities: Senate and House of Representatives prioritize mental health services
The Senate and House of Representatives are targeting an adjournment before January 1, 2023 — and have an ambitious agenda to expand certain government programs and related funding, as well as address various policy issues. A key healthcare issue currently under discussion is greater support for mental health services.
The increase in violence and demands for more mental health services in virtually every community are prompting Congress to seek new solutions to ensure care is available and to expand identification and prevention services for those at risk.
The Senate Finance Committee has released another proposal to fund the availability of mental health services through investments in mobile vans and funds to improve Medicare integration of behavioral health/health services. In addition, senators recommended that the Center for Medicare & Medicaid Innovation consider incorporating the behavioral orientation of health services into the development of new models of care.
The purpose of this current effort is to improve crisis response and stabilization for Medicare patients in need of mental health services. This measure is consistent with previous legislative efforts that have funded government activities to expand services, particularly those aimed at integration into primary care. Under Medicare, senators are proposing a single global payment for physicians to fund the services of mobile crisis response teams.
The House of Representatives is working on a similar effort to increase the supply of behavioral health professionals, support a broader reach and focus on a prevention strategy. While those efforts are “at the forefront,” it’s unclear what will be included in a final year-end bill.
If there is an agreement to move forward, look for increased Medicare funding and funding for states to expand service availability and funding to align mental health care with primary care service programs.
California is overhauling its behavioral health system
The State of California has made significant expansions and investments in the behavioral health care system available to Californians in its ongoing effort to achieve several goals: (1) contain the growing cost of health care in the state, (2) provide necessary behavioral health services in connection with the growing need for such services due to the COVID-19 pandemic and homelessness crisis, and (3) to reduce long-term healthcare costs by providing effective and timely behavioral healthcare services. The State of California is attempting to meet these goals through several new initiatives, some of which are discussed below.
|1.||Community Assistance, Recovery, and Employment (CARE) courts to treat untreated mental illness|
Under California Senate Bill 1338 (SB 1338), several California counts are required to establish a new CARE court no later than October 1, 2023. CARE courts are designed to address the needs of Californians with untreated serious mental illness. Named counties include Glenn, Orange, Riverside, San Diego, San Francisco, Stanislaus, and Tuolumne, with the remaining California counties set to follow suit through December 1, 2024. CARE courts are empowered to order clinical evaluations from qualified individuals and order a treatment plan focused on community assistance, recovery and strengthening (a “CARE Plan”) of the person through medication services, social services, housing assistance, etc. SB 1338 also directs that California regulated healthcare plans pay for mandatory assessments and services or are recommended by a CARE plan, regardless of whether the provider is contractually affiliated with that plan or whether prior approval has been obtained. Individuals may apply to the CARE courts for eligible beneficiaries, including the person suffering from a current serious mental illness, clinical instability, and other needs.
|2.||Mandatory school-based services through a new Child and Adolescent Behavioral Health Initiative (CYBHI)|
California is committed to improving behavioral health services for children and adolescents through its new CYBHI, which will expand behavioral health services by making such services easily accessible in schools. To facilitate this and encourage provider participation, California Assembly Bill 133 (AB 133) directs the California Department of Health Care Services (DHCS) to allocate a new statewide minimum fee schedule for “school-bound” outpatient treatment for mental illness or addiction develop services for students up to 25 years. Under AB 133, all health plans regulated by the State of California must pay providers of school-based behavioral health services at least the minimum amount in the fee schedule, regardless of whether the provider has a contract with the health plan. DHCS intends to use this fee schedule to create a sustainable source of funding for school-based behavioral health services, regardless of payer/health plan.
Another aspect of the CYBHI is that DHCS develops and selects evidence-based interventions and practices to improve outcomes for children at risk and children diagnosed with behavioral disorders, and to provide financial incentives for parties investing in these programs. DHCS will provide Californians ages 25 and younger, regardless of payer, with a virtual platform for the delivery of telebehavioural health services. In particular, DHCS has the task of acquiring a provider for setting up and maintaining such a platform.
|3.||Improvements and integration of the California Advancing and Innovating Medi-Cal (CalAIM) initiative|
CalAIM will create new, standardized patient screening tools for referrals to California County’s behavioral health systems, which is just one route through which Medi-Cal beneficiaries can currently receive behavioral health care services. Medi-Cal beneficiaries can also access behavioral health services for “mild to moderate” behavioral health services through California’s Medi-Cal Managed Care health plans. To that end, California introduced a “No False Door for Mental Health Services” policy beginning in July 2022, allowing providers to bill both counties and Medi-Cal-administered care plans for clinically appropriate mental health services during an assessment period or before one determining diagnosis. These changes are intended to ensure that beneficiaries can maintain a treatment relationship with providers under either or both plans (and give providers flexibility in billing for these services) pending referral.
The CalAIM Behavioral Health Payment Reform Initiative also aims to move counties away from cost-based reimbursement in favor of value-based payment models that reward better care and quality of life for Medi-Cal beneficiaries. Districts will also be relieved of the burdens associated with current cost-based reimbursement processes using DHCS for behavioral health services via Medicaid Certified Public Expenditure (CPE) methods. This transition to payment reform will also result in specialized mental health and addiction services moving from Healthcare Common Procedure Coding System (HCPCS) Level II coding to Level I coding, using current codes whenever possible Procedural Terminology (CPT) are used. These payment reforms are expected to go into effect on July 1, 2023.
©2022 Greenberg Sad, LLP. All rights reserved. National Law Review, Volume XII, Number 342