On March 30, the Senate Finance Committee held the third in a series of hearings on mental health titled, “Behavioral Health Care When Americans Need It: Ensuring Parity and Inclusive Care.” This hearing followed the February 8 and 15 committee hearings on youth mental health. [refer to Washington Highlights, Feb. 11, Feb. 18].
Witness testimony at these hearings, as well as responses to Chairman Ron Wyden’s (D-Ore.) and Ranking Member Mike Crapo’s (R-Idaho) September 2021 Request for Information (RFI), will be used. to inform the committee’s ongoing bipartisan efforts to remove barriers to mental and behavioral health care. The AAMC previously contributed to the committee’s efforts through a response to the RFI outlining recommendations to invest in the nation’s behavioral health workforce capacity, promote the integration of physical health care behavioral and leveraging telehealth to improve access to care. [refer to Washington Highlights, Nov. 19, 2021]. These recommendations were taken into account in the committee’s final report summarizing the responses received from stakeholders. [refer to related story].
In the thirteen years since the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA, PL 110-343), Wyden said, true parity between physical and mental state continues to elude patients. He described tactics employed by insurance companies to circumvent the law, including the use of “shadow networks” or outdated provider directories, mental health coverage limits, unreasonable prior authorization requirements and the practice of obstructing the payment of claims. “I strongly believe that more needs to be done to hold the leaders of these mental health companies accountable,” he said.
Additionally, Wyden emphasized the importance of integration between mental and physical health care. “Mental health should not be isolated from the rest of the health system. Lack of integration can be fatal,” he said.
In his opening statement, Crapo spoke of the enormous toll the pandemic has taken on healthcare professionals, leading to labor shortages that limit patients’ timely access to mental health care and behavioral. He also observed that people living in rural communities often face additional barriers to accessing care, citing telehealth as a potential solution. Crapo concluded by stressing the need for fiscally responsible solutions to the county’s mental health issues. “We can’t just throw more money at the problem and hope to fix everything,” he said. “Instead, we need to focus on developing innovative and creative data-driven solutions to address these challenges.”
The committee heard from Dr. Anna Ratzliff, MD, PhD, professor of psychiatry and co-director of the Advancing Integrated Mental Health Solutions (AIMS) center at the University of Washington. In his testimony, Ratzliff emphasized the importance of continued investment in care models that promote the integration of physical and behavioral health care, including the Collaborative Care Model (CoCM), which was first developed at the AIMS center at the University of Washington. Ratzliff highlighted the potential of CoCM to increase access to timely and appropriate behavioral health care: “This model is evidence-based with more than 90 validated studies showing its effectiveness and has been recognized by Medicare Service Centers and Medicaid with specific billing codes which were introduced in 2017.
Ratzliff also described how integrated behavioral health models like CoCM can expand the capacity of existing behavioral health staff to expand access to care. Ratzliff explained that the CoCM “leverages expertise like mine, as a psychiatric consultant, to support 60-80 patients in as little as 1-2 hours per week.” Ratzliff described how this team-based approach to behavioral health care delivery can effectively expand access to treatment for mental health and substance use disorders, especially for rural and underserved populations. . Ratzliff presented specific policy recommendations to encourage widespread adoption of the CoCM, including additional funding to support practice-level implementation, elimination of patient cost sharing under Medicare, and reimbursement increased via current Medicare procedural terminology codes.
In an exchange with Sen. Chuck Grassley (R-Iowa), Ratzliff described how integrated care models like CoCM can improve care for children and youth with mental and behavioral health issues. “I also think there is the possibility, especially for children with complex needs, of being able to have all their needs met in one place, hopefully reducing the burden on their families and really trying coordinate this care. I think a lot of my patients have commented on how they didn’t have to manage this communication between their different providers when this service was offered together in one setting.
In another exchange with Sen. James Lankford (R-Okla.), Ratzliff described how integrated, team-based behavioral health models, made possible by partnerships between academic medical centers and rural hospitals, can expand access to mental and behavioral health care in rural areas. . Citing the example of a partnership between the University of Washington and a rural access hospital, Ratzliff described how behavioral health professionals at the university provided consultations to equip primary care providers in the rural hospital to better manage the behavioral health needs of their patients. “I think that was a really powerful example of how you really have to get creative with partnerships and leverage the workforce in new ways,” Ratzliff said.