Providers, Advocates Push for Higher Reimbursement Rates in Federal Legislation

February 28, 2022

Lawmakers are considering legislation that would aim to address the gaps in the behavioral healthcare system. Senator Patty Murray (D-WA), Chair of the Senate Health, Education, Labor and Pensions Committee, was quoted on saying, "Our mental health and substance use disorder workforce is stretched too thin to meet the needs of our kids, let alone our communities at large . . . If we keep stretching without taking action, something is going to break."

According to Centers for Disease Control and Prevention (CDC) data, Americans have experienced higher rates of mental health issues, as well as an increase in substance misuse and overdose, during the COVID-19 pandemic.

While there has not yet been a bill introduced, behavioral healthcare providers, advocates, and lawmakers are putting a focus on low reimbursement rates and restrictions on coverage that are limiting access to care. Jennifer Snow, National Director of Government Relations and Policy at the National Alliance on Mental Illness, was quoted on saying, "Parity law is not the reality for many people with mental illness . . . There might be laws on the books, but health insurers are really falling short on providing equitable coverage."

Stephen Gillaspy, Senior Director of Health and Healthcare Financing for the American Psychological Association, argues that payments and administrative burdens are driving mental healthcare providers away from private and government insurance programs. He was quoted saying, "More and more providers will say 'I'm not going to be on panels for Medicare or Medicaid,' or 'I'm just going to go to cash-only,' . . . Then, the only people that can access mental and behavioral health services are those folks that have the income for it, so it's a huge health equity issue."

A Milliman Research Report released in 2019 indicated that from 2013 to 2017, patients were 5.7 times more likely to go out of network for outpatient behavioral healthcare than for outpatient medical and surgical services. Additionally, the report found that primary care reimbursements were 24% higher than behavioral health payments as of 2017.

Higher reimbursement payments would encourage more mental healthcare providers to accept insurance, which would, in turn, entice more students to enter the field.

Dr. Sabrina Lim, System Vice President of Health and Safety and Quality for the Mount Sinai Health System, was quoted saying, "The core of those problems is we're under-reimbursed and behavioral health cannot meet our costs . . . One of the best ways to actually demonstrate that we're going to treat mental health in the same way as physical health is that we have to pay for it in the same way."

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