On March 30, the Senate Finance Committee held its third in a series of hearings on mental health titled, “Behavioral Health Care When Americans Need It: Ensuring Parity and Care Integration.” This hearing served as a follow-up to the committee’s Feb. 8 and Feb. 15 hearings on youth mental health [refer to Washington Highlights, Feb. 11, Feb. 18].
The witness testimony at these hearings, along with responses to Chair Ron Wyden (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 address barriers to mental and behavioral health care. The AAMC previously contributed to the committee’s efforts through an RFI response outlining recommendations to invest in the nation’s behavioral health workforce capacity, promote the integration of physical and behavioral health care, and leverage telehealth to improve access to care [refer to Washington Highlights, Nov. 19, 2021]. These recommendations were reflected in the committee’s final report summarizing 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, P.L. 110-343), Wyden stated, true parity between physical and mental health care continues to elude patients. He described tactics employed by insurance companies to subvert the law, including the use of “ghost networks” or out-of-date provider directories, mental health coverage limits, unreasonable prior authorization requirements, and the practice of stonewalling on paying claims. “I strongly believe that more needs to be done to hold the executives of these mental health companies accountable,” he stated.
In addition, Wyden stressed the importance of integration between mental and physical health care. “Mental health should not be fenced off from the rest of the health care system. The lack of integration can be fatal,” he said.
In his opening statement, Crapo reflected on the enormous toll that the pandemic has wrought on health professionals, resulting in workforce shortages that limit patients’ timely access to mental and behavioral health care. He also observed that individuals living in rural communities often face additional barriers to accessing care, citing telehealth as a potential solution. Crapo concluded by emphasizing the need for fiscally responsible solutions to the county’s mental health challenges. “We cannot simply throw more money at the problem and expect to solve everything,” he stated. “Instead, we must focus on developing data-driven, innovative and creative 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 her testimony, Ratzliff underscored 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 University of Washington AIMS Center. Ratzliff highlighted the potential of the CoCM to increase access to timely and appropriate behavioral health care: “This model is evidence-based with over 90 validated studies showing its effectiveness and has been recognized by the Centers for Medicare and Medicaid services with specific billing codes that were introduced in 2017.”
Ratzliff also described how integrated behavioral health models like the CoCM can extend the capacity of the existing behavioral health workforce to expand access to care. Ratzliff explained that the CoCM “leverages expertise like mine, as a psychiatric consultant, to support 60 to 80 patients in as little as 1 to 2 hours a week.” Ratzliff described how this team-based approach to the provision of behavioral health care can effectively expand access to mental health and substance use disorder treatment, particularly for rural and underserved populations. Ratzliff outlined specific policy recommendations to encourage the widespread adoption of the CoCM, including additional funding to support implementation at the practice level, the elimination of patient cost sharing under Medicare, and increased reimbursement through existing Medicare Current Procedural Terminology codes.
In an exchange with Sen. Chuck Grassley (R-Iowa), Ratzliff described how integrated care models like the CoCM can improve care for children and youth suffering from mental and behavioral health conditions. “I think also there’s the opportunity, especially for children with complex needs, to be able to address all of their needs in one place, hopefully reducing the burden of their families and in really trying to coordinate that care. I think many of my patients commented on that fact that they didn’t have to manage that communication between their different providers when that service was all offered together in one setting.”
In another exchange with Sen. James Lankford (R-Okla.), Ratzliff described how team-based, integrated behavioral health models, enabled 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 consultation to equip primary care providers at the rural hospital to better manage the behavioral health needs of their patients. “I think that that was a really powerful example of how you really need to get creative in partnerships and leveraging the workforce in new ways,” Ratzliff stated.