Five minute read

Most clinicians and managers are not involved in policy-making, a process often compared to sausage production. Yet, healthcare policy impacts all clinicians and other health professionals. Policy is essential for change at the highest levels in our society. Training programs, academic publications, and grant projects cannot hold a candle to the power of effective policy.

The current healthcare system is fragmented, driving health disparities, and creeping costs. Policy, driven by science and careful debate, sets the expectations for our healthcare system, keeps organizations accountable, and ensures compliance with the law.  The right policies at the right time could lead to better care coordination, care transition, treatment access, and more. It’s just a really slow process.

Two recent Congressional meetings show that there is momentum brewing in the capitol for behavioral healthcare change. The Senate committee on Health, Education, Labor and Pensions (HELP) held a hearing on the U.S. mental health crisis on Tuesday 1 February. The House Ways and Means committee met one day later (the first House committee hearing on mental health in more than a decade).

For summaries of the Senate HELP hearing, click here, and for the House Ways and Means hearing, click here. Here is an article summarizing both meetings.

House Ways and Means Committee Hearing on Mental Health Crisis

Senator Murray leads HELP Committee hearing on growing mental health & substance use disorder crises

Here are the major topics addressed in both meetings:

• Increase Centers for Medicare & Medicaid Services reimbursement
• Mental health professional shortage areas
• Mental health trainees not reimbursed under Medicare
• Offer more loan repayments
• Mental health treatment silos
• Mental health parity law enforcement (no plans are in compliance)
• Coverage for mental health and substance use treatment is poor, both private and public
• Prior authorization delays treatment
• Telehealth: some required to have in-person visit before

These issues are not surprising to health professionals in the behavioral health field. We have known for a while that mental health parity is still a dream, that patients in rural and underserved areas wait for months to see a mental health clinician, and that medical and mental health systems do not interface well with each other. My own clinical license (marriage and family therapy) is not recognized by Medicare.

A 2020 Gallup survey in my home state of Arizona revealed that 85% of Arizonans want available and affordable mental health services. However, my state ranks toward the bottom in mental health treatment access. Patients want better mental health access. Congress and other policy makers have the power to get the ball rolling.

Bills with strong potential for change:

Mainstreaming Addiction Treatment Act of 2021 (S.445). This bill removes the requirement that a health care practitioner apply for a separate waiver through the Drug Enforcement Administration (DEA) to dispense certain narcotic drugs (e.g., buprenorphine) for maintenance or detoxification treatment (i.e., substance use disorder treatment). Further, a community health aide or community health practitioner may dispense certain narcotic drugs for maintenance or detoxification treatment without registering with the DEA if the drug is prescribed by a health care practitioner through telemedicine. It preempts state laws related to licensure for this activity. The bill also directs the Substance Abuse and Mental Health Services Administration to conduct a national campaign to educate health care practitioners and encourage them to integrate substance use disorder treatment into their practices.

Effective Suicide Screening and Assessment in the Emergency Department Act of 2021 (S.660). This bill requires private health insurance plans that cover in-person mental health or substance use disorder services to cover such services on equal terms via telehealth (i.e., information technology used to aid treatment and diagnosis at a physical distance) during and shortly after the COVID-19 (i.e., coronavirus disease 2019) public health emergency. Specifically, this bill requires plans to, among other things, cover these services at the same rate as in-person services, exclude charges for facility fees, and provide information about how to access these services. Additionally, providers of these services may not charge facility fees to plan enrollees.

There is also talk of a bill to ensure that National Guard members are not discharged for seeking treatment to improve their mental health and another bill that supplies SAMHSA with more funding for integrating mental health into schools.

Conclusion

The future is getting brighter for behavioral health. In addition to the ideas above, I would like to see team-based care training become standard for most healthcare training programs. Generalists and specialists need specific skills for working as members of care teams, with an emphasis on behavioral health. Also, telehealth is here to stay. We need policy that removes barriers for telehealth and increases training opportunities and reimbursement.