Minnesota Hospital Association

Policy & Advocacy

rules, regulations and comments

The Minnesota Hospital Association continually monitors state and federal rules and regulations to keep members informed and advocates on behalf of members regarding the impact of regulations on the state’s hospitals and health systems. MHA submits comment letters to share recommendations and feedback with the appropriate government organizations and health care stakeholders. Examples of rules and regulations that MHA addresses include those implementing federal or state health care reform efforts, changing payment methodologies, establishing community benefit or other standards for tax-exempt organizations, or modifying government oversight of health care activities.

September 26, 2013

Comments regarding improvements to mental and behavioral health care under Medicaid and Medicare

September 26, 2013    

 

The Honorable Max Baucus, Chair, Committee on Finance
The Honorable Orrin Hatch, Ranking Member, Committee on Finance  

Submitted electronically to [email protected]  

 

Dear Senator Baucus and Senator Hatch:  

On behalf of our 144 member hospitals and their associated health systems, the Minnesota Hospital Association (MHA) thanks you for the opportunity to provide comments regarding improvements to mental and behavioral health care under Medicaid and Medicare.  

Minnesota’s hospitals provide a wide range of mental and behavioral health services, from inpatient care to outpatient therapy and support services. Our members also see the otherwise avoidable pain, suffering and costs that occur when community-based options are not available or sufficient – desperate people who turn to the emergency department as a last resort in a mental health crisis, patients receiving more expensive care in settings that are not designed or staffed to best meet those patients’ needs, and patients and their families often experiencing frustration and anxiety as a result of having to wait for services or a transfer or an appointment opening.  

MHA expects that many individuals and organizations responding to your request for information and suggestions to improve mental and behavioral health care will advocate for additional spending to support these aspects of the healthcare system, increase the number of providers available to deliver these important services, and secure the infrastructure necessary to ensure that Medicare and Medicaid enrollees receive high-quality, timely, accessible and efficient care in their communities. MHA and our members struggling to provide the care and services needed by residents in every community of our state support these requests.  

Our mental and behavioral healthcare system has a myriad of needs, from education and training for the healthcare providers needed to serve patients to increased reimbursement rates to support new and existing providers offering these service, and from investments in community-based care options to funding of the non-ambulance transportation needs of patients who are transferred from one facility to another.  

There are other actions Congress can take to improve mental and behavioral health care for Medicare and Medicaid beneficiaries in Minnesota and throughout the country.       

One way to help increase access to community-based services is to allow Medicare credentialing for Licensed Marriage and Family Therapists (LMFT), Licensed Professional Clinical Counselors (LPCC), and Licensed Alcohol and Drug Counselors (LADC). Although these professionals are licensed and allowed to provide services to enrollees in Minnesota’s Medicaid program, they are not allowed to bill Medicare for services provided to Medicare beneficiaries.  

In one of our rural hospitals, for example, only two of five mental health providers currently are Medicare credentialed. Medicare beneficiaries who need mental health services and counseling within LMFTs’, LPCCs’ and LADCs’ scopes of practice could be served more quickly and at lower cost to Medicare by having access to these professionals as covered services. This is particularly important given the significant shortage of psychiatrists and psychologists in Minnesota, and especially in rural areas.  

In addition, most addiction treatment in Minnesota is provided by LADCs. Because Medicare does not pay for care provided by LADCs, Medicare is essentially blocking seniors from accessing outpatient substance abuse treatment.  

The integration of primary and behavioral health care is particularly important. A regulatory barrier to providing cost-effective, integrated care is the federal regulations pertaining to data privacy for persons receiving substance abuse services. These regulations are an obstacle for providers striving to achieve integration of behavioral health and primary care. Providers designing a comprehensive care plan for patients as part of Minnesota’s Multi-Payer Advanced Primary Care Practice demonstration project with Medicare, for example, cannot build a complete picture of their patients’ medical history or ongoing care needs when data pertaining to a significant health care issue such as substance abuse are not accessible in the same manner as other medical data.  

While appropriate when put in place in the 1970s, the need for these regulations has gone away as there are other federal and state protections in place to prevent discrimination against persons who might seek treatment for substance abuse. The regulations continue to perpetuate a sense of stigma by virtue of requiring providers to treat these patients and their medical information differently, as opposed to simply another health care problem.  

MHA respectfully suggests that Congress and the Centers for Medicare and Medicaid Services (CMS) revisit the statutory and regulatory basis for these rules and develop new standards that recognize the need for healthcare providers to access medical information pertaining to their patients’ substance abuse treatment under the same protections and safeguards as other patient data.  

Thank you for raising attention to and soliciting feedback on the growing needs of our mental and behavioral health care system. We are grateful for the opportunity to comment and welcome any opportunities to participate in further discussions of these issues. Please do not hesitate to contact me with any questions or concerns.  

Sincerely,

Jennifer McNertney, MPP

Policy Analyst