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