Two pieces of draft legislation aim to bolster the behavioral health care workforce and remove barriers to integration of behavioral health into primary care
Dec. 16, 2022 (ACP) — The demand for behavioral health care services in the United States has never been higher. The American College of Physicians is actively working to ensure patients get the care they need through legislation aimed at strengthening the health care workforce and integrating behavioral health services into internal medicine and other practices providing primary care.
The U.S. Senate Finance Committee recently released bipartisan draft legislation aimed at bolstering the mental health care workforce. “We are supportive of this draft legislation, but we also have specific recommendations to improve it,” said Brian Buckley, ACP senior associate for legislative affairs.
The legislation includes a provision that would increase the number of psychiatrists by funding 400 additional Graduate Medical Education (GME) slots for psychiatry residencies each year starting on Oct. 1, 2024.
This is helpful, but it does not address the shortage of primary care physicians, many of whom are on the frontlines of the behavioral health epidemic, Buckley said. “We really need more primary care physicians available to treat patients in need of behavioral health care, as these practices are largely where patients show up,” he said.
To that end, ACP is urging the Senate to include the Resident Physician Shortage Reduction Act in any final legislation. This bill would provide about 14,000 new GME positions over seven years.
The legislation would also expand the Medicare Health Professional Shortage Areas bonus program to increase bonus payments for physicians in behavioral health care shortage areas that diagnose, evaluate or treat mental health or substance use disorders starting Jan. 1, 2024. Physicians who provide care to medically underserved populations and those in areas where the prevalence of behavioral health conditions exceeds the national average will get priority for these grants. ACP supports such policies, including loan forgiveness programs, mentoring initiatives, and increased payments to incentivize more individuals to train and practice as behavioral health professionals.
ACP also remains focused on bolstering behavioral health care and services for physicians to reduce rates of burnout, increase resiliency and prevent suicide, Buckley explained. Named for an emergency medicine physician who died by suicide at the peak of the first COVID-19 wave, the Dr. Lorna Breen Health Care Provider Protection Act became law earlier this year and authorizes funding to support the mental health and well-being of physicians. This legislation was a win, but more work is still needed, Buckley said. ACP supports improved access to evidence-based programs for physicians to improve their mental health and reduce stress. “We are working toward expanding access to behavioral health care for patients and physicians,” Buckley said.
ACP is also working to remove barriers to the integration of behavioral health care services into primary care practices. In a second letter to the Senate Finance Committee regarding another piece of draft legislation, ACP outlined a multipronged effort to remove silos by increasing Medicare payment rates for behavioral health integration services in 2025, 2026 and 2027 to help defray startup costs and by removing administrative and financial barriers that impede such integration. To that end, ACP is also urging Congress to include H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act, in the final legislation. This bill would provide grants through the U.S. Department of Health and Human Services to primary care physicians who choose to deliver behavioral health care through the behavioral health integration model known as the Collaborative Care Model. Specifically, this bill authorizes $30 million annually for the fiscal years 2022 through 2026 for hiring staff, establishing contractual relationships with health care clinicians, purchasing or upgrading software, and other necessary activities.
In addition, ACP supports Congress's efforts to increase Medicare payment for mobile crisis response teams, Buckley added. The draft legislation would require that the Centers for Medicare and Medicaid Services establish a single global payment under the Physician Fee Schedule and clarifies that peer support specialists can furnish mobile crisis response team services under the supervision of a physician or other practitioner who is billing Medicare, a provision built on the 9-8-8 National Suicide Prevention Lifeline Implementation Act that ACP supported earlier this year.