Better pay for psychiatrists and other mental health practitioners.
Elimination of repeated prior authorizations for mental health services.
Mental health care advocates say that even if a comprehensive health care reform bill championed by state Sen. Julian Cyr, D-Truro, accomplishes only these two goals, it would improve lives across the commonwealth.
“Believe it or not, a psychiatrist is reimbursed through MassHealth at a lower rate than other doctors,” despite their years of specialized training, said Heidi Romans Nelson, CEO of Duffy Health Center in Hyannis.
“We get paid less for a psychiatrist visit when psychiatrists are harder to find,” she said.
Duffy Health Center averages 30,000 patient visits a year, about a third of which, 8,900, are for mental health services, Nelson said.
Parity in payment for mental health services “would be very significant” for the health center, she said.
The mental health bill, known as An Act Addressing Barriers to Care for Mental Health, passed the state Senate last week. Supporters expect it to go before the House before the end of the fiscal year on June 30.
The bill would make sweeping changes in the way mental and behavioral health care is delivered in Massachusetts and would eliminate discrimination between coverage of medical or primary care and mental health care.
In addition, the bill would level the playing field by ensuring mental health providers are reimbursed at a rate equitable and consistent with primary care and eliminate prior authorization requirements for patients needing acute psychiatric inpatient care.
Eliminating the need for repeated prior authorizations will get patients the mental health counseling they need in a timely way, Nelson said.
Determining the best course of action for a patient needing mental health services “should really just be a clinical decision,” in the same way that coming up with a treatment plan for patients with diabetes or hypertension is, she said.
A lot of time is wasted seeking approval for patients with psychiatric emergencies, said Jacqueline Lane, executive director of NAMI Cape Cod & Islands.
“You spend a lot of time playing games with insurance companies,” she said.
The mental health reform act would put teeth in previously passed mental health parity bills passed at the state level in 2000 and federal level in 2008 by giving the state the ability to penalize insurance carriers for violations in parity.
“Parity hasn’t been enforced,” Lane said. “The whole idea was mental health is health and should be treated equally.”
Lane predicted that the proposed legislation will “get a lot of pushback from insurance companies.”
“Hopefully, we’ll get something out of it” after the bill goes to the House and Gov. Charlie Baker, she said.
Lane said more needs to be done to address mental health care needs, including development of a long-term care unit on Cape Cod.
“It’s getting harder and harder to get anybody in anywhere,” she said.
In the meantime, legislation that effectively increases mental health practitioner pay could attract more people to the field, mental health advocates said.
Finding a licensed mental health care provider is a struggle for patients and families, especially since a growing number of providers are accepting only private pay, Nelson said.
“Half of licensed clinical social workers in Massachusetts do not accept insurance,” Nelson said. “Not even just MassHealth, they don’t accept any insurance. Fifty percent are private pay only,” she said.
“In Massachusetts, we have the best social worker schools in the country,” Nelson added. “Only people who can afford to pay cash can benefit from that.”
“Everybody has someone in their family” that has struggled with a mental health or addiction issue, Nelson said. If mental health providers were paid more fairly, “there might be more services available,” she said.
Follow Cynthia McCormick on Twitter: @Cmccormickcct.
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