Democratic presidential candidate Kamala Harris has unveiled a new plan to reform mental health treatment. If passed, it could lead to new opportunities and higher reimbursement rates for behavioral health providers.
The plan aims to double the number of mental health treatment beds nationwide, remove the institutions for mental disease (IMD) exclusion, increase the availability of telehealth, expand parity and tackle the mental health worker shortage, among other initiatives.
The California senator announced the plan Monday in South Carolina, which is be a priority state under the proposal, in addition to Iowa, Nevada and Michigan.
“It is about time that we take this issue out of the shadows, that we stop stigmatizing this issue and that we give people the health care they need both from the neck down and from the neck up,” Harris said when announcing the proposal.
Funding, reimbursement
While Harris didn’t directly address how much the plan would cost, she said it would be largely funded by her previously released Medicare for All plan, without deductibles or copays for those seeking treatment.
Additionally, the proposal outlines a $100 million Tribal Emergency Fund, which SAMHSA would create and administer to help tribal communities address behavioral health issues of their own.
Beyond how the plan will be paid for, the proposal outlines how behavioral services should be funded. The goal is to “close the gap in reimbursement rates between psychiatric providers and other medical professionals,” according to the text of the proposal.
“It takes time and visits [to address behavioral health issues] — multiple visits over a long period of time — but we’re not compensating mental health providers in a way that encourages them to take the time,” Harris said.
That’s an unfortunate reality that behavioral health providers know all too well — and one that’s backed by research. A recent report published by Seattle-based actuarial and consulting firm Milliman Inc. shows that U.S. employees are far more likely see lower reimbursement for behavioral health services than for physical health services. The same is true of the likelihood that they’ll go out of network for care.
Harris’s plan seeks to tackle these issues and others in part by expanding parity rules. The proposal would require parity for private Medicare plans, as well as for the commercial insurers, managed care organizations and Medicaid expansion plans that are currently bound by parity rules.
Traditional Medicare and certain Medicaid plans are not currently bound by pairity.
Staffing, treatment
Harris’s proposal also targets the behavioral health worker shortage, as well as access issues in various areas and populations nationwide. To help with both, the plan would lead to the investment in telemedicine so “all Americans can get mental health care whenever and wherever they need it.”
Additionally, it would introduce a student loan forgiveness program for mental health workers in areas experiencing the worst shortages and fund programs to encourage more nurse practitioners and physician assistants to become psychiatric specialists.
While many of the aforementioned initiatives would be beneficial to behavioral health providers, a few items in the plan are likely to be especially pleasing.
Namely, that includes the proposal to double the number of mental health treatment beds available nationwide and to remove the IMD exclusion, in addition to continued and expanded funding for the certified community behavioral health clinic (CCBHC) Medicaid program.
The IMD exclusion currently prohibits Medicaid from paying for beneficiaries to be treated in in-patient psychiatric facilities with more than 16 beds — unless the state in question has received special approval. Opponents have criticized the rule, calling it illogical and detrimental to those who require serious mental health or substance abuse treatment.
Meanwhile, the CCBHC program is currently live in eight states — but is set to expire in December, unless additional funding is set aside. CCBHCs receive higher-than-usual Medicaid reimbursement to provide 24-hour crisis care and other services for those who need mental health and substance use disorder (SUD) services, regardless of their ability to pay.
CCBHCs have been shown to improve access to services and decrease wait times for patients, two reasons that industry advocates continue to push for further expansion of the program, as is outlined in Harris’s plan.
Beyond those pushes, Harris’s proposal also puts a special focus on certain populations, such as veterans, minorities and children touched by trauma. Additionally, it outlines several measures to “end the mental illness to jail pipeline,” among other initiatives.
You can read the full plan here.
Harris isn’t the only presidential candidate pushing for mental health reform. Pete Buttigieg, Amy Klobuchar, Elizabeth Warren and John Delaney have also proposed various mental health plans of their own.
