After years of being neglected, behavioral health issues are finally getting some attention in Washington, D.C.
The Centers for Medicare and Medicaid Services (CMS) has opened new up reimbursement opportunities for behavioral health services; the Substance Abuse and Mental Health Services Administration (SAMHSA) continues to roll out additional grants; and a growing number of state governments have proposed legislation to take aim at parity.
But there’s still room for improvement, according to Chuck Ingoglia, president and CEO of the National Council for Behavioral Health.
The National Council has more than 3,300 provider members across the country, most of whom are safety net organizations, meaning they represent the under- and uninsured.
Ingoglia and his organization will spend 2020 advocating for higher reimbursement for and better access to behavioral health care. His top priorities include extending and expanding the Certified Community Behavioral Health Clinic (CCBHC) Demonstration Program, fighting restrictive Medicaid rules and getting behavioral health care on the 2020 presidential ballot.
Behavioral Health Business connected with Ingoglia to discuss all that and more. You can find the conversation below, edited for length and clarity.
BHB: What are your biggest priorities going into 2020?
Ingoglia: There’s so much going on in 2020 that we’ll need to be paying attention to.
Obviously, Congress needs to extend and hopefully expand the Certified Community Behavioral Health Clinic (CCBHC) Demonstration Program. That’s going to be something that is top of our priority list early in 2020.
We’re going to continue to pay attention to efforts by the administration to weaken the Medicaid program by making it more difficult for people to participate … , whether that’s through the application of work requirements or … guidance [that reportedly] will be coming out to states around getting block grants for the Medicaid program. There might also be efforts to look at Medicaid eligibility.
Those are all things that are concerning to us because they make it harder for beneficiaries to access the program, which makes it harder for providers to deliver care.
We’re also going to be looking at the appropriation cycle next year. [We’re] looking at programs that support access to addiction prevention, treatment and recovery services [and] making sure those federal investments remain robust and flexible so communities can respond to whatever their most pressing needs are.
You mentioned the CCBHC program, which has long been a priority for you guys. SAMHSA recently announced that CCBHC expansion grants are now available to clinics nationwide. What implications does that have for providers?
It’s a step in the right direction. We think every community should have access to high quality care [and] that individuals who are looking for care should be able to access it easily.
We think that the grant program is a great way to help organizations begin to think about the capabilities needed to be a CCBHC.
As an association representing organizations, we want to raise the bar in terms of the quality of care provided, how quickly that care is provided, how comprehensive it is [and] how coordinated it is.
The grant helps organizations begin to build the capacity to do that. It also then gives communities an opportunity to see the potential of CCBHCs.
It begins to paint a picture of what’s possible, but in order for that picture to be implementable and sustainable, we need the flexible Medicaid funding to come along with it.
You mentioned another priority of yours is fighting against impediments to Medicaid coverage. Medicaid expansion could be threatened depending on what the Supreme Court has to say about the Affordable Care Act’s constitutionality. That review probably won’t come until after the election. What would that mean for behavioral health providers?
If we had crystal balls, all our lives would be a lot simpler.
I tell people not to worry too much about this. This is really stuff that’s beyond our control. Continue to keep your head down and focus on the great work that you’re doing in your communities.
ACA is the law of the land, and if something happens in the future, then we’ll deal with it.
Speaking of the election, I know the National Council has been working to bring behavioral health issues to candidates’ attention. Can you tell me a little bit about that and how the fact that it’s an election year will affect things on the regulatory front?
Our effort is really just trying to harness what we’re hearing from the public.
The polling that we’re doing and that other people are doing … shows the American public is concerned about the quantity and quality of mental health and addiction services available in their communities.
All we’re trying to do throughout this election process is elevate [those] issues, so that whoever is in office pays attention.
We know, unfortunately, in healthcare, funding does matter. We’re not going to magically increase access to care without investment.
We want to take every opportunity that’s available both during and after the election to help people understand why it is in our common best interest to further invest in mental health and addiction prevention, treatment and recovery services.
How have your educational efforts been received so far? I know you’ve helped with a couple town halls. What’s on the agenda going forward?
We helped spearhead the town hall in New Hampshire in cooperation with Mental Health for US, and we supported their other two town halls.
Now we’re really focusing more on the conventions, as well as getting out the vote efforts.
The most important thing is continuing to make sure this is an issue that the campaigns are hearing about.
If you think about the work that Congress has done the last few years to try to address the opioid crisis, that’s because every time [legislators] went home, they were hearing about the effects of the opioid crisis in their communities. They were hearing from their own families, from their friends [and] from their neighbors about overdoses and other things.
We need to make sure that mental health is also on their minds, so when they get to legislating, it’s something they pay attention to.
This year, opioid treatment programs (OTPs) have some new opportunities to be paid by Medicare. Specifically, Medicare can now pay OTP through bundled payments for opioid use disorder (OUD). What does this mean for providers?
We’re excited about both the particular, as well as the potential.
We’re glad that methadone is finally covered by Medicare, and we’re glad that CMS is doing it in the way that they’re doing it, as a bundled payment. It seems like they’re paying attention to the field in terms of adjusting the payment rates to be truly reflective of what’s needed.
The potential of introducing bundled payment into behavioral health and Medicare — and hopefully Medicaid — we think it’s really exciting as well.
Under a bundled payment, you’re going to look at: What are the range of services that we need to provide to people? It allows you some more clinical flexibility.
The predominant payment model right now is fee-for-service. In many states, you’re having to bill in 15-minute increments. … You’re with a client for an hour, but you have to do four different progress notes to reflect four different charges that you’re making to account for that hour. And sometimes the auditors want each one of those progress notes to have independence and to be able to stand up for itself independently.
That’s a lot of busy work. It’s keeping staff doing a lot of paperwork and preventing them from the important clinical work that needs to happen.
Bundled payment has the opportunity to provide flexibility to clinical teams [so they can] actually focus on what’s most important to that client.
Obviously, that Medicare opportunity relates to opioids. A lot of behavioral health providers worry that the government might be putting too much emphasis on opioids at the expense of other behavioral health conditions. Do you see that improving at all?
We’re really grateful Congress is paying attention to addiction issues. The reality is that there are regional variations .. [in what the] predominant drug of use or abuse is in different communities.
We want to make sure that [Congress] is giving states the flexibility they need to respond to local reality.The most recent indication of that was with the appropriation bill that was just passed and signed into law. Money that had previously only been eligible to be used for the treatment of opioid use disorders was expanded to include stimulants.
Some people have actually described the rise of stimulant abuse and deaths as the fourth wave of the opioid epidemic. We’re seeing methamphetamine and cocaine making a return.
But it’s also true that four times as many people die in this country every year from alcohol as from as many of these things, so we want to try to make [sure] state policy makers [and] providers have the flexibility to respond to whatever the most pressing addiction prevention, treatment or recovery issue is in their community.
I couldn’t end this interview without talking about staffing, given how persistent behavioral health workforce shortages are nationwide. What do you think needs to happen in 2020 and beyond to help fix those problems?
Part of our strategy [around CCBHCs] is to make sure that clinics get paid adequately, so that they can offer competitive salaries.
One of the fundamental problems we have is that if you can make as much money working at Burger King as you can in one of our treatment organizations — and you might have a little bit less stress at Burger King — it’s going to be attractive, right?
We’ve got to deal with how we make sure there’s adequate reimbursement so people can get paid adequately to work in this field. We need to expand loan repayment. We need to look at how to encourage more schools to offer social work programs.
A huge effort we’re engaged in is expanding Medicare to pay for other types of providers — namely marriage and family therapists and licensed professional counselors — so that the pool of people available to get reimbursed improves.
We’ve also got to continue to work to expand the number of people who are entering and staying in the field.