Behavioral health is top of mind for the U.S. Senate as it discusses a new bill that could be a “savings driver and a game changer” for patients and providers.
The Senate Finance Committee met to discuss a bipartisan package of health proposals called the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act. The bill would, if passed, expand access to mental health care and restrict pharmacy benefit managers’ (PBMs) “shadowy tactics.”
“Attention to mental health is needed now more than ever,” Senator Steve Daines (R-Mont.) said. “The legislation we’re considering today explicitly targets the lack of access in several ways, including bolstering telehealth, addressing coverage gaps and ending the mental and behavioral health workforce shortages.”
The finance committee approved the bill with 26 ayes and no nays.
Ghost networks
Within the package of health proposals is a provision to stamp out what Senator Ron Wyden (D-Ore.) called “one of the worst rip-offs of all time”: ghost networks.
Ghost networks are inaccurate lists of in-network providers that list providers who are no longer in-network or accepting patients. These directories can lead to extensive costs for patients.
“Ghost networks make it more difficult for patients to find in-network health care providers, an issue that is more acute in the mental and behavioral health fields than in any other field that we face,” Senator Michael Bennet (D-CO) said. “These outdated networks can lead to unexpected costs or, in some cases, delayed patient care or no patient care.”
The provision, called the Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, aims to ensure that Medicare Advantage plans maintain accurate directories of providers. It also requires the U.S. Centers for Medicare & Medicaid Services (CMS) to publish guidance for plans on how to maintain accurate provider directories.
“It also ensures seniors do not pay out-of-network costs for appointments with doctors who are inaccurately listed as in-network in these directories,” Bennet said. “In the richest country in the world, seniors should be able to make informed decisions about their health insurance, and the REAL Health Providers Act takes common sense steps toward transparency in the Medicare Advantage Program.”
Increasing access to care
The bill takes a multi-pronged approach to increasing access to behavioral health care, including incentivizing behavioral health integration into primary care and expanding telehealth flexibilities.
Integrating behavioral health into primary care could be one way of addressing workforce shortages.
“Our current specialty mental health care delivery service cannot meet the service demands of the pandemic and beyond,” Debbie Stabenow (D-MI) said. “By incentivizing primary care to adopt and implement integrated care models, the provisions in our bill will improve access to timely and effective behavioral health care.”
Under the new bill, payments for certain behavioral health integration services under the Medicare physician fee schedule would increase beginning in 2026 and then phase down in 2027 and 2028.
CMS finalized a new rule expanding behavioral health care integration for seniors and people with disabilities in April.
The act seeks to expand telehealth flexibilities, which the DEA recently extended for another year.
If passed, the Department of Health & Human Services secretary would be required to establish a code or modifier identifying claims for certain telehealth services.
It would also guide providers on how to offer telehealth care to people with limited English proficiency and provide information on licensure requirements for telehealth services delivered under Medicare and Medicaid.
“We learned from COVID-19 that telehealth is an important part of more accessible, affordable health care, and I was pleased that we were able to incorporate many changes into this bill,” Senator Ben Cardin (D-MD) said.
Cardin submitted an amendment to the bill to make the telehealth exemption permanent.
The bill would also increase access to substance use disorder treatment for certain populations.
“We’ve also made it easier for states to provide continuity of mental health and substance use disorder care for people in the justice system who haven’t been convicted of a crime,” Wyman said.
The bill would also provide guidance on SUD treatment for at-risk children and youth.
