New Report Recommends CMS, HHS Make Changes to Increase Participation of Mental Health and Substance Use Care Providers in Medicare, Medicaid, and Marketplace Health Insurance Plans
WASHINGTON — The Centers for Medicare & Medicaid Services and U.S. Department of Health and Human Services should take action to increase the participation of care providers for mental health and substance use disorders in Medicare, Medicaid, and Marketplace health insurance plans, says a new report from the National Academies of Sciences, Engineering, and Medicine.
Behavioral health care encompasses care for mental health and substance use disorders. One in five adults, adolescents, and youth — over 50 million Americans — experienced a behavioral health issue between 2019 and 2020. However, less than half of all adults with a mental health issue had timely access to behavioral health care in 2021, and those with a substance use disorder were even less likely to have timely access. The situation is even more dire for youth with behavioral health disorders, with only one-quarter receiving treatment.
Plans provided through Medicare, Medicaid, and the Health Insurance Marketplace serve a larger population of patients with behavioral health needs when compared with most private insurance plans — and Medicaid is the single largest payer for behavioral health care services in the U.S. Yet, behavioral health care providers participate less in these public insurance plans, and the distribution of these professionals across the U.S. remains misaligned with patient needs. Psychiatrists accept insurance at a rate lower than any other physician specialty, and the acceptance rate of public insurance among psychologists and other mental health professionals is also low.
Patients with behavioral health conditions are not a homogenous population, and the current system for delivering care is failing to provide them with equitable, appropriate, and accessible care, the report says. Increasing the diversity of the workforce and ensuring it can meet the needs of publicly insured populations — for example, children and youth, who face not only growing behavioral health needs but also are one of the largest populations served by public insurance — is an important aim.
Our report offers recommendations to greatly expand the behavioral health workforce’s participation in Medicare, Medicaid, and Marketplace insurance,” said Daniel Polsky, chair of the committee that wrote the report and Bloomberg Distinguished Professor of Health Economics and Policy at Johns Hopkins University. “There are many valid reasons why providers might not participate — they could be paid less, and the administrative burden is high — so we recommend reforms that will make the system work better for care providers, patients, and health care as a whole.”
Promoting and Easing Entry into Public Insurance
The report recommends reducing credentialing, enrollment, and licensing barriers, and focusing training programs and telehealth support where gaps are greatest for patients who use Medicare, Medicaid, and Marketplace plans.
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- Streamlining Credentialing and Enrollment — CMS should streamline behavioral health care provider credentialing and enrollment processes, which the report says are lengthy, repetitive, and burdensome, and discourage care providers from enrolling with multiple insurance payers.
- Guidelines for Telehealth — CMS should develop an interagency strategy to set guidelines for coverage and payment of telehealth services for behavioral health needs. Behavioral health has the largest sustained use of telehealth, and CMS has an opportunity to use this tool to improve patient access to care.
- Licensing Across State Lines — HHS should develop a uniform strategy to reduce barriers to care provider licensing in multiple states to expand access to these providers as part of public insurance programs.
- Training — CMS and the Substance Abuse and Mental Health Services Administration should incentivize training programs to better support career choices in behavioral health care, which in turn will benefit more patients enrolled in Medicare and Medicaid.
Optimizing Performance and Accountability
The report calls for strengthening accountability for managed care plans, and improving opportunities for behavioral health care providers to increase their capacity for delivering care.
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- Enforcing Standards for Managed Care — CMS should develop standards for managed care plans participating in Medicare that carry significant financial penalties and bonuses based on behavioral health outcomes. CMS should also work with states to develop similar standards for Medicaid managed care plans.
- Improved Quality Measures — CMS should invest in improved quality and risk adjustment measures for behavioral health care and link them to payment. These measures should consider the administrative burden that would fall on care providers.
“The U.S. is facing unprecedented challenges in providing care for mental health and substance use issues,” said Victor J. Dzau, president, National Academy of Medicine. “Expanding access to behavioral health care through these plans would not only greatly benefit patients, but the behavioral health care workforce as well.”
The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, engineering, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.
