Voices for Health seeks legislative and regulatory changes in Massachusetts that make it possible for people with mental health conditions to access quality and timely care. Some of our policy goals are below:
- Require insurance companies in Massachusetts to cover patient navigation and case management servicesalong the continuum of care, including before a patient actually sees a provider. This involves creating a CPT code that allows providers to bill for these services. This legislation is essential to breaking down barriers that prevent patients from seeking care in the first place and will help them maintain their gains following treatment. This policy goal has the potential to attract broad-based support outside of the mental health space since patients with all health conditions can benefit from case management services.
Examples of services we would like to see covered include, but are not limited to:
- Helping patients understand what is covered under their insurance and finding a provider who accepts their insurance
- Interviewing providers to see if they are a good match for a patient
- Scheduling appointments
- Coordinating and providing transportation to appointments
- Checking on patients after a few sessions with a provider to see if it’s a good match and finding a different provider if necessary
- Following up with patients as they receive treatment to be an additional source of support
- Following up with patients after their treatment is complete to ensure they maintain their gains and do not relapse
Accountable Care Organizations (ACOs) are already able to include patient navigation and case management services as part of a bundled payment structure. Covering these services as bundled payments only benefits patients seeking services from ACOs, but is a step in the right direction toward making them reimbursable more broadly since the healthcare landscape is shifting toward making ACOs the standard model of care. An alternative to creating CPT codes is to require all ACOs to include the services that Voices for Health provides. Currently, no ACOs offer this complete suite of services.
- Require insurance companies to make their reimbursement rates public. This is very important for the sake of transparency and for helping to keep healthcare costs in Massachusetts below the benchmark of 3.6% of the PGSP as established in Chapter 224 of the Acts of 2012.
- Provider reimbursement parity. The “allowed amount” that is considered by insurance companies for providers of mental health services should be comparable to the allowed amount for other providers with the same level of education and training. Furthermore, the percentage of the allowed amount that is considered for reimbursement should be on par with what is permitted for non-mental health providers. This will encourage more behavioral health providers to accept insurance and therefore increase affordability of these services for more people.
Note: A similar goal titled “Reimbursement Rates for Healthcare Providers” is listed on NAMI Massachusetts’ 2016 Budget and Legislative Priorities.”
- Insurance companies should lower their caps for the number of psychiatrists and other mental health professionals that they allow into their networks. Insurance companies limit the number of psychiatrists in their networks in order to lower costs.As a result, many psychiatrists can’t get on insurance panels even if they are okay with accepting the lower reimbursement rate. This poses an accessibility problem for patients with HMOs given that there is a shortage of psychiatrists to begin with.
- Require students studying to become public school teachers to take a course on recognizing common mental illnesses in the classroom as a prerequisite to receiving their certification to teach in public schools. Current teachers would be offered incentives such as continuing education credits. While teachers have a growing number of State-mandated requirements to comply with, extensive research is available showing that educational and health outcomes are significantly improved when patients with mental illnesses are diagnosed early in life.