2023:

• Federal health agency’s (HHS) top research quality unit (AHRQ) released a draft review of all of the existing evidence-based approaches to the integration of behavioral health care in primary care practices.

  The Agency for Health Research Quality on October 2, 2023 issued a comprehensive strategic look at all current evidence-based approaches to the integration of mental health/substance use care in primary care sites, with discussion on the pros/cons, gaps in evidence, areas for future research.

  Strategies Integrating Behavioral Health and Primary Care

• Medicare’s Innovation Center announced on June 8, 2023 a new voluntary test project for a primary care alternative payment model called Making Care Primary (MCP).

  Integration of behavioral health services will be an essential part of this whole-person care approach to improve patients’ health outcomes and patient experience in primary care, while also lowering costs and treatment delays. It is also part of a larger strategy by Medicare to integrate patient-centered, accountable care in primary care practices. Increased payments will go to practices as they integrate behavioral health services. This demonstration will begin in early 2024 in eight states (CO, MA, MN, NJ, NM, NY, NC and WA) and run for ten years during which time Medicare will be watching practices progress closely and will make adjustments as needed.

• Bipartisan legislative bill introduced.

  On April 27, 2023 a bipartisan legislative bill was introduced in the U.S. Senate by Senators Catherine Cortez Masto (D-NV) and John Cornyn (R-TX), entitled the Connecting Our Medical Providers with Links to Expand Tailored and Effective (COMPLETE) Care Act (S. 1378) in which Medicare payment to primary care practices for delivery of behavioral integration services will be temporarily increased during years 2025-2027. This bill is just one approach the Congress is actively considering to help U.S. primary care clinics adopt evidence-based models of integrated behavioral health care services thereby expanding Americans’ access to mental health care when they visit their primary care doctor.

2022:

• First Behavioral Health Integration Federal Training Program for Primary Care Practices Created.

  In December 2022 Congress passed the Consolidated Appropriations Act of 2022 which includes a provision for a new federal training and technical assistance program for primary care physicians on delivering evidenced-based, proven effective approaches to integrating behavioral health services (mental health, substance use) in their primary care practices (CAA, Sec. 1301). This is the first behavioral health integration federal training program for PCPs of its kind. It will greatly increase Americans’ access to mental mental health and addiction care. This grant program allows for primary care practices to receive up to $2 million/yr for five years (2023-2037) to help them deliver integrated care including screenings, assessments, and treatments for mental health and addition conditions. (See Archive section for more detail).

• Congressional Legislation Introduced.

  In 2022 four legislative bills have been introduced in the U.S. Congress, House and Senate, on behavioral health integration. The bills would train primary care physicians to deliver integrated care; increase payment to primary care practices that offer integration services; make behavioral integration in primary care a core part of Medicare and Medicaid programs; and test innovations in how hospitals might provide integrated medical-behavioral care to inpatients. NHMH has provided inputs and recommendations on these bills to the House Energy & Commerce Committee, the Senate Finance Committee and the Senate Help, Education, Labor & Pensions (HELP) Committee and has worked with individual Congressional offices of both parties in support of these bipartisan bills.

• Biden Administration Includes Integrated Medical-Behavioral Care in its Mental Health Strategy.

  Integrated care is now included in the Federal Government’s March 2, 2022 White House Mental Health Strategy for the first time. See p. 4, the Connect Americans to Care section, bullet #2. This prioritization of integrated care by the Administration is a meaningful, substantive development. While the funding the White House proposes must be enacted by Congress, the federal health department’s (HHS) testing of new payment models to reimburse primary care doctors for providing integrated care can now go ahead. Another significant building block in widespread implementation of whole person care.

2021:

• New High-Level Bipartisan Call for Health Policy Change Enabling Behavioral Health Integration.

  On March 30, 2021 the highly respected independent Bipartisan Policy Center issued a detailed report urgently calling for integration of mental health into primary care. The Report led by a BPC Task Force comprised of experts and former Members of Congress from both parties, details specific policy actions that should be taken by Congress and relevant health agencies to make effective, evidence-based mental health services available in primary care across the country. NHMH has been engaged with the BPC since 2014 to advance BHI and believes this Report to be a major breakthrough to place BHI high on the health policy reform agenda.

  Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration | Bipartisan Policy Center

2020:

• Congress Enacts New Law Effective 2020 Helping States to Enforce Compliance with 2008 Federal Parity Law

  The 2020 federal law provides States with badly needed new funding to allow them to carry out mental health parity enforcement and implementation required by the federal parity law passed in 2008. Parity = Access to mental health care. With that in mind, Congress passed the 2008 federal parity law to require a majority of health insurance plans, including those provided by private employers, to cover treatment for mental health conditions no more restrictively than treatment for physical conditions. Implementation of the 2008 federal law requirement by insurers has been slow. The 2020 law funds States to support their oversight of health plans’ compliance with parity requirements as long as States collect and review comparative analyses from insurers.

  MHLG Letter to Senators Murphy and Cassidy

• Number of Nurse Practitioners Doubles Playing Key Role in Primary Care

  Between 2010-2017 the number of nurse practitioners (nurses with advanced training) grew by 109%, as compared with growth of RNs of 22% and physicians 9%. NPs play a vital role in team-based care such as the integrated medical-physical care in primary care. The significant growth of this key healthcare worker category reflects the increasing focus on improving primary care advocated by groups such as NHMH. Increased educational programs in nursing schools, part of NHMH’s advocacy focus, allows for graduation of more NPs to join primary care clinical care teams.

  nurse-practitioner-workforce-doubles-amid-primary-care-push

2019:

• Congress Renews Patient-Centered Research Organization Working to Advance Behavioral Integration into Primary Care

  NHMH was one of a coalition of 200 organizations that successfully advocated for Congress to re-authorize the Patient-Centered Outcomes Research Institute (PCORI). With the signing of HR 1865 into law on December 20, 2019, PCORI was re-authorized by Congress to continue its research trials developing information for patients and providers on which treatment approaches work best for what conditions and for which patients, until September 29, 2029. Currently, NHMH is participating in several ongoing PCORI national and regional research studies, all comparing different approaches to integrating mental health treatment into primary care for their effects on patient outcomes, with the aim to make that information available to patients and their doctors.

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