2019 (Continued):

  • Medicare Changes Way It Pays Doctors, Helping Advance Integrated Care:

    On November 1, 2019 the Centers for Medicare & Medicaid issued a Final Rule that includes changes to its physician payment policies, payment rates and quality measures for services provided by doctors and other practitioners under the Medicare Physician Fee Schedule effective 1/1/20. This FinalRule includes the following changes beneficial to primary care teams seeking to integrate behavioral health services into their practices:
    — reduces the documentation burden on physicians and other care-team practitioners;
    — broadens the practice role of practitioners who work with physicians as part of care team, e.g. RNs APRNs, PAs, etc;
    — prioritizes treatment of opioid use disorders;
    — adds new payment codes to list of allowed tele-health services, and
    — increases payment for patient care coordination and care management.
    Finalized Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020

  • Kaiser Permanente Launches PHQ-9s in Its Clinics.

    The growing presence of PHQ-9 patient surveys in primary care clinics is an important development and first step on a continuum of change, adding mental health services to patients care in medical settings. On completing the 9-question survey, patients can identify behavioral, emotional, mental health issues to talk to their doctor about. It will be a universal survey so that all patients will be asked to complete it. There is no stigma to its use. We know talking about behavioral problems can be difficult for patients to raise, and for doctors to discuss, so the PHQ-9 gives a science-based impetus for this discussion to begin. The PHQ-9 is a sign it is OK, in fact encouraged, for patients to bring up their behavioral issues with their PCP, e.g. depression, anxiety, phobia, etc. So that physicians can then assess, develop a treatment plan and consult with behavioral specialists as needed to provide behavioral health care. We are redefining health to include behavioral health and the PHQ-9 is an exciting early sign of progress! PHQ – 9 Form

  • July 2019 Medicare/Medicaid (CMS) announced that, starting in January 2020, it will begin paying medical practices for virtual psychotherapy, delivered via video-conferencing, as part of a bundled payment (i.e. per patient per month payment) to physicians for opioid use disorder treatment. CMS also proposes to begin paying medical doctors for substance use disorder services delivered via tele-health, again as part of a bundled payment. And where CMS leads, private commercial insurance companies usually follow in paying for such services.


  • New Harris Poll shows majority of Americans now think mental disorders are nothing to be ashamed of and can be treated effectively.
  • In a Harris poll commissioned by the American Psychological Association, it is clear the American public has moved significantly towards greater understand of mental disorders and acceptance of fact that effective treatments exist for behavioral conditions and should be accessed when needed. These changes in U.S. popular opinion reveal two things:
    1. The work of advocacy groups like NHMH and others are having a real effect, and as more Americans seek mental health care, NHMH’s mission becomes all the more critical: to ensure that effective, evidence-based care will in fact be available to them in primary care, when they seek that care.



  • Behavioral health services into primary care was one of the four Chronic Care policies that Medicare implemented through the calendar year 2017 physician fee schedule rule.
  • Congress passed into law The Chronic Care Act of 2018 which includes provisions to pay primary care practices for integrated care services delivered to Medicare patients.


  • Medicare agreed to pay medical practices for providing some elements of the integrated care model called collaborative care;
  • NHMH persuaded the main federal agency, the Department of Health & Human Services, to hold the first-ever HHS-wide integrated care conference where all federal agencies doing integrated care (e.g. Veterans, Indian Health Services) reviewed findings and best practices;


  • Federal Government’s Center for Medicare & Medicaid agreed to allow same-day billing for medical practices where patient received physical and behavioral health services in one visit;
  • Congress enacted The 21st Century Cures Act which requires the Asst. Sec. for Mental Health to submit a report every 2 years on inter- and intra-agency coordination efforts across all programs including bi-directional integrated care.

San Francisco's Fragmented Mental Health Services Are Literally Killing Its CitizensSan Francisco’s fragmented city services are harming – and killing – the most vulnerable,S.F. Chronicle, Michael Cabanatuan Sep. 27, 2022 “A small number of San Franciscans — almost all of them unhoused — are responsible for overly heavy use of both the city’s medical and legal systems — but the systems’ fragmented approach is failing, according to a new study. The study, from the nonpartisan California Policy Lab and the Benioff Homelessness and Housing Initiative at UCSF, shows that a small group of people are repeatedly cycling in and out of both the county’s health and criminal legal systems each year and represent a disproportionately high amount of utilization of these systems.The systems provide fragmented care that fails those who use it, the study’s authors said, and one finding backs that up: Nearly one in four of the people with heavy use of both systems in 2011 were dead by 2020, “reflecting how vulnerable these individuals are and how high the stakes are for improving the systems that support them,” said co-author Dr. Hemal Kanzaria, medical director at Zuckerberg San Francisco General Hospital and an associate professor of emergency medicine at UCSF.The study underscores what health care workers and public hospital officials told city leaders in July — that far too many people struggling with severe mental illness and addiction cycle through San Francisco’s overburdened emergency rooms, failing to get long-term help, and at a high cost to the city. For instance, just five people in the past five years accounted for 1,781 ambulance transports, possibly up to 2,000, at a cost of $4 million.The study’s authors called for a more coordinated approach, such as connecting people released from the emergency room or jail with housing and continued care. “Our research highlights the need for coordinated, evidence-based interventions to address these individuals’ complex needs, promote stable housing, and prevent poor health outcomes including untimely death,” said co-author Dr. Maria Raven, chief of emergency medicine at UCSF Medical Center and co-lead of the Benioff Homelessness and Housing Initiative program on adults with complex needs.The study looked at 10 years of data from 270,000 people who used the city’s acute medical care or legal systems between 2011 and 2020. It narrowed its focus to two groups of people who had interactions with both systems in the same year, one from 2011 and one from 2020, to investigate trends among frequent users of city services.The study is unusual, researchers say, because it links data from multiple agencies to see how people are using critical city services including mental and physical health care and housing over a several-year period.Among the study’s findings, according to the Policy Lab:• About 24% of the 2011 group continued their high use of both systems the following years but their use declined each of the following years. • Between 80% and 90% of the people in the 2011 and 2020 groups had substance use problems and many also had chronic mental and and physical health issues. • More than 90% of the individuals in both groups had been booked into jail for a felony and a misdemeanor. • The research team determined that many of the people in the 2020 group were in San Francisco in 2011 and had contact with both health and criminal legal systems in the prior 10 years. For example, 30% of the 2020 cohort was booked into jail in 2011.” Michael Cabanatuan is a San Francisco Chronicle staff writer, email: mcabanatuan@sfchronicle.com ... See MoreSee Less
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NHMH Salutes the Passing of American Scientist Dr. Paul Greengard, a Pioneer in Brain Research and Mental Health Treament. We owe Dr. Greengard a great debt for his incredible, break-through work, and his amazing life of service.


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