With 988 going “live” on July 16, there’s been much discussion on capacity and funding. Behavioral health leaders have pointed out that supporting a robust crisis system will take a braided approach, including federal grants and sustainability through state telecom fees, Medicaid, Medicare, and private commercial insurers. However, while 988 helps foster parity by establishing 988 as the 911 for behavioral health emergencies, insurance reimbursement has lagged far behind. That’s precisely what Paul Galdys, Dr. Brian Hepburn, and David Covington as well as contributors Brenda Jackson, Melissa Rowan, and Dr. Henry Harbin hope to address in the paper Sustainable Funding for Mental Health Crisis Services. The paper tackles billing codes, giving recommendations for coding options for crisis lines, mobile crisis services, and crisis stabilization facilities.
Paul Galdys, the deputy CEO at RI International and former assistant director at Arizona Medicaid, has said that adequate reimbursement for behavioral health is dire as a sustainable funding stream for crisis systems. In addition, lack of reimbursement equity has created system disparities where medical providers have reimbursement rates that allow them to expand and improve their services while those in behavioral health don’t.
In 2019, Dr. Brian Hepburn, executive director at NASMHPD, told #CrisisTalk that there aren’t enough public dollars to pay for the ever-expanding crisis services people need. He shared yesterday that 988, and the likely exponential increased demand on the system, will only compound the issue if insurers don’t step up to the plate. Telecom companies must direct calls and texts to the three-digit number for mental health, substance use, and suicidal crisis to the National Suicide Prevention Lifeline by July 16.
The below graphic puts in stark contrast the parallel mental health and behavioral health crisis systems, of which only one is heavily supported by public and private insurers. The other is not, even though behavioral health crisis services divert people—privately insured, publicly insured, and uninsured—experiencing mental health and substance use crises from the emergency department and jail. “Better connections to less intrusive services and care result in cost savings and reduce avoidable contact with law enforcement and hospitals,” says David Covington, CEO at RI International. “It just makes sense.”
A robust and integrated system can match people to the level of care they need, helping the community and the entire healthcare sector. “Leaders in the private and public insurance sectors and mental health must establish codes for crisis care services,” said Dr. Hepburn. “Otherwise, we all lose.”
In the paper, the authors and contributors identify standardized existing healthcare codes that every insurer should reimburse, including commercial, Medicare, Medicaid, VA, FEHB, and Tricare. Establishing a common language and codes for mental health and substance use crisis services is critical to the coding process and fosters true parity between medical and behavioral healthcare. Without it, write the authors and contributors, communities can’t function as the “no-wrong-door safety net services” laid out in SAMHSA’s National Guidelines for Behavioral Health Crisis Care.
The safety net for physical health crises includes 911, which accepts all calls and dispatches support that matches the caller’s needs, law enforcement, ambulance, fire services, and emergency departments. People require the same parallel level of support for behavioral health crises, including a 988 call center hub (sometimes call care traffic control), mobile crisis services, and crisis stabilization facilities.
Contributor Dr. Henry Harbin, a healthcare consultant and former CEO of Magellan Health Services, said it’s time crisis mental health services be reimbursed by “all insurers, including Medicare, Medicaid, and Commercial.” However, Dr. Hepburn notes that simply adding the recommended billing codes will only frustrate providers. “Insurers won’t reimburse them simply because codes exist,” he says. Instead, to rapidly develop equity in reimbursement and prepare for 988, the paper is designed as a conversational tool to get the dialogue started—quickly followed by implementation—between state leaders, providers, and insurers.
Read the entire paper here: Sustainable Funding for Mental Health Crisis Services.