The National Academies of Sciences, Engineering and Medicine (National Academies) has issued a major report recommending that the federal government and the states take several steps to improve health care provider participation in public insurance programs.
The final report—Expanding Behavioral Health Care Workforce Participation in Medicare, Medicaid, and Marketplace Plans—provides nine recommendations that fall into three major goals to expand behavioral health care provider participation in Medicare, Medicaid, and Marketplace plans and improve the overall behavioral health care system:
Goal 1: Ease Provider Entry Into Medicare, Medicaid, and Marketplace Plans
Goal 2: Make Provider Entry Into Medicare, Medicaid, and Marketplace Plans Worthwhile
Goal 3: Once Providers Are Operating in Medicare, Medicaid, and Marketplace Plans, Support Opportunities to Provide Better Care and Hold Providers Accountable
At the request of the Centers for Medicare & Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Academies explored several factors that influence mental health care provider participation in key public insurance programs, including administrative burdens, adequate reimbursement rates, billing systems and barriers, and approaches for mental health providers working with diverse patient needs.
Key recommendations in the report for CMS and SAMHSA relevant to mental health providers in the Medicare and Medicaid programs include:
Restructure the current mental health workforce and training mechanisms and their funding to better support training environments that encourage career choices that will more directly impact care for Medicare and Medicaid beneficiaries with an emphasis on high-need populations.
Use regulatory authority over Medicare (including Medicare Advantage) to streamline behavioral health provider credentialing and enrollment processes to facilitate more rapid initial enrollment.
Ensure adequate access to a full continuum of behavioral health care services under the Medicare Physician Fee Schedule by identifying the actual costs of care delivered by mental health care providers. To address this issue, CMS should revise the resource-based relative value scale (RBRVS) on a regular basis through updated cost studies.
Allow mental health care trainees to bill for services under licensed mental health provider supervision.
Monitor prior authorization practices of managed care plans in public insurance to eliminate low-value processes.
Support single-wide platforms for credentialing and enrollment and allow for sharing of data between state and federal licensing agencies.
With the NAS report requested by CMS and SAMHSA, it is expected that the recommendations will receive serious consideration in upcoming proposed legislation and regulations.
For more information about the National Academies report, please see:
NAS News Release, Aug. 8, 2024
Consensus Study Report Policy Brief, States
Consensus Study Report Policy Brief, Federal Agencies
Consensus Study Report Action Guide, Behavioral Health Care Providers
