AAFP Input Informs CMS Move to Expand Mental Health Parity

Academy Also Touts FPs' Expertise in Diagnosing, Treating Mental Illness

June 10, 2015 01:39 pm News Staff
[Distressed young man appears to be praying]

The AAFP emphatically supports parity in health insurance coverage for patients regardless of medical or mental health diagnosis and, therefore, was pleased see a CMS proposed rule on the subject published(www.gpo.gov) in the April 10 Federal Register. The Academy drove that point home in its recent comments on the proposal.

AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., was particularly gratified to see that the recent proposal incorporated language similar to amendments the AAFP suggested some 18 months ago when CMS finalized a rule that implemented the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

At that time, the AAFP pressed CMS to extend parity in mental health coverage to the Children's Health Insurance Program and Medicaid. The agency's new proposal does just that.

In a June 3 letter(2 page PDF) to CMS Acting Administrator Andy Slavitt, Blackwelder highlighted the various related issues near and dear to the Academy, such as

Story Highlights
  • The AAFP recently responded to a CMS proposed rule that would, among other things, extend parity in mental health coverage to the Children's Health Insurance Program and Medicaid.
  • The AAFP had suggested similar changes 18 months ago when CMS finalized a rule that implemented the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
  • In a letter to CMS, AAFP Board Chair Reid Blackwelder, M.D., stressed that family physicians have the appropriate training to diagnose and treat mental illness and should be paid appropriately to do so.
  • payment mechanisms that recognize the importance of family physicians and other primary care physicians in the treatment of mental illness;
  • equal health plan coverage for mental health and all other medical care;
  • the family medicine focus on treating the whole patient, including the integration of behavioral and mental health in patient care; and
  • recognition that diagnosis and treatment of mental illness in individuals and families are integral components of family medicine.

"Family physicians support appropriate public mental health policy, and … they promote better mental health services for those with mental illness," including early intervention, appropriate and timely treatment, careful use of medications, and suicide prevention, said Blackwelder.

"The AAFP therefore supports these proposed policy changes and encourages CMS to swiftly promulgate a final rule," he said.

Blackwelder then reminded Slavitt that a provision of the Patient Protection and Affordable Care Act that set Medicaid payments for certain primary care services at Medicare levels expired on Jan. 1, 2015.

"The AAFP is dismayed that many state Medicaid programs and Medicaid managed care organizations have reverted to payment rates for primary care services that are lower than Medicare's rates," said Blackwelder.

He warned that dramatically cutting Medicaid payments for primary care physicians threatened access to care for millions of patients.

"The reductions in payment also threaten access to mental health and substance abuse services for Medicaid patients because such services are typically billed as primary care office visits in family medicine and other primary care settings," Blackwelder pointed out.

In addition, the exclusive payment policies of certain Medicaid managed care plans are wreaking havoc with family physicians' ability to provide care for patients with psychiatric disorders and even diagnose mental illness.

"The absence of payment can impact the lack of screening in primary care practices. Magnifying this threat is the potential stigma attached to mental illness and to accessing the formal mental health system," said Blackwelder. For that very reason, a great many patients rely on their family physicians to treat their mental health and substance abuse problems.

Blackwelder stressed that family physicians were well prepared -- through their residency training and ongoing CME activities -- to diagnose and manage mental health issues in patients of all ages.

The AAFP "strongly encourages CMS, Congress and state Medicaid agencies to adopt policies that do not discriminate against family physicians as providers of mental health services and that support the provision of both medical and mental health services in the patient's medical home," Blackwelder concluded.

Related AAFP News Coverage
Integrating Mental Health, Primary Care Is Focus of IHI Webcast
Collaborative Approaches Benefit Patients

(12/10/2014)

Robert Graham Center Forum
Speakers Emphasize Need to Build Bridges Between Primary Care, Mental Health

(10/20/2014)

More From AAFP
Mental Health Care Services by Family Physicians (Position Paper)


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