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Same Day Billing Policies Affect Health Centers and Patients

Community Health Centers have a long-standing and proud tradition of providing patient-centered care.  That means a patient’s individual needs and health outcomes drive clinical decisions.  A key feature of how many health centers accomplish that task is through the integration of primary care and behavioral health.  Health check-ups in the exam room focus on both physical and mental health, recognizing the strong mind-body link required in achieving wellness.  This approach also makes sense for the patient population of health centers, who include a large portion of chronically ill people living in poverty. Health center patients also typically suffer from multiple health conditions that can co-occur with mental illness and addiction.  According to the Department of Psychiatry and Behavioral Science at UC Davis, as many as 40 percent of patients seen in a primary care setting on any given day have an active psychiatric condition.

Ideally, patients seamlessly navigate from primary care to onsite behavioral health care as needed on the same day.  Indeed, multiple studies have underscored the benefits of integrated health care.  However, that is not always the case.  Policies that prevent adequate reimbursement from Medicaid if a patient is scheduled for multiple services in one day are a key challenge for both health centers and their patients.   In some states, if a patient receives care from a medical provider and a mental health specialist on the same day, only one treatment is reimbursed as a visit.  In many states, a patient who, for instance, needs treatment for a substance use disorder and oral health care, cannot receive treatments for both conditions in the same day.    For impoverished patients, or those without transportation, getting to and from the health center or taking off time from work can pose a hardship.  Medicaid covers almost half of health center patients and is the single largest payer for mental health in the United States.  For health centers, adequate reimbursement is critical for operational and financial sustainability.

The need to reform federal and state level policies is more important than ever as the nation combats the opioid crisis, and  health centers are front and center on this battlefield. To date, only 32 states and DC have amended their laws so that Medicaid beneficiaries can receive multiple services in one day – but the number of patient visits for behavioral health services, including mental health and substance use disorders has grown by 83 percent in the last eight years.  The Health Resources and Services Administration earlier this fall rolled out $352 million in grants to 1,232 health centers (see blog post) so they can continue advancing evidence-based strategies that fight addiction and promote prevention and Congress also recently passed a legislative package that makes it easier for health centers to treat patients with substance use disorders and provide medication assisted therapies.   But updating billing same day billing policies would go a long way toward ensuring health centers can reach more patients who need treatment.  NACHC has produced a fact sheet that describes this issue in more detail that you can access at this link.

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