The Fight for Medicare Reimbursement in Mental Health
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The reimbursement’s low on Medicare. Because of that, there’s a lot of private practices—whether it’s primary care, or behavioral health, or physical therapy—that might not want to take Medicare.
Tiffany Leturno, Clinic Administrator, Benson Health Clinic
Last year, the Improving Access to Mental Health Act made waves by foregrounding the importance of safeguarding the mental wellness of our most vulnerable and at-risk citizens. In its 2019 Medicare Reimbursement Issue Brief, the National Association of Social Workers noted that professionals such as social workers and caregivers comprise the foremost “mental health service providers in the United States and are among the professions that can bill Medicare Part B for mental health services.”
These workers are in danger of being unable to provide the proper care to their patients, due in part to some resistance from Medicare plans to cover the full gamut of mental health services.
It’s true that low reimbursement rates from private plan coverage can cause problems for patients seeking access, but the fact is that researchers from the Congressional Budget Office determined that the average commercial insurance plan reimbursed providers in their own networks between 13 and 14 percent less than comparable Medicare coverage plans. Many therapists and counselors have historically opted not to accept private plans or state-offered health insurance.
But that’s beginning to change.
On the whole, Medicare coverage has a history of struggling to properly meet the needs of those it serves. Read on to learn about the challenges, complexities, and intricacies of Medicare disbursements for mental health coverage. Additionally, read excerpts of our expert interview with Tiffany Leturno, clinic administrator at the Benson Health Clinic in Eugene, Oregon.
Featured Interviewee: Tiffany Leturno, Clinic Administrator at Benson Health Clinic
Tiffany Leturno is the clinic administrator at Benson Health Clinic in Eugene, Oregon. Her background includes time spent at other clinics, offices, and practices in the Lane County area in similar executive or administrative roles. In her role at these facilities she acted as office manager and site administrator.
She is a graduate of Lane Community College, from which she holds an associate’s degree in the arts.
Medicare Reimbursements for Healthcare Services
Medicare has been known to have some significant challenges paying out to healthcare providers and covering the costs of treatments or medicines in the past. Improperly tailored governmental insurance plans often do not fit or meet the needs of those who hold them.
But are there particular categories of treatments, medicines, counseling, and therapies that Medicare reimbursements typically cover when it comes to mental health? Tiffany Leturno, clinic administrator at the Benson Health Clinic in Eugene, Oregon, says that the variety of types of care virtually guarantee that specialists diagnose and prescribe in line with their assessment of their patient’s best treatment path.
“Providers are in the [business] for the care of the patient,” says Leturno, with proper coverage and reimbursement helping to ensure that patients have access to up-to-date technologies and current best practices.
But patients on a tight healthcare budget might not be able to afford additional courses of treatment or counseling—particularly if Medicare has predetermined that the patient need only be attending appointments within a fixed six- or twelve-month period. This process of Medicare coverage approval is something of a mystery, but it can’t be denied.
The issue of imbalance in Medicare reimbursements for mental health treatment cannot go unaddressed. It’s a pervasive and critical medical issue that has vast implications for the future mental health of underserved communities.
The Problem with Medicare Reimbursement for Mental Health Services
The practice that Leturno administrates is Benson Health Clinic. It offers behavioral health services, psychotherapy, and counseling to patients living in Eugene, Oregon and the surrounding region of Lane County.
Leturno’s time spent as an office leader has brought her into contact with a number of the spheres involved in the patient pipeline. One of these is Medicare, the federal health insurance program for those over 65 that was established in 1965. It also covers younger people with certain disabilities or chronic illnesses.
Where, then, does the difficulty with Medicare reimbursements for mental health coverage come in?
“I know a lot of providers—it doesn’t matter if it’s behavioral health or mental health—don’t take Medicare because the reimbursement is so low,” says Leturno. She says it comes down to a matter of comparison. “Medicare’s reimbursement is minimal” when compared to most other private insurance plans. What this means is that Medicare plans often meet a threshold of coverage, but that’s usually just about it.
“There’s a lot of costs that go into running a practice,” says Leturno. “We like to have a medical office assistant that works with providers to help with prior authorizations and things like that.” Apart from that, clinics require a number of administrators, specialized staff, technicians, and medical assistants to help make the process of diagnosis and counseling prescription run smoothly.
Individuals might be considered vulnerable or at-risk owing to a number of factors, from homelessness to addiction to debt or grief. While the Affordable Care Act motivated states to build infrastructures for state-run health insurance plans for low-income persons, this coverage is funded by Federal Medicaid programs. Such programs still require applicants to overcome obstacles that may be difficult for those in at-risk populations.
“With accessibility there’s a shortage of behavioral health providers in Lane County, in Oregon, and nationwide,” says Leturno. Lane is the fourth-largest county in Oregon by population.
The Future of Expanded Access to Mental Health Services
The coming decade must distinguish itself as a new reality for discussions about mental health, therapies, counseling, and other forms of treatment and self-care. In some sense, the field can’t keep up without acknowledging that mental health services can and should adjust their coverage models to include a wider range of treatments.
“There’s just not enough providers,” says Leturno. In fact, recent Bureau of Labor Statistics reporting suggests that the openings for substance abuse, behavioral disorder, and mental health counselors nationally is set to grow 22 percent between 2018 and 2028. This is much faster than the national average growth in all U.S. occupations.
Fortunately, there have been some positive strides for expanded mental healthcare—especially within Lane County. Eugene has featured prominently in recent national discussions about community-based alternatives to bloated police budgets. CAHOOTS—Crisis Assistance Helping Out On The Streets, a division of the city’s groundbreaking White Bird Clinic—has raised public awareness about the importance of services that foreground a positive community response to collective mental wellness. They also provide critical on-site services for those in crisis.
Along with Benson Health Clinic and advocacy organizations like the Lane County Psychologist’s Association, groups like CAHOOTS will be crucial in helping people plan paths to improved mental health and in ensuring at-risk persons enter the patient pipeline.