Primary CareServices

Drug -Alcohol Services

Old System: Minimal Integration

• BH and PC providers: – work in separate facilities – have separate systems – communicate sporadically

Mental Health

Services

• BH and PC providers: – share the same facility – have systems in common (e.g., financing, documentation,

EMR, etc)– regular face-to-face communication

Integrated Behavioral Health and Primary Care

System

Toward a New System: Integrated Services

The Primary Care Services

Substance use and Mental

health services

Policy Recommendations from Survey

• Expand workforce who can bill for SUD services. In particular add MFTs. Currently only Licensed Clinical Social Workers (LCSWs) and psychologists can bill for behavioral health. “We do not have enough LCSW providers to be able to go into all the community health centers as we would like.”

– This would require legislation and a Medicaid waiver from the federal government.

– Same would apply for SUD counselors.

• Allow same-day billing for two services.

“It would be very helpful if we could bill for mental health and physical health visits on the same day. The current restriction impedes access for our patients.”

Would allow “warm hand-offs” between primary care and SUD or MH. Otherwise they tend to become “no shows”.

• 28 states currently allow same-day billing, but California does not.

Policy Recommendations from Survey

Policy Recommendations from Survey

• Stabilize funding.

“Our integrated effort . . . is funded wholly by grants and MHSA, making it feel precarious and temporary by comparison with other primary care services.”

“allow for reimbursement of case management services. Currently, important roles such as a navigator and peer partner, must be funded by grants, but in the long term these roles must be funded through FQHC or Medi-Cal reimbursement.”

So what’s stopping us?Primary barrier seems to be concern over additional State general fund expenditures. For example, AB 1785 (Lowenthal) would have added MFTs as reimbursable providers and passed 17-0 out of the Assembly Health Committee, but it is currently held under submission by Assembly Appropriations Committee

Translation: probably dead, due to concerns over costs.

How about a pilot project, like CMSP and other states?