Finding ways to bring more behavioral health services to more residents of Rhode Island is high on the agenda for consideration this year in the Rhode Island Legislature. The Health and Human Services Committee of the Rhode Island Senate considered a number of bills recommended by the Special Joint Legislative Commission to Study the Integration of Primary Care and Behavioral Health on Tuesday March 25, 2014. The Commission was created by an Act of the legislature in 2013 and submitted its report in March of 2014.
The Special Joint Commission was empowered to examine “the current behavioral health and primary care system in the Ocean State, and with identifying opportunities to further integrate clinical and payment reform and examine the feasibility of establishing a primary care trust.” Behavioral health services includes treatments for mental health conditions, substance abuse, and health-related behaviors. The Special Joint Commission found that (1) additional training of primary care practitioners and behavioral health practitioners is needed to complete integration of the two health care systems, (2) opportunities for collaboration between theses types of providers needs to be embedded in their systems, (3) a strong financing component is needed to achieve success, (4) parity of insurance coverage needs to be achieved in Rhode Island, and (5) better data on behavioral health disorders needs to be collected in Rhode Island.
The Special Joint Commission found that one in five Rhode Island children ages 6 to 17 has a diagnosable mental health or addictive disorder, while one in 10 has a significant functional impairment, and that these kids are not receiving treatment through the schools, communities or clinical settings despite showing symptoms or “action signs.” In addition the Special Joint Commission pointed to an Institute of Medicine report which found that the number of adults over 65 with mental illness is expected to double by the year 2030. Compounding that fact is the rate of growth of this segment of the population over that time period will result in 25 percent of Rhode Island’s residents being 65 or older. The Special Joint Commission underscored the need for integration, as Rhode Island has the highest rate of adults with serious mental illness at more than 7 percent of the population, which far exceeds the national average of 4.6 percent.
The legislators who were members of this Special Joint Commission introduced a package of bills to address these findings. Primary among them is the Behavioral Health Reform Act of 2014. This bill would require behavioral health screenings to be conducted by primary care physicians during primary care exams given to anyone under 21. The screening shall be for psychiatric, psychological, interpersonal, or any other condition. The Rhode Island Department of Health is to certify appropriate screenings and establish a fee structure for these screenings. In addition the screenings will be mandated to be covered by all health insurance providers.
A second bill in the package would require insurers to make a decision on whether to authorize emergency inpatient or residential treatment for mental, emotional, or substance abuse within two hours of receipt of all the necessary paper work having been submitted. A third bill in the package amends the existing mental health parity law to ensure that substance abuse and other behavioral health issues are covered like other mental health conditions. All of the bills await further action by the committee.
Integration of care, where behavioral health care providers work within and as part of a primary care team, was the best method of care delivery, the Special Joint Committee found. Other coordinated care concepts, such as having primary and behavioral health care providers at separate facilities, were found not to be as effective, according to the Special Joint Commission. The lack of appropriate billing codes was found to be a barrier to obtaining behavioral health services, as were wide variations in co-pays and prior authorization requirements for behavioral health services, said the Special Joint Commission.
“We must strive to embrace the cooperative care model of practice, where there is no ‘wrong door’ for full access to comprehensive care,” said Senator Joshua Miller, Co-Chair of the Special Joint Commission. “If a patient enters through an emergency room, doctor’s office, or a clinic the patient should be connected to health services that include a full range of needed behavioral treatment approaches,” continued Miller. The Rhode Island Legislature is in session until July and action on all of these proposals is expected before adjournment.