Legislators Must Lead on Reimagining Behavioral Crisis Response System

The Consolidated Appropriations Act (CAA) was a great start, but more is needed from legislators to improve the delivery of high-quality crisis care. One could argue that funding—an absolutely critical component for any industry—is even more important in the world of behavioral health crisis care.

“The federal role in mental health includes regulating systems and providers, protecting the rights of consumers, providing funding for services, and supporting research and innovation,” according to Mental Health America, adding, “as a major funding source for mental health services, the federal government establishes and enforces minimum standards that states can then expand upon.”

While certain guidelines are shared at the federal level, the state plays a large role in decision-making.

Behavioral healthcare delivery is not a one-size-fits-all approach. Certain guidelines are shared at the federal level, but states play a large role in the decision-making. While important to ensure states can customize the care their communities need, it does lead to large variances in care delivery and reporting state-to-state.

It is time for a reimagined crisis response system that provides immediate access to high-quality behavioral health crisis care for all who need it when they need it. A properly built crisis care continuum must ensure the ability to safely serve the highest acuity crisis patients who are most in need of more appropriate care and cannot be left out of the debate.

The recently adopted CAA made great strides in treating mental illness and substance use disorder, and lawmakers have the opportunity to build on those efforts in the new Congress. In particular, additional provisions are needed to strengthen the crisis continuum for high-acuity individuals, to ensure that those with the most need for specialty crisis care are no longer routed to emergency rooms and jails.

The CAA includes several robust mental health provisions. Examples include provisions to: improve mobile crisis care under Medicare by establishing increased payment rates for crisis psychotherapy services, require the Department of Health and Human Services (HHS) to identify, publish, and update best practices for a crisis response continuum of care, and establish a pilot program to allow for mobile crisis response teams. These are significant steps in the right direction.

As the 118th Congress sets its priorities, it is important for our elected officials and appointed policymakers to embrace the value of medically integrated care models that serve the highest acuity crisis patients presenting with suicidal behaviors, acute agitation, and substance intoxication.

Today, crisis care services are primarily covered by state Medicaid programs and county governments. As a result, much of the population that is covered by Medicare and commercial insurance have limited options if they’re in a behavioral health emergency—making the recently enacted provisions an important part of efforts to strengthen our mental health care system.

While not included in the CAA, the Senate Finance Committee’s work toward payment for crisis stabilization services in additional settings by proposing to establish a bundled payment under the Outpatient Prospective Payment System (OPPS) for crisis stabilization services for Medicare beneficiaries who are in crisis should also be recognized. This would cover up to 23 hours of crisis stabilization services, which include observation care, screening for suicide risk, screening for violence risk, assessment of immediate physical health needs, and other services necessary for the diagnosis, active treatment, or de-escalation of a mental health or substance use disorder crisis. These are important components in the delivery of crisis stabilization services and would benefit communities nationwide.

As our elected officials explore payment for crisis services, wouldn’t it be great if they would focus on models that incentivize improved quality, access, patient experience, and sustainability, so that behavioral health services always put the patient first and do so in a sustainable, cost-effective way for the long-term viability of the behavioral health system?

The world of behavioral health crisis care is ever evolving. Providers, government, communities, and all parties involved need to be willing to change along with it to best serve the people who need it most when they need it most.

Chris Santarsiero is vice president of government affairs for Connections Health Solutions.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.

Reference

The Federal and State Role in Mental Health. Mental Health America. Accessed February 14, 2023.