Compared to the general population, those with mental health issues or substance use disorders are more likely to have co-occurring diseases – including cardiovascular diseases and pregnancy complications.
When left untreated, mental health and substance use disorders can result in worse quality-of-life and significantly shorter life expectancies in comparison to the general population, dying, on average, 25 years earlier than the general population.
The integration of mental health and Substance Use Disorder (SUD) services into comprehensive primary care settings, like FQHCs and RHCs, makes services more accessible, improves coordination of care, and supports a “whole person care” approach to serving Medi-Cal beneficiaries.
Senate Bill 66 (Atkins and McGuire) Same Day Visits Bill Text BEING HELD AS A 2 YEAR BILL (2019)
In California, if a patient receives treatment through Medi-Cal at a community health center from both a medical provider and a mental health specialist on the same day, the State Department of Health Care Services will only reimburse the center for one “visit,” meaning both providers can’t be adequately reimbursed for their time and expertise. A patient must seek mental health treatment on a subsequent day in order for that treatment to be reimbursed as a second “visit.” This statute creates an undue financial barrier for community health centers, known as Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), preventing them from treating their patients in a comprehensive manner in the same day.
Notably, this barrier doesn’t exist for similar health services. California currently allows FQHC and RHCs to bill for two separate Medi-Cal “visits” if a patient sees both a primary care provider and a dental provider on the same day. Further, the federal government encourages states to allow FQHCs and RHCs to bill for care provided by a primary care specialist and mental health specialist in the same day as two separate visits in recognition of the value comprehensive care generates. Most states already allow for same-day billing of medical and mental health services, as does the federal Medicare program. Inexplicably, California has refused to change its MediCal billing statute to align with federal policy and its own state policy regarding dental care. Emergency rooms are too often a costly point of entry for mental health services, and we see the fallout of untreated mental illness on our streets, our jails, and our communities.
Senate Bill 66 would allow FQHCs and RHCs to bill MediCal for two visits if a patient is provided mental health services on the same day they receive other medical services. Allowing health centers to access the same-day billing statute already in place in other public programs will ensure more early intervention in mental illness and guarantee that we are using the integrated health services available to our communities at their full potential.
SPONSORS: CaliforniaHealth+ Advocates Steinberg Institute California Association of Public Hospitals Local Health Plans of California.