Lawmakers support primary care as setting for mental health care, substance use disorder treatment

Federal lawmakers hope their bill will spur greater integration of mental health care and substance use disorder treatment in primary care.

The U.S. Senate Finance Committee will meet Nov. 8 to mark up a bill that also aims to cut prescription drug prices. Committee Chair Sen. Ron Wyden (D-Oregon) and Ranking Member Sen. Mike Crapo (R-Idaho) announced the hearing and have published a discussion draft with policies that would expand mental health care under Medicare and Medicaid.

The two announced the committee intends to advance the proposals with pharmacy benefit manager reforms the committee approved in July, and pursue full passage in the Senate.

A news release stated one of the aims is to fund “primary care physicians to deliver behavioral health and primary care to Medicare beneficiaries in the same setting. There will be improved access to Medicare mental health services delivered through telehealth, and better integration of mental health services and substance use disorder care for youth in Medicaid and the Children’s Health Insurance Program.

Another goal: “Supporting physicians and professionals by mitigating predicted Medicare payment cuts.”

PBMS are a target

Pharmacy benefit managers (PBMs) are a target for the legislators as a way to rein in drug costs. The senators cited the committee’s summer discussion and autumn introduction of the Modernizing and Ensuring PBM Accountability Act (MEPA) as an example of bipartisan effort. The legislation could lead to lower prices for consumers by ensuring more transparency, accountability and competition in pharmacy benefit manager practices.

“Every American should have access to the mental health care they need when they need it. And sticker shock at the pharmacy counter must become a thing of the past,” Wyden said in the hearing announcement. “I am proud that once again this committee is coming together on a bipartisan basis to expand access to mental health care, further rein in damaging actions by PBM middlemen, and lower prescription drug costs for American families and seniors. I look forward to a constructive, bipartisan markup next week.”

They hope for bipartisan support for the additional bill, which did not yet have a formal name in the draft language.

“In July, the Finance Committee took crucial steps toward improving health care access and affordability for Americans from all walks of life, and committed to continue our work on prescription drug benefits,” Crapo said in the hearing announcment. “With this markup, we are building on that success by taking up additional commonsense, comprehensive proposals championed by members across the dais to strengthen our federal health programs.

Additional goals

The senators’ list of legislative goals included:

• Expanding the number of mental health and substance use providers participating in Medicare – including psychologists, clinical social workers, marriage and family therapists, and mental health counselors – in rural and underserved communities.
• Expanding the use of licensed clinical social workers and occupational therapists under Medicare.
• Requiring Medicare Advantage plans to have up-to-date and accurate provider directories and protecting beneficiaries from paying higher out-of-pocket costs when relying on an incorrect directory.
• Assuring pharmacy access and choice for Medicare beneficiaries.
• Protecting seniors from paying higher copays on certain prescription medicines.
• Increasing access to more affordable biosimilar medicines in Medicare Part D.
• Extending essential Medicaid and Medicare provisions that will expire this year to avert harmful Medicaid cuts to safety-net hospitals and protect rural providers and patients, among others.