July 22, 2008

Reimbursement of Mental Health Services in Primary Care Settings

In 2005-2006, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA), with guidance from the Centers for Medicare & Medicaid Services (CMS), sponsored a study to identify the barriers to reimbursement of mental health services provided in primary care settings. This study was divided into two main efforts to better understand the payment policies and practices that may prohibit or discourage the provision of mental health services in primary care settings.

This report, by Danna Mauch, Ph.D., Cori Kautz, M.A., Shelagh Smith, M.P.H., incorporates deliberations and addresses the purpose and rationale of the project, outlines the project's tasks, details findings, and provides suggested actions to the Federal government on steps to overcome existing or perceived barriers to reimbursement and provision of mental health services in primary care settings. An annual survey undertaken by SAMHSA has established the prevalence and treatment rate of mental health problems. Among adults who reported an unmet need for mental health problems, about 47 percent reported cost or insurance issues as one of the main barriers to treatment. Research confirmed that the provision of frontline mental health services in primary care settings has positive impacts, overall health care cost efficiency, improved clinical and functional patient outcomes, and adherence to regimens and treatment of mental health disorders.