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Reimbursement of Mental Health Services in Primary Care Settings
Donna Mauch (au); Cori Kautz (au); Shelagh Smith (au)
In 2005–2006, the Substance Abuse and Mental Health Services Admin. (SAMHSA) and the Health Resources and Services Admin. (HRSA), with guidance from the Centers for Medicare & Medicaid Services (CMS), jointly sponsored a study to identify the barriers to, and possible solutions for, reimbursement of mental health services provided in primary care settings. The Fed. Action Agenda, emanating from the 2003 report of the President’s New Freedom Comm., “Transforming Mental Health Care in America,” includes direct reference to addressing barriers to reimbursement for mental health in primary care. This study, in response to that identified need, 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. The first part synthesized an Environmental Scan, literature review, and Key Informant Interviews into a White Paper background report. The White Paper identifies the barriers to successful provision and reimbursement of mental health services by practitioners in primary care settings. The second part convened a high-level Expert Forum, with participants chosen from various organizations (including consumers, practitioners, providers, government, and researchers), who reviewed the White Paper, discussed and ranked suggested actions to reduce those reimbursement barriers. This Final Report incorporates their deliberations and addresses the following: Describes the purpose and rationale of the project; Outlines the project’s tasks; Details findings from the White Paper; Summarizes the June 2006 Expert Forum discussion; and Provides suggested actions to the Fed. government on steps to overcome existing or perceived barriers to reimbursement and provision of mental health services in primary care settings. Tables.
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