Connecting Our Medical Providers with Links to Expand Tailored and Effective Care
Impact
The passage of SB1378 is anticipated to have a significant impact on how behavioral health services are delivered within Medicare. By providing higher reimbursement rates for behavioral health integration services, the bill seeks to encourage more primary care practitioners to incorporate these services into their practice. This movement towards integration aims to improve patient care by providing comprehensive support that addresses both physical and mental health needs. Additionally, the Secretary of Health and Human Services is mandated to offer technical assistance to facilitate this integration, thus ensuring the necessary support for primary care practices to adopt these models effectively.
Summary
SB1378, known as the ‘Connecting Our Medical Providers with Links to Expand Tailored and Effective Care’ or ‘COMPLETE Care Act’, aims to amend Title XVIII of the Social Security Act. The primary objective of this bill is to provide incentives for the integration of behavioral health services in the Medicare program, specifically through financial adjustments intended to increase the payment rates for certain behavioral health services provided in 2025, 2026, and 2027. The new structure includes adjustments in payment amounts based on designated HCPCS codes for various services, thereby setting a framework for enhanced provisions for mental health care under Medicare.
Contention
Despite its promising prospects, the bill may raise several points of contention among lawmakers and healthcare advocates. Critics might argue that while financial incentives can boost the provision of mental health services, there may be concerns about the consistency of service quality and the adequacy of training for primary care providers in this dual role. Furthermore, adjustments in payment structures may be scrutinized regarding their potential impact on overall Medicare funding and resource allocation. Lawmakers and stakeholders will need to balance the push for integrated care with the realities of system capacity and provider readiness for this significant shift in service delivery.
Cover Outstanding Vulnerable Expansion-eligible Residents Now Act or the COVER Now Act This bill establishes a demonstration program to allow local governments to provide health benefits to the Medicaid expansion population in states that have not expanded Medicaid. Under the program, local governments may provide coverage for individuals who are newly eligible for Medicaid under the Patient Protection and Affordable Care Act (i.e., the Medicaid expansion population) for a maximum of 10 years, or until their respective states expand Medicaid. The bill provides a 100% federal matching rate for the first three years of program participation. The bill prohibits states from taking certain actions against participating localities, such as withholding funding, increasing taxes, or restricting provider participation. States that violate these requirements are subject to certain funding penalties.