OR: Legislative Task Force Hears Mental Health Providers’ Reimbursement Concerns

F-Oregon Legislature

The Oregon Legislature’s Joint Interim Task Force on Primary and Mental Health Care Reimbursement heard from representatives of psychiatric and nurse practitioner organizations last Friday that the current methodology for reimbursing providers presents numerous barriers to providing more efficient, coordinated mental health care.

The Legislature in 2013 passed House Bill 2902, which established the task force to study payment reform and payment parity for different providers and to suggest new payment methodologies that support the coordinated care model on which Oregon increasingly relies.

“A lot of the reason we don’t have more people working in public mental health has to do with the two Ps: payment and paperwork,” said Linda Morley, a Salem-based nurse practitioner representing the Nurse Practitioners of Oregon.

Morley said various insurance codes “don’t reflect what I do.”  For example, one insurance company may pay her $100 less than another company for the same service.  Particularly problematic are codes that don’t reflect the complexity of a patient’s health needs, she said.

Dr. Rick Kincade, the task force co-chair, agreed with Morley, noting that current insurance codes and payment rates “account for complexity of visit interaction, but not necessarily the complexity of the patient in total.”

The neediest and most complex patients – known as “high utilizers” – are becoming a bigger focus of coordinated care organizations (CCOs) because they tend to use specialty care and cost more than an average patient, even though much of their care can be preventive.

Many CCOs are creating innovative programs or care teams to care for those patients, and oftentimes there aren’t payment codes or methodologies to support that work – which means that creating payment methodologies that reflect the work those providers do will be vital to the success of CCOs, coordinated care and primary care homes.

“Finding ways to create a scaffolded, multi-disciplinary system [that] will help get more promising services out into the communities…is the way we ought to go,” said Kathryn Flegel, president-elect of the Oregon Council of Child and Adolescent Psychiatry.

Providers also mentioned problems with time-consuming paperwork, changing training requirements, and urged more use of telemedicine to deliver services.

But Sen. Laurie Monnes Anderson, D-Gresham, a member of the task force, advised her colleagues to drill down on insurance codes.

“The intent of [House Bill 2902] was to focus on the way insurers are manipulating the system for billing right now,” Anderson said.  She suggested the task force should focus “on things we can put into statute that would give direction to insurers as to what they could or could not do.”