State needs to take advantage of federal money for behavioral health care
As examined in two recently published articles in the Post-Gazette, the fate of vulnerable residents across the Commonwealth who have behavioral health challenges is in jeopardy.
By not fully taking advantage of the federal dollars that currently are available to reimburse Pittsburgh Mercy and other Certified Community Behavioral Health Clinic (CCBHC) providers across the Commonwealth for the total cost of care that is provided, Gov. Tom Wolf and Teresa Miller, Pennsylvania Department of Human Services Secretary, are leaving Pennsylvania over 10,000 residents — particularly those with mental health and addiction challenges — at risk of going without potentially life-saving behavioral health care services.
Mr. Wolf and Ms. Miller have the opportunity to get federal funding already set aside to provide vital services to people and families who have behavioral health challenges. If they do not act and take advantage of the federal funding that is available, Pittsburgh Mercy and other CCBHCs will have no choice but to cut vital behavioral health services and, potentially, jobs.
In 2017, Pennsylvania became one of the first states to provide CCBHC services. The intent of the CCBHC model was to implement innovative behavioral health best practices to achieve integrated, whole-person care and to cover the cost of behavioral health services, which historically have gone underfunded when compared to physical health services like cardiac care and cancer care.
As one of only seven CCBHC providers in Pennsylvania and as the only CCBHC provider in Western Pennsylvania, Pittsburgh Mercy has:
• Decreased the average wait time for behavioral health services from 10.1 days to 1.5 days.
• Increased access to care.
• Increased capacity and served more than 10,500 individuals. Notably, 80% of that group had not received behavioral health services in the prior six months.
• Strengthened the integrated physical and behavioral health care model according to population, such as women, veterans, etc.
• Established greater care coordination and service for vulnerable populations.
• Expanded substance use disorder treatment services, including the availability of Medication Assisted Treatment for persons who have substance use disorders and are addicted to opioids. Notably, the overdose death rate in Pennsylvania dropped 18% from 2017 to 2018.
• Implemented evidence-based initiatives to support peers as part of the recovery process. A peer is a person who has a shared, lived experience with mental health, addiction, and recovery.
Federal money available
The federal government has given four, short-term fundingextensions for the CCBHC care model. The fourth extension includes funding through Nov. 21. CCBHCs have become the standard in behavioral health care and can now be found in more than 20 states. The U.S. House and Senate as well as President Donald Trump, have supported funding and CCBHC expansion. The funding is expected to be included and expanded in the new federal budget.
Additionally, there is local support for funding CCBHC services as well. Sixteen local state representatives wrote a letter to Gov. Wolf’s administration in support of continuing behavioral health funding.. However, Pennsylvania has yet to pull down the approved federal funds. As a result, funding for Pittsburgh Mercy’s CCBHC and others throughout the Commonwealth of Pennsylvania is in jeopardy.
In spite of the early outcomes and the funding extensions, the reimbursement Pittsburgh Mercy and other CCBHC providers receive does not cover the total cost of care. Of the more than 60 original participating providers nationally, Pittsburgh Mercy had the lowest cost of care. Yet, under the current payment structure, Pittsburgh Mercy receives approximately half of the total cost of care.
Collectively, Pittsburgh Mercy and other CCBHCs throughout the Commonwealth have lost millions of dollars on CCBHC services. Pittsburgh Mercy has lost more than $2 million on CCBHC services since July 1. Every day CCBHC
providers across the state do not have access to the federal funds, the funding gap grows. Continued losses would be difficult to sustain.
Some Pennsylvania CCBHCs already have reduced or cut behavioral health and opioid treatment services. Such measures result in reduced access, less capacity, longer wait times, lost jobs, fewer care providers, fewer services, less care coordination, increased emergency department visits and hospitalizations, and higher incidence of incarceration and homelessness. These consequences could quickly become the norm if Pennsylvania does not make the funds available to Pennsylvania CCBHC providers.
Without access to federal funds, state CCBHC providers likely will have no choice but to cut vital CCBHC services. Thousands of people with mental health and substance use disorders will lose access to care, and jobs will be negatively impacted. Of the eight states enrolled in the federal program, six have accepted funds and integrated them into their Medicaid plans. The seventh state is working on its plan. Pennsylvania, however, has not.
The goal of Pittsburgh Mercy and other CCBHC providers is to ensure that the people who are the most vulnerable have access to the services they need, when they need them.