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Bill would spur health centers to create in-house mental health services

For years, a number of local health centers have spent a great deal of money and effort making sure a therapist or psychologist was staffed just down the hall from a primary care doctor — an attempt to catch signs of depression, post-traumatic stress and other mental health issues as early as possible.

That effort is part of a larger health care trend driving the integration of medical, mental and dental health services. But in California, federally Qualified Health Centers and Rural Health Clinics are not allowed to bill medical and mental health services on the same day.

The state Department of Health Care Services is only allowed to reimburse clinics for one doctor’s visit. That means the clinic has to absorb the cost of one of the visits. But lawmakers in Sacramento are trying to change that.

Senate Bill 1125, sponsored by state Sen. Toni Atkins, D-San Diego, would require the state to allow the health centers and rural clinics to bill Medi-Cal for two visits if a patient receives mental health services on the same day they receive medical services.

“We still do the care no matter what, because the patient needs it, but it’s unpaid currently,” said Dr. Lisa Ward, chief medical officer of Santa Rosa Community Health, the largest system of health centers in Sonoma County. “Now with this legislation the psychologist’s time is actually paid.”

SB 1125 is scheduled for its first committee hearing on April 25 before the Senate Health Committee. Assemblyman Jim Wood, D-Santa Rosa, who co-authored the bill, said the bill will allow clinics to bill for both visits at a recalculated and approved single rate.

“FQHCs and Rural Health Centers provide a significant amount of care to people who qualify for Medi-Cal in the North Coast, and often patients travel miles to see a doctor, and patients sometimes need to see more than one health care provider,” Wood said.

The single-visit limitation is set in the state’s agreement with the Centers for Medicare & Medicaid Services. The bill would require the state to amend its plan with the centers. Many states already have.

In fact, according to the bill’s supporters, the federal government encourages states to allow same-day billing for mental and medical health services. California does allow same-day billing for dental and medical care visits.

According to UC Davis researchers, as many as 40 percent of patients seen by a family physician have some type of active psychiatric condition. When a primary care doctor discovers that one of his or her patients requires mental health services, it’s critical the patient receives help quickly, said Ward.

Ward said same-day billing has become imperative given the ongoing opioid crisis. In many cases, those with a substance use disorder could benefit greatly by seeing a therapist or psychologist on the same day they see a physician about their medications.

“We provide it on the same day in the same space, and it’s coordinated altogether by us as a team,” said Ward.

Ward said the bill, if approved, would encourage more clinics to develop in-house mental health services.

She said that many health care organizations don’t provide mental health and substance abuse services because they’re not financially sustainable.

“They just don’t break even,” she said. “It limits the providers who will even go down that path.”