Bridging from the COMPLETE Care Act to New Legislation
U.S. legislators continue to prioritize mental health funding, and in particular, integrated behavioral health programs. If passed into law, these policies could facilitate widespread integration through generous reimbursements. Building upon our previous discussion of the COMPLETE Care Act, it is important to explore how its principles have been embedded into the new legislative framework. This evolution is prominently reflected in Section 104 of the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, a significant piece of legislation aiming to reshape the landscape of mental health care. In November, the Senate Finance Committee voted to advance the Extenders Act, moving it to the Senate for a vote.
Incentives for Behavioral Health Integration
Central to this new legislation is the focus on incentivizing the integration of behavioral health services within primary care. Starting in 2026, the Act proposes a substantial increase in payment rates under the Medicare physician fee schedule for specific behavioral health integration services. This approach adopts a tiered payment system, where reimbursement starts at 175% of the Medicare Physician Fee Schedule (MPFS) in 2026, reducing to 150% in 2027, and further to 125% in 2028. This structured plan underlines a deep commitment to enhancing the integration of behavioral health into primary care settings, addressing a critical gap in current healthcare services.
Impact of Enhanced Payment Rates
These enhanced payment rates serve as a catalyst for change, encouraging primary care providers to incorporate behavioral health services into their practices. The higher reimbursement rate in the initial year is especially crucial, as it helps offset the startup costs associated with integrating these services, such as training staff, investing in new technologies, and adapting existing systems. This financial incentive is expected to lead to broader adoption of integrated care models, ultimately benefiting patients through more comprehensive and accessible care.
Broader Benefits of the Bill
While Section 104 stands out, the bill encompasses other significant provisions that collectively aim to improve mental health care accessibility and affordability. Notably, the bill addresses the high costs of prescription drugs and expands eligibility for Health Professional Shortage Area (HPSA) bonuses. These measures are crucial in making mental health care more affordable and accessible, particularly in underserved communities where shortages of healthcare providers are most acute.
A Step Forward in Mental Health Care
The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, particularly through Section 104, marks a decisive step towards a more integrated and effective mental health care system. By financially incentivizing the incorporation of behavioral health into primary care and addressing broader challenges in the healthcare system, the legislation paves the way for a more inclusive, efficient, and patient-centered approach to mental health care.
The next steps are for a full vote and in the Senate and passage in the House. We call on the behavioral health policy community to continue to push for this important piece of legislation.