GAO recently released their report on behavioral health issues in terms of patient access, provider claims payment, and the effect of the COVID-19 pandemic on mental health in this country.
Senator Ron Wyden Chairman of the Committee on Finance https://www.wyden.senate.gov requested the report to study the demand for behavioral health services as well as coverage and payment for these services.
John Dicken. Director for Health Care at GAO sent detailed information to Senator Wyden covering behavioral health, patient access, provider claims payments, and the general effect of the COVID-19 pandemic.
GAO found evidence showing via CDC surveys that about 38% of respondents reporting symptoms of anxiety or depression from April 2020 through February 2021, were up from about 11% in 2019. Emergency Department visits for overdoses and suicide attempts from mid-March to mid- October 2020 were up 36% and 26% respectively from 2019.
GAO interviewed officials from the National Council for Behavioral Health (NCBH) plus hospital associations and insurance regulators. Four states reported that provider reimbursement rates and health system capacity were serious issues.
As reported, longstanding unmet needs for behavioral health services were worsened by new challenges associated with the COVID-19 pandemic. There has been longstanding concerns about the availability of behavioral health treatments, particularly for low income individuals given the demand for these services during the pandemic.
Also, when GAO interviewed provider groups to discuss access to behavioral health services, provider groups reported stressors associated with the pandemic has resulted in a reduction in outpatient services, limited capacity for in-patient services, plus a lack of resources for patients requiring in-person services.
GAO discussed payment of claims issues from selected stakeholders concerning behavioral services. GAO interviewed various stakeholders including officials from insurance regulators and hospital associations in four states to include Oregon, Pennsylvania, Texas, and Virginia.
Officials from the Hospital and Health System Association of PA noted that concerns about payment denials and delays had decreased during the pandemic likely as a result of a state policy change implemented in response to COVID-19.
Problems with payments for behavioral health services include issues related to delays and denials of claims that predated the pandemic. Also, most provider groups interviewed raised issues with claims payments for behavioral health services under Medicaid more frequently than issues with other payers.
Go to https://gao.gov/products/gao-21-437r for the report Behavioral Health: Patient Access, Provider Claims Payment, and the Effect of the COVID-19 Pandemic.