FQHCs, BH and same-day billing

June 28, 2019


NYS Council note:  It appears to me the statistic (below) claiming an increase of 83% in the provision of behavioral health services by FQHCs since 2010 is a national number although there is no doubt FQHCs are serving more individuals with significant behavioral health conditions than ever before.  This is why the NYS Council and CHCANYS have been working together on a two year project designed to bring our members together and to provide training and technical assistance to enhance their ability to work together to offer bi-directional and integrated care.

Community Healthcare Network calls on state to allow same-day billing

An organization that provides primary and behavioral health care to New Yorkers at 14 federally qualified health centers and mobile vans is calling for the state to allow same-day billing for integrated care.

FQHCs are generally not able to bill for more than one type of visit per patient per day, for instance, primary and behavioral health care, Community Healthcare Network said. And that creates a “significant barrier” to both the quality and continuity of care.

Robert Hayes, president and CEO of Community Healthcare Network, said in a letter delivered this week to state Health Commissioner Dr. Howard Zucker that the barrier is particularly detrimental for patients in medically-underserved areas who have several health conditions. Challenges related to transportation, employment and child care can prevent such patients from scheduling multiple appointments in a short period of time.

Hayes added that, although 37 states have moved to allow same-day billing, New York has not put the same substance behind the stated policy of integrating care.

“Patients’ outcomes are best when their primary care and behavioral health needs are addressed in tandem,” Hayes wrote. “This allows for ‘warm hand-offs’ between primary care providers and behavioral health teams, reducing the risk of patients falling through the cracks or out of care.”

He also noted that behavioral health visits at community health centers have increased 83% since 2010. Removing Medicaid restrictions on same-day billing, he wrote, allows FQHCs to serve an existing need and is aligned with the patient-centered medical home model.

Last year the state Department of Health introduced that model, which was designed to transform primary care by establishing better relationships between individuals and their clinical care teams to improve quality and reduce associated costs.

“Same-day billing not only benefits patients with co-occurring primary care and behavioral health needs, but also patients whose treatment involves multiple practitioners,” Hayes wrote.

The National Association of Community Health Centers detailed the same sentiment in an August 2018 report, stating that “allowing health centers to bill Medicaid for two different types of visits on the same day is the foundation for integrated care.”

It added that Medicaid is the single-largest payer for mental health services in the U.S., and additional same-day billing policies—at the federal or state level—would better the ability of health centers to provide integrated care to patients.

A spokeswoman for the Department of Health said that it had received the letter from Hayes on behalf of the Community Healthcare Network and was reviewing it. —Jennifer Henderson