 |
Tami L. Mark, Ph.D., M.B.A., and colleagues analyzed data from outpatient medical claims from 2014 for 11 states. The claims were for a primary behavioral health diagnosis such as a mental or substance use disorder and included evaluation and management procedure codes of 99213 (established patient office visit, low to moderate severity) or 99214 (established patient office visit, moderate severity). The states included were Georgia, Idaho, Michigan, Minnesota, Mississippi, New Jersey, Pennsylvania, South Dakota, Vermont, West Virginia, and Wyoming.
Primary care physicians were reimbursed more than psychiatrists for code 99213 in 10 of the states and for code 99214 in nine of the states. Primary care physicians were reimbursed $1 to $34 more than psychiatrists for code 99213 and $5 to $40 more for code 99214.
“The disparity in reimbursement rates between psychiatrists and primary care physicians is inconsistent with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which requires that provider reimbursement rates for treating mental and substance use disorders be based on criteria that are comparable to the criteria for setting reimbursement rates for medical providers and applied no more stringently,” the researchers wrote. However, although MHPAEA applied to Medicaid managed care plans and the Children's Health Insurance Program as of 2009, these health programs had until 2017 to comply, the researchers noted.
“A key implication of these findings is that reducing reimbursement disparities between psychiatrists and other medical doctors may increase the supply of psychiatrists willing to treat Medicaid patients,” the researchers wrote.
(Image: iStock/utah778)
HHS Extends COVID-19 Public Health Emergency
Health and Human Services Secretary Alex Azar on Thursday extended for an additional 90 days the current COVID-19 public health emergency, which was set to expire on July 25. APA has heard from many members expressing concern about the impending deadline and the implication for various regulatory waivers implemented because of the pandemic, including those pertaining to telemedicine.