Resolution on Psychologists in Integrated Primary Care and Specialty Health Care Settings

Insurance practices that do not or poorly reimburse psychologists

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Insurance practices that do not or poorly reimburse psychologists

services can be a barrier to integrated care.
State health insurance exchanges that cover health services under Medicaid have historically not reimbursed psychological and substance abuse services or done so at disproportionately low rates for psychologists. This barrier contributes to health disparities for under- served children and adults across the lifespan.
Coordinated care necessitates addressing reimbursement bar-
Health care policy has not changed to accommodate the new coordinated care delivery model (Kathol, Butler, McAlpine,
& Kane, 2010). Various external factors continue to influence the ultimate effectiveness of integrated and collaborative care. These factors include 1) current payment systems and financial reimbursement 2) lack of reimbursement for multiple services on same day 3) multiple copays and deductibles on same day 4) the need for CPT codes in addition to Health & Behavior
(H&B) codes which accurately reflect team-based work and 5) integration of electronic health records. Mental health remains largely carved out of physical health reimbursement practices. This payment schism is not only a significant policy barrier for integration efforts, but it also affects care coordination and team- based training which leads to organizational and cultural barriers

(Kathol et al., 2010; Miller, Phillips, Petterson, & Teevan, 2011). Although the new Medicare Physician Fee Schedule released by the Centers for Medicare and Medicaid Services (CMS) allows primary care providers to receive additional payments for chronic care coordination and telehealth services, it does not include payment for psychologists and other non-physician providers who deliver such services, which limits integrated care teams effectively funding the valuable care they provide.

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