BCBSRI announces investments to improve access to behavioral healthcare


PROVIDENCE, RI – Blue Cross & Blue Shield of Rhode Island (BCBSRI) today announced two key investments to improve access to high-quality, affordable behavioral healthcare. Effective January 1, 2019, copayments for behavioral health office visits will be consistent with primary care office visits. Additionally, as of August 1, 2018, BCBSRI will remove approval requirements (also known as utilization review) for in-network behavioral health services. Concurrent with this change, BCBSRI will enhance its care management model to ensure better health outcomes for members. These policy changes are part of BCBSRI’s larger focus on programs to improve access to high-quality behavioral health services for our members and to address the state’s behavioral health crisis.

Behavioral health encompasses both mental illness and substance use disorders. According to the Truven Health Analytics report, commissioned by the state in 2014, adults in Rhode Island have the highest rate of psychiatric general hospital admissions among New England states. BCBSRI President and CEO Kim Keck noted, “Rhode Islanders should have access to the right level of every type of care, including behavioral healthcare, at the right time in the right place. We are committed to developing sustainable programs to improve behavioral health outcomes.”

Specific details of the policy changes include:
• Copayment adjustment: Effective on January 1, 2019 (upon a plan’s renewal) all BCBSRI insured plans will provide coverage for all mental health and substance use disorder office visits, including medication-assisted treatment (MAT), at a copayment consistent with primary care office visits. Previously, the copayment for behavioral health services has been consistent with specialist visit copays, which are often higher than primary care copays.
• Utilization review: Starting on August 1, 2018, BCBSRI will no longer require prior approval for any in-network mental health or substance use disorder services. Out-of-network services will still be subject to review.

“Behavioral health issues impact children, teens, their families, schools, and even pediatricians and other non-behavioral health providers. Anything we can do to facilitate access to care across time and levels of service is an important step forward,” said Henry T. Sachs, M.D., vice president and chief medical officer of Bradley Hospital, the nation’s first psychiatric hospital devoted exclusively to children and adolescents. “By enacting this change, Blue Cross is taking an important step in increasing access to the outpatient care families need before they reach a crisis.”

“Blue Cross continues to be forward thinking in their commitment to improving the health of Rhode Islanders, by actively eliminating the financial and logistical hurdles to accessing mental health and substance abuse treatment,” said James K. Sullivan, M.D., Ph.D., chief medical officer for Butler Hospital and senior vice president for the Care New England Health System. “These changes will open avenues of care and decrease the stigma long associated with these services. They will also enhance the quality of life for those who suffer from illness related to mental health and addiction.”

These policy changes are part of BCBSRI’s larger focus on programs to improve access to high-quality behavioral health services for our members. Most recently, BCBSRI partnered with the Addiction Services Center at Roger Williams Medical Center to deliver MAT to Rhode Islanders struggling with opioid use disorder. The program aims to provide evidence-based patient care by working to ensure timely, reliable access to clinical treatment and comprehensive services that focus on patients building recovery capital and improving their health outcomes. Additionally, BCBSRI recently announced its support of Bradley Hospital’s Mindful Teen Program, an innovative effort that promotes alternatives to inpatient hospitalization for children and teens facing mental illness.

“The behavioral healthcare system can be difficult to navigate, leaving many unsure of where to go when they need care,” said Matt Collins, M.D., vice president of clinical integration at BCBSRI. “These new policies help remove barriers to care and improve health outcomes for our members, especially after they leave inpatient treatment. We look forward to continued collaboration with the provider community as we explore more ways to improve the behavioral healthcare delivery system to enable a better experience, better outcomes, and more cost effective care for Rhode Islanders.”

BCBSRI is committed to continuing our work with the Governor, General Assembly, providers and other stakeholders to find sustainable solutions to improve the behavioral health of all Rhode Islanders.

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