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House of Representatives
Session of 2023 - 2024 Regular Session


Posted: December 16, 2022 09:08 AM
From: Representative Seth M. Grove
To: All House members
Subject: Medical Assistance Physical Health & Behavioral Health Integration
In the near future, I plan to re-introduce legislation to integrate behavioral health and physical health services in our Medicaid program.

As some background, HealthChoices is the name of Pennsylvania's managed care programs for Medicaid recipients. Known as the carve-out, mental health and drug and alcohol services provided via the HealthChoices program differ from the physical health component of the HealthChoices program. Unfortunately, a major barrier from the carve-out is the inability to engage providers in whole-person care.

According to the Substance Abuse and Mental Health Services Administration, 68% of adults with mental illness have one or more chronic physical conditions. People with serious mental illness need integrated care, as they die on average 25 years earlier than those without, largely because of preventable chronic physical illness, complicated by the mental health and/or substance use disorder factors. Furthermore, tackling the opioid crisis necessitates actively coordinating a member’s physical health, pharmacy, mental health and substance use services. The current paradigm supports disconnects

In November, the Centers for Medicare and Medicaid Services (CMS) sent out a letter to state Medicaid Directors to announce opportunities to design innovative service delivery systems for adults with serious mental illness. CMS specifically stated integration is critical for improving access to treatment for comorbid physical health conditions and substance use disorders that are common among individuals with serious mental illness.

Therefore, I am re-introducing legislation to coordinate mental health, substance abuse and primary care services in an effort to produce the best outcomes and to best care for people with complex health needs. In other states, behavioral health integration has proven less administrative costs. It provides easier integration of a single treatment plan (i.e. confidentiality barriers), easier data collection and monitoring of outcomes tying together the entire cost of care and better quality of care.

Please join me in cosponsoring this important legislation that will improve health outcomes and lower costs in the system.

Introduced as HB1255