Two House lawmakers reintroduced a bill Thursday that would allow Medicare to fund mental and behavioral health services from trained specialists with similar challenges to their patients.
The Promoting Effective and Empowering Recovery in Medicare Act of 2021, introduced by Reps. Adrian Smith (R-Neb.) and Judy Chu (D-Calif.), would clarify that CMS can reimburse peer support specialists for services rendered in mental and physical health settings. Currently, Medicare and private health insurers are not able to reimburse these services, leading to a lack of funding and dwindling number of available jobs for specialists.
Providers refer patients to these peer support specialists, who often work with a team of nurses and coordinators, for support in addition to medical treatment. Many studies show that peer support can increase quality of life for patients and save a lot of money for program providers. In a study of Medicaid claims within New York City, use of peer specialists for crisis respite over an eleven month period reduced Medicaid expenditures by $2,138 per month. Another study of the Georgia Department of Behavioral Health and Developmental Disabilities saw patients use of certified peer specialists over "typical services in day treatment" saved the state an average of $5,494 per person.
People who have mental and behavioral conditions want these services because [counselors] have the lived experiences and training they need to help think through potential treatments and provide more assistance," said Mary Gilberti, executive vice president of policy for Mental Health America, which worked on the bill with Chu and Smith.
Gilberti said many patients who are seeking services are nervous about treatment, allowing specialists to provide a first step toward getting help.
Patrick Hendry, a peer support specialist for over 31 years, said his ability to find meaning and success in life as a man living with bipolar disorder shows others they can do the same. Having enough counselors with diverse experiences to treat patients would improve care, but the funding is not there.
"I have worked in settings where there would be five to six counselors for up to 1,300 people," Hendry said.
Since specialists are paid through Medicaid or state revenue there is no baseline for hourly wages, leaving many without a livable income. Gilberti said the PEERS Act would help create a national standard for how much to pay counselors by allowing Medicare to reimburse for treatment.
Lawmakers did not vote on the initial version of the bill introduced in September 2020.