Transcripts For CSPAN2 Physicians 20240706

Finance committee will come to order today across Insurance Companies are excelling Mental Health coverage to our people worried about their Mental Health or that their loved ones. Unfortunately too often after these insurers take big premiums from our people. They let them down. The providers they advertise arent available. They can get appointments. The firm basically says we arent taking new patients which of course we not represented to theminitially in that way. The fact is these americans are being off e by what the government accounting process as described as a goat network. Not my language, the of accountability. The, was a Ghost Network is all about is essentially selling Health Coverage under false pretenses. Because the providers who can advertise avarent picking up the phone. They arent seeing patients in business product or service doesnt meet expectations consumers get a refund. In my view is a breach of contract for Insurance Companies to sell their plans for thousands of dollars each month while there i is unusable. Unusable due to a Ghost Network. So im going to work with all my colleagues here on both sides track and get some real accountability for these patients who paid good money for Mental Health coverage tland they find there is very little there. And in the moment of National Crisis of Mental Health and with problem growing at such a rapid rate the existence of these Ghost Networks is unacceptable and somebody is worried about their Mental Health is our work up the courage to step up and try to coordinate their care if they cant get help , the last thing they need from the Insurance Company is a survey of these old music when a call. And nonworking numbers and rejection. We can all mention what were hearing from our constituents. I talked to all all my colleagues about this Mental Health challenge weve been working on it together. What ive described is notan owner. Staff conducted a secret shopper study. They made appointments with Mental Health providers. In 12 Medicare Advantage Insurance Plans and results were clear. Our secret shoppers and this is after people had a vast sums t. They could get an appointment only 18 percent of the time. That means more than eight in 10 missile providers listed in these Insurance Company materials were inaccurate or taking appointments third of the time the phone number a day. Alled was oh one was connected to High School Health center. Senator cassidy is a real pro all this and i think both of us would probably laugh we feel like crying for the patients are representative of. In my home state im not proud of our investigators to my staff found we can make one successful other secret shopper studiesfound the same thing. Researchers ngseeking care for depression esand present time 18 pretty much the same result. Those networks are anongoing persistent problem. I actually start looking for redress on this issue on equity into improving dental health care for all and i look down the road darting with senator crepo on this because weve been working on this bipartisan basis we got plenty more to do to talk about our weekly conversations. Finally just looking at the Ghost Network issue to wrap up, we got to have more oversight, Greater Transparency and serious Insurance Company is losing american consumers. And i believe certainly Greater Transparency up to be an easy one for members of this committee to get around i dont know anything about the ability you get with transparency in nonpartisan issue i want to work with my colleagues on that issue, only constantly question i want to look at this cross lord not just with respect to medicare and medicaid then my colleagues expressed interest in applying policies to commercial interests sponsored plans will not be anything partisan and many of my friends will have a review. Thank you senator wyden is no secret to and you and i have prioritized mental en Health Delivery in america. The number of major initiatives through side of the law there are a number of major issues such as this one that we still have work to do i appreciate the opportunity to work with you on it. Last congress came together to dozens of bipartisan policies to expand access to Mental Health care services. These reforms will increase the number of providers and allow patients to receive care in a more convenient to location including rooftop. However in order for these approved improvements she patients need accurate and uptodate information. Ive long champion Medicare Advantage for its ability to offer patients choice and control over their healthcare through robust competition and innovative benefit offerings Medicare Advantage provides consumer focus healthcare coverage to millions of americans as enrollment continues to grow and accuracy and provider directories to strengthen Medicare Advantage. The patient provider relationship is the foundation of the health care system. Whether a patient is suffering from Mental Healthcare crisis were just received a troubling diagnosis directories should serve as crucial tools to help seniors across the country. While we were to better align incentives provider directory accuracy we must also do so without increasing burdensome requirements will only weaken our Mental Health workforce. Regulatory redtape and reimbursement strain can decrease patient access, exacerbating physicians shortages, compounding burnout and eroding Health Care Access and quality. Congress should build on her relief measures like the ones we advanced last year including temporary schedule support medicare telehealth expansion to address these issues of bipartisan and sustainableaces. Physicianpatient stabilization and Health Coverage for seniors received on support from members of both parties in both chambers. As we look to enhance medicare we should prioritize these and other bipartisan goals and we must do so in a fiscally responsible manner. I look forward to hearing from witnesses opportunities to streamline and improve provider reporting requirements , empower patients and ration and is moretransparent Healthcare Systems. Thank you senator and you wake up number of areas where we can continue our bipartisan cooperation is important to resuming it with you and your colleagues. Let me introduce ourwitnesses briefly. Our partnership is inseparable in partnerships working to improve Mental Health care and we welcome you and you are a leading alhealthcare advocate doctor jack resnick is here president of the medical association. I know youre a professor and chair of the Dermatology University of california San Francisco and i have been in healthcare discussions a number of times phd md comes to us with a recommendation on the American Psychiatric Association Organization at the forefront of Mental Health parity. We welcome you and you had a long relationship with the American Association married gilbert and served as chief Public Policy officer for Mental Health america and is also author of an important series looking at how these powerful special interests determine the quality and stability of solar Mental Health care in america and going have doctor jeff riddell president and ceo of integrated Healthcare Association be recognized for his work in provider Data Management. Thats a mouthful and plain old english makes sure theres a focus on only now where theres so much content on injuries presented in an intolerable way here lets begin with you. Thank you chair wyden, Ranking Member crepo. Thank you for conducting this hearing today and are testifying regarding those networks my name is caro Vice President inseparable, a nonprofit working to advance policy reflexively the health of our minds and our bodies is in several im also a Mental Health advocate and survivor with milived experience of Ghost Networks and health plans. Im your attention to this critical issue. Ghost networks present invisible eyesight barriers in our Health Systems for preventing peoplefrom accessing the support they need. They are particularly damaging those of us living serious Mental Health conditions itlike me as they can result in delay or in a or even going without any of which can be devastating and have devastating consequences First Experience with Ghost Networks i had to change Health Insurance due to an in 2014. Navigating a Blue Cross Blue Shield provider directory to find a psychiatrist in the dc or maryland turned into r. One rejection after another call after call resulted in the following types ofresponses. . She doesnt work you know where they are. I dont know that is not true they work here dies. Recorded message. Doctor fill in the blank is no longer accepting new patients. This is an emergency and 11 was days and hours during the finally found a psychiatrist taking new patients success though was shortlived call to set up an appointment i was asked about my diagnosis and i responded schizophrenia. I contacted my psychiatrist in california asked if and how remains. I like regularly to los angeles for over a fouryear period to ensure i could be instable. I paid high network copay but at least i have a provider on same plan turned out to be thyroid cancer, is able to find an endocrinologist the same day but for Mental Health is a different story, a story that continued throughout my career. 2018 began working for the Los Angeles County department of Mental Health l. A. Based psychiatrist now with my colleague along with another psychiatrist. I searched directory is received. Jpo2020 and 2022 i dont with Insurance Plans from a provider directory. Each time it felt like the movie groundhog day to provider here, no one butob me, they retire arent taking new patients unfortunately my story is not unique. I peers with the help no space based similar challenges regardless of that they are covered by medical, private insurance. He is by having Health Insurance otherwise considered excellent, i have no regular psychiatrist. This leaves me with ongoing anxiety about what happened if i should be more ongoing of experience interactions with system andstice involuntary hospitalization. I dont ever want to go, has an extrinsic and because i wasnt able to find a provider for my directory and get the help i needed to stay well. About this my thyroid condition, i have a specialist, ethnologist available under every Insurance Plan. I did not hang . Emergency care and get out of bed and later to find a provider covered by their insurance. Mean Providers Companies directories are almost useless, as a driver with the decant health plans, i urge the committee to act on this critical issue policies and i have three recommendations. Provide oversight enforcement and incentives necessary for highly inclusion of specialties andd directories implement federally operated mechanism only reporting dedicated 1800 number for consumers to report their experience is in use Information Support policies and inform policy and enforcement action. Thank you again for the opportunity to share my story today. Id bery happy to answer any questions you may have. Its clear youre going to get plenty of questions. Thank you for being here. Thank you for the invitation to participate in the hearing. The president of the American Association, practicing physician and chair of the university of california San Francisco. As you said physician provider directory is critically born tool they haveys patience select Insurance Products that cover positions part of the care team and in network care they need once covered. The first patient in representation in Network Adequacy regulators. Directory information is incorrect, results are sleek and devastating for patients youve heard. From her experience. A time when our nation is fighting the behavior of crisis, directories are not actually families already in great stress. Li they must waste time on practice after Practice Department network and accepting new patients. It masks the fact that insurers consistently and egregiously failed to provide adequate networks that comply with the laws causing harmk to millionsf americans. The problem is not. Not only have i read studiesan showing the local problems of directories but have conducted a study myself in this hearing addressed to me. A few years ago i met students called every dermatologist for every plant and it doesnt u. S. Metropolitan areas. Patients with severe rash and the results are dismal or thousand listening, almost half present a duplicate among remaining prisons, many didnt exist and have never heard of the physician reportedly died,d, retired or moved away. Others were not accepting new patients or the wrong specialty altogether. In the end, 27 and offered an appointment. More recent studies including your own, mr. Or chairman, demonstrate these problems persist or even worsening. Directory accuracy and i acknowledge physicians have a role to play but the responsibly of directly ultimately lies with the plan. Being listedf correctly is a component of a health plan contract. The plan for not making it easy for physicians to help i work Academic Medical Center our staff would equate to more accuracy complaints once to add or delete after we notify them of changes. Use standardized formats and different rosters formatting for each andrm everyone. G carcasses typically contract plans a costly demoralizing the term when the pandemic directly levels of burnout they think about the growing obstacles like errors positions. They need to spend time doing their called to do in the first place, taking great care of our patients water solution 21 corroborating to examine position directory here to arch all organizations regarding health plans an active role in reviewing and assessing actors and directors. For example regulars should require plans to submit accurate directories of your. Thats what patients deserve on a fauci, take enforcement action plans to maintain a directory of monetary penalty and encourage stakeholders to develop common standards forar updating directy and they dont have 20 different numbers and require plansns to remove physicians who no longer participate in the network. My city was in 2014 and here we are today. Enough is enough. We can fix this. I urge policymakers to continue issues forha inaccurate directories. Problems like overall Workforce Shortages, lack of adequate plans and here in Mental Health purity lost. Thank you for hearing my comments. Chairman whiting. On behalf of the American Psychiatric association, i want to thank you for conducting this hearing and all of us. We greatly appreciate continue bipartisan efforts topp confront myself Substance Abuse crisis in america. Refer the opportunity testimony today. Plans purchased by individuals andriha employers in public plas like medicaid and medicare my written testimony state of several studies about ubiquitous nature of directory inaccuracies. These include misrepresentation clinicians accept new patients, home phone numbers clinicians no longer in the state that i would like to speak about my personal how networks affect ourr patients. Providers increased costs. Mymy department is in rural virginia deliver 90000 care physicians year, individuals with a broad range of complex Mental Illness and Substance Abuse disorders. Access to care rural settings like my is particularly challenging generally required to travel hours to find psychiatric care. Finding anyone accepting new patients would be nearly impossible. Currently over 800 people. For those who are healthy and well educated going through inaccurate provider was being told repeatedly we are not taking new patients, providers retired, we no longer accept your insurance or leaveea a message that no one returns is frustrating for people expanding significant Mental Illness or Substance Abuse disorders, the process at best is demoralizing and at worst is a set of four medical deterioration and preventable crisis. Many are experiencing profound feelings of worthlessness, free from loss and trauma and the impact of Substance Abuse. Patients have shared with me they felt themselves repeatedly rejected somehow the fact that they couldnt find it was their fault. Some people for care updated time claims any for Insurance Companies including medicaid and medicaid plans. A burden Insurance Companies i believe should bear, not those of us trying to provide desperately needed care. The National Administrative burden for Physician Practices to send directory updates to insurers for technologies, schedules and formats is 2. 6 billion annually. Not all practice settings like mine willing and able to invest resources needed to participate. How did practitioners make up a significantac portion of the psychiatric workforce . Many do not participate because of the administrative burden. The networks are a cause and symptom short changed Mental Health care for decades. Ch we need the help of congress to change that. My written testimony includes recommendations we asked the committee to consider many of which are already pursuing. Its time to hold plans accountable for maintaining directories and making accurate representation and to employers. Our patients need Public Private sectorts plans to be held accountable to the Mental Health parity law. And incentivized the adoption of models, integrated care like the collaborative care model that improves outcomes and expands access while furthering the support of our primary care physicians and their ability to deliver a lot ofir the care. Written testimony details my experience helping with families and Community Members access Mental Health providers. The first question, do you need these Services Covered by insurance . I asked that question because i know its going to be quicker and less effort if they can pay outofpocket but so much more expensive. I was helping one like many others found she was deteriorating during covid and her therapist recommended medication. Not surprisingly she wanted to pay minimal copay is not hundreds each visit so i helped her make a list recommend psychiatrists on her directory and by nowow youve heard this many times, started making call and others told her they were not on her network even though they were in her directory. Weeks went by and her condition only worsened. Somebody at work knew about telehealth option and she was able to get a network care but only after a delay. Some people after making these unsuccessful calls. When youou experience lack of motivation, psychosis and youre getting worse, you are least able to navigate inaccurate directories and these are not just anecdotes, they are supported by many studies and unfortunately, Medicaid Managed Care programs, claims data researchers found two thirds of Mental Health subscribers listed in the plant directory for not filling the plan. Two thirds. Medicare advantage plans show high levels of inaccuracies so what can be done . We know himdi studies, its not enough to just require accurate directory. Thats been done and has not worked. We have three recommendations for policy change. First, the data mustor be verifd by a reliable method such as independent audit and claims data. Nonprofit organizations like mine, we can just submit financial data, we have to have it audited by somebody. Last week proposeddju medicaid s rule requiring states to use secret shopper surveys by an independent entity, surveys wouldec determine accuracy of directories and wait times for Mental Health and substance disorders among others. This policy is an important step forward and should be finalized and needs to require audits for Medicare Advantageie plan for hs own review and independent entities. Plans should be required to use lames data to periodically reconcile directories. The worker shortages we t have f they are not seeing somebody, we know if they are not filing claims, they are not in the directory. Second, the information should be transparent. Other areas of healthcare requires transparency, this area needs more. Proposed rule requires secret shopper information posted on the websites and the consumer will and we have entrance present across plans related we can see what is going on i plan. Third and most important is to provide. Thiss requires carrot sticks. We can incorporate rates into overall quality that affect which plans consumers choose and bonus payments like the rating system. It is important and doing well are rewarded for doing well. None should have penalties for those not doing so well. Provisions with plans reviews, clear benchmarks and civil monetary penalties thatt are enough to change behavior. An individual should always have financial protection if they rely on inaccurate directories. In my written testimony, a reference related areas that would affect directories including reimbursement rates, integrated care, telehealth stability and expanding coverage to Medicare Advantage and medicaid and medicarent service. In conclusion, there will always be some provided directory and accuracy but the high rate consistently reveals in recent studies not minimal errors. They are consumer and government deception, misrepresenting values of the plan undermining Consumer Choice and causing great suffering. But the verification of data, transgressing requirements andht fiscal incentives, we can do so much better. Thank you for your questions. Thank you. Good morning, chairman members of the committee. Thank you for inviting me here today. President and ceo of the integrated Healthcare Association in california leadership including physician groups, health plans, hospital assistants, regulatory and other healthcare stakeholders. Among many programs managing california why provider Data Management program, the focus of my remarks today. Provider information accuracy ia great concern to me. Prior to joining iha, is the first senior medical advisor to color california, states Insurance Exchange overseeing the lodge and shortly following, the wind down of provider o directory l so i am very familir with challenges creating accurate provider information. The problem is real and pervasive in the key question is how to solve it. The challenges exposed in that effort led to regulatory requirements inor California Senate bill 137 and led to comprehensive industry effort to address longstanding challenges and provider data accuracy that became program. The goal is to simplify and unify letters and care reconcile and information. Technologyid partner utility designed to be the primary source of information which will report using processes between health plans and providers. To determine what the information for multipleag organizations. It is a form of machine learning. More organizations the likelihood of finding errors for this information going back to the plans and providers for inclusion and the directory. Now 17 contract plans with an 100 contracted Provider Organizationss, and engage with covered california. Participation is a covered california requirement for all participating things currently maintains 170,000 provider records andn supports 300 Data Elements such as life and verification and accepting new patients. Ultimately, sustainable improvement divides a collaborative solution. The Case Services in 2018 report, its become clear a centralized repository for provider data is a key component for providerr directory. Its exactly that centralized repository. What did we learn so far . Provider income is literally hundreds of data in most need to be verified on a frequent basis we needt more Data Elements related to lgbt support and more related to ethnicity and race so this will grow, notnt shrink. In addition to the data, providers need to attest accuracy of information every 90 days or sooner. Providers are much moreth willig to do so if they can attest for multiple plans understand provider data ultimately populating provider directory and the ultimate source of accuracy. Based on data homes, all stakeholders have agreed to prioritize Data Elements for concert such as accepting new patients a. A dynamic process that continues to adapt. Before they could get started processing data, we had to create standards that conform with regulatory requirements and timeliness, data quality and completeness and data accuracy. These are the same hospital plans and Provider Organizations. It allows to apply the process to identify inconsistencies. Identify inaccuracies in correcting them is necessary. The last 30 days, provider data of 169 unique providers identified over 138,000 inconsistent Data Elements which would call for corrections that require providing changes. Of these 5004nd errors in addres is an access issue. 2200 related and we do this every 90 days. Improving accuracy for independent providers and Mental Health providers more likely to be cost prohibitive. Without this data m repository r multiplan provided directory, health plans and providers will be unable to maintain provider data and provided individually. This is critical for mental Behavior Healths providers less likely to be in health Plan Networks making it critical to update their inconvenience, centralized repository. Thank you for your attention. Thank you. I was listening to your eloquent statement and i was saying to myself, what is it like in america when someone like you who was in the obama administration, who specializes in healthcare get bounced around the Mental Health system the way you describe. I just kept thinking to myself, whats it like for a difficult person and a typical family if they go through what you describe . This question i have for you because i think exhibit a for why we so desperately need reform, what is going to be the consequence of doing nothing . What if Insurance Companies keep doing business as usual, what are going to be the consequences . It seems to me the problem you describe intersecting with tremendous increase in demand is big problem for the country so if you would, paintur the pictue what happens if we dont the reforms you and your colleagues are talking about. Thank you for the question. I dont know that im there but i think about the consequences of what i talked about in my testimony, if youre going without healthcare and Mental Health care, the consequences are dire and we view them in our statistics related to people with Mental Health condition to become an housed, criminalized in their own minds and really i think about consequences at the end of the day are about the difference between life and death and that is pretty dire. By thera way, both comments [laughter] if you want to be in california. When you are making comments, your colleagues particularly the position on the panel, everybody nodding so thank you for that. Let me go to you with respect of the financial burden because i mentioned the financenc committe felt like a gazillion calls but 120 looked through an appointment for a senior withy depression, the vast majority of cases, the vastt majority, one thing if it was incidental resulted in a dead end phone call, we were able to make an appointment 18 of the time after hours and the reason i wanted to talk to you because it reminded me of experiences youre talking about crunching some numbers for some patients were able to make an appointment, they found out the provider they saw listed in their plans directory was outofnetwork. The patient gets stuck with the bill. Its what theyve reported. For consumers. It seems to me backwards is the Insurance Company has done what they indicated to do but they were on the hook they need coverage. Work in awe bipartisan way and when you see a problem, what is the Common Ground here so we can help the patient and thats what we used towa say. Where should we pursue their . It should not be the responsibly of the individual. In my view, they should be compensated for the stress that comes when you get a bill like that. You open a paper and its like hundreds of dollars you expected 25 copay and you are looking at hundred of dollars. Ol you should pay that so if the directory is inaccurate, they should pay in network so there are copay in the directory was inaccurate so it should not fall on the person is least able to bear this cost. Ri whos in the position to bear the cost, the individual or the company . They represent the network and thats not what youreme paying for it when you choose that plan the consumer close to thee website they can pick one the cap based on being accurate, and should be their problem. They shouldnt have to pay for it. Like to start with you and i will ask a question similar to the one said in her biden asked the work youve done on the ground in terms of improving accuracy provided directories and youve talked about important things in your testimony and if you could summarize key practices we need to be focusing on is the solution. Transparency being one, logic and penalties and my concern would be on the ground operation solution, he would double down on best practices. We would get to avoidid penaltis and suppression of networks and potentiallyns more urgency and challenges and other providers who cant afford and are being distracted so ultimately having a Single Source of truth however organized by state or nationally, gives everybody a fighting chance to say the problem is about attention or accuracy or aay combination of both. I would say it is hard work, he got are fixed as well or else we will double down on whats happening now. Thank you. Only up on the scene, you mentioned in your testimony the physicians are facing a crisis themselves trying to deal with the solution and we are seeing unprecedented stress exacerbated by burns. We dont want Government Program or mandate that puts burdens on everybody and doesnt get to the solution. If you could concisely bring it down to, what iss the best what are some of the best things we should consider here to achieve this objectiveve without causing the damage that could be caused . Bi we appreciate leadership and bipartisan engagement. There are some things that can be done and while there are some excess regulation we go to w tak about another hearing, this is an area where we actually need congressional help and i think there is a great thing, we hear from hhs they dont think they have the tools to impose monetary penalties and Exchange Plans they have oversight on. I know it may not be on this committees jurisdiction but the. Department of labor around these plans and we at the American Association of putting in work with colleagues and medical associations, society is going to make sure Insurance Commissioners have increased authority. We dont have monetary, forth continuing to put out these networks to make notes look bigger than they are, who will not make it. According to the National Institute of health, americans in ruralal communities as indicated in your testimony, experience disparate Mental Health outcomes even. The past to congress is, weve explored how different problems in our mental system disproportionate impact rural communes. Could you tell us from your esperance and practicing Rural Community rescinded access issues impact these areas difference in metropolitan areas . Q, senator. Many of thesese issues are identical. The challenges, provided directories are even morein spae for us. The geography is really challenging. The challenges patients have faced have criminals too many limited resolution, oftentimes primary care physicians test to take care of psychiatric issues because theres no one else available. Helping us empower them is critical so i think thats another extraordinary advantage for people with broken access and ability to afford data plans, they have telehealth with video which is wonderful but many rural areas including mine, i doo this last week by audio only because that was all that was available. Very important points. During our telehealth discussion, we heard consistently Rural Community they support broadbent but they dont have it, they wont audio only. Thank you for the things to the witnesses for distribution and those of the sender and i have introduced in your testimony, the complete care act, ih know the nature of prophecy evolved a lot probably during your professional career the one of the things that seems to make sense to me is we are embracing the wholeta person not just physical health Mental Health, to, find ways to integrate Mental Health into position practices and able to help. I understand bill in the partnership between primary care and psychiatry and this model at the university of washington. Ive worked with people around the country and tried to implement collaborative care model in my own health system. It is challenging and a little wrinkly that so much on the side of psychiatry. The challenge is on the side of primary care. Its hard to change workflows, its hard to have an integration and support system so the complete proposal you and senator forgive me cortez musto developed is critical, the reimbursement and support for primary care to make it real for the first marriage. Its a wonderful opportunity. We look forward to working with you and others on that. In the Mental Health area and certainly i agree status quo was to provide that the Health Safety net but one thing i would draw attention to or refresh on as we passed the bipartisan Safest Community act, senator tillis and i were involved in hot and heavy negotiations with senator sinema and senator murphy on this the terrible shooting in uvalde. One of the most overlooked aspects i think happens to be one of the most important aspects, expanding the Certified Community Behavior Health clinics and funding for that. As the Pilot Program senator stabenow and blunt have been taking the leadership on for many years. They have really love thewa way that i think the single largest investment which is credible and is the a challenge. Rather as you all probably know and talk, over the years, which is part of it but its across all specialties were we seek shortages in patients facing long wait times about it in a few ways, the front end, trademark physicians nurses, we need more gmp dollars in support for the bill that will help accomplish that. Training positions takes a while. We need integration reform and Additional Resources for the 30 program to help grow that as well for excess in cities around the country. I think about work enforcement at the tail end of the pipeline. Im worried because as i look at my colleagues around the country, soaring rates of burnout in the last few years and we know the things that contribute to that but if we continueue health plans for physiciansre, inaccurate directories, weve got one in five physicians telling us they are likely to retire in the next few years so we could lose a lot of workforce so its important training and getting the obstacles and burdens out of the way of the. Workforce we have. And of course that applies as you indicated not just physicians Healthcare Professionals and School Counselors part of the problem making an investment in safer schoolsme because thats where most of the Mental Health problems i believe are likely to been identified and the care of the kids need to get well and not get sicker and sicker be a danger to themselves and perhaps others. Thank you. I think myha colleague. My colleague a lot of time on these Mental Health issues and senator has been a good work. Making very good and points and points. We got a challenge ahead of us with workforce and thats why senator crapo and i appreciate the chance to work with the two of you on those workforce issues and thel, practice the gun safey bill, the reason we got in was we had taken the time to write black letter law. We were ready to go and the two of you spearheaded the effort. I do want to make sure my approach to this, im going to be all in on these workforce issues but is not the same thing as running a network misrepresentation, with got to do with these issues and look forward to working with alex in a bipartisan way senator grassley is next. Theres no way we got plenty of people. What we will do because senator grassley has touched on these issues, we will have senator tillis now andr senator stabenw and other colleagues on the way, senator tillis and senator stabenow and then i hope other colleagues will come. And live senator part of the Safer Communities act, Mental Health and civic communities bill because it is an extraordinary investment in one of the first ten states to receive funding to expand Behavioral Health access particularly in rurals communities across the board, and 2007 i was diagnosed with an illness that required me to take medications that cause me to have pharmacologically induced mania qualified clinical i depression so i got a window into Mental Health that i consider to be a blessing. I might add when i am in mania, feel like i can fix any problems anyway, i would not have solved it. If i was in depression, i went to ae. Website and said whats e use . We need to understand this has reallife consequences and in the worst possible state tosi he complexity and maybe even depression finding out you have to pay for costs. You got financial stressors and whatever the underlying condition is, Everybody Needs to understand that. I want to get regulations right. I think if we are punitive to insurers will come from dsomewhere and likely from the pockets of patients at theer end of the day so we had to get this right but we have to do something and im sorry, how do you pronounce your last name . Im sorry, i got yours. [laughter] will be wrong with hhs . I work for a Management Consulting program is my professional career. One thing, it is shocking insurers would have this part ou their annual regiment, theyth already dont have all of them have internal audits. It is shocking to me that i have a program where they are going to Provider Networks so rather than mandating that, why couldnt we move toward mandating and giving cms the technology and resources necessary to do it . Were going to determine medicare provider information so about 50 accurate. What would be wrong with an audit or review giving them an f because they have a failing grade and published it on the website . Has think a competitive advantage would be go to the cms website, abc grade but why not incentive to just make this operating procedure and get the underlying informationat system they have in place to get a higher grade we come down with a heavy hammer they are going to apply but its taking attention away from additional providers driving down cost of insurance and a number of other things. What would be wrong with the regiment as al, way to start ovr give bipartisan support . I think thatn is an importat component and advanced forward. I think having that would be very helpful but they can identify but what youre saying youre going too find very quickly come upic with Advisory Services that will go after these companies and figure out how they can accelerate from what we have today. If you have a selective plan movie because they look that large Provider Networks improves not to be the case may have to go out, i think its a legitimate case where the person who sold you the expectation that you have ald lot of models, that should be the insurers me closer relatively a lot of changes that it probably would have significant behavioral benefits the insurer. I have no more time left the thing if we want to get this right, i cant educating more doctors because we simply wont get the pipeline. I spent a lot of time, i got a couple these, chapel hill, they tell me the alec so youre still not going to have enough and we wont be getting people into this profession if we dont do with underlying reasons why people are leaving early or not getting into profession so those of the things we have to talk about if we are seriously going to get it done. Im so a strong supporter of telehealth when his committee chairman, permanent and medicare. Several seats followed suit in theirmeil kids program. I reported making telehealth permanent for all services, mental telehealth is an important tool in Rural America soi im going to give one question the question im going to state both of these now. In your written testimony youne said nearly half of the adults have Mental Health needs and dont receive treatment, access to care and have many challenges. As telehealth and investments in broadbandd, the access issue and testimony you sent access to care and ruralal settings challenging and telehealth improves access to more time the care given recent expansion of telehealth, patient will the best Mental Health care and if not, what can we do to improve the quality of care . Absolutely telehealth has a tremendous effect. The story i told him of the one woman finally got care using telehealth and its affected Mental Health communities. Want access to in person as well but having telehealth particularly in rural areas has been a game changer. We need to extend flexibilitys and make them permanent. We need to worry about licensing between states because it becomes a problem as the emergency and. Senator, thank you and thank you for your work on this issue. It is enormously challenging the benefits of telehealth during the pandemic has demonstrated, they are substantial many people in rural areas are unable to meaningfully come to us without takingca off days of work. Many dont have paid medical leave. They lose a lot of money coming to see us. The opportunity with telehealth is really substantial providing appropriate care. The data ist still evolving aso whos best served in person, whose adequately or appropriately served by video and whose adequately served by audio only and whatce condition. My own experience i have had insight into peoples lives seeing them in their homes that they otherwise would never have gotten if they travel to me so have hadha opportunities that benefited me as the doctor as well as outpatient having access in a timely way and a way that doesnt put additional burdens and cost and time on w them and allows me to see them in the environment. I heard from islands about challenges in Network Providers including Mental Health services. There are many reasons for the bad provider directories even the best information may not be userfriendly. For any witnesses who want to comment, government regulations preventing the private sector from sellingdo this, you can comment on it. The lack of standardization is a a problem so several Panel Members discussed this, the fact that provided me have to whether a physician or Mental Health provider, they have to literally have dozens of Health Plan Requirements that come at different elements and different times, different expectations and then have to repeat it over and over again every time something is potentially wrong. Will work and have seen the accuracy problem together. Thank you, senator grassley. Because of senator caseys graciousness, senator stabenow logo. Thank you so much and thank you to all of you, this is so important we have accurate provider directories and the whole big picture. I remember in the committee on the Affordable Care act provisions on Mental Health care,ha your findings this in every way we are coming back. Have kept below the neck and thank you for your testimony and sharing with us. Im sorry you had to go through this. I do want to expand a couple of thingsi because i want to stres as senator cornyn was talking about, weve made progress and one of the alternatives, id love for you to be able to contact your local community Behavioral Health in areas where they have been fully funded, you can walk in the door and people are seeing immediately and within ten days and theres a bunch of things that. We have stayed coming and we are moving to get statesal engaged n the largest investment in current Mental Health funding for the country so step by step byby step this is part of the answer but both registries, will get you some care so it is a start. We will come back to that but i wanted to follow up on the issue providers because we just dont have enough providers so we know this and we worked on last year senator daines and i in the working group widened and i is a really important part, did a few things to do. We had graduate medical case and an half of those were psychiatrist but the first time designated this sub able to get medicaidor coverage and is loose ntin the they wanted to ask one thing weve introduced new social workers and improving access to Mental Health as it relates to medicare and being able to access social workers and Services Provided as well as compensating social workers so will provided and Mental Health as well and how could this help meet the demand . Social workers are critical and as i talked about how hard it is on providers and a chronic healthhr the position you have multiple providers in social work and help you with that ordination and provide treatment as mentioned in results of the doing that in the very important in health we know housing and Food Insecurity although things affect people. They can help people get connected and serve underserved communities who disproportionally are not able to access those h things and it affects health and Mental Health and theres integrated care in the provide services in his care and they have an Important Role to play in they need that number of care. A couple of things, and our discussion draft senator and i raise positions on this followingnd them to receive bons and focus on underserved areas. Any thoughts on netflix any comments you would have on what we need to be doing . Yes and yes. The short answer clearly having additionalti compensation and encouragement for people to join us in rural areas is phenomenally valuable. Le with regard to an ex issues, that these are phenomenal programs. Our challenge willow be aware to be out next year . When do you in network. Helping us understand what is what. I work now structurally the same, the same medicaid reimbursement. What we are seeing is there ofti together at the same site which is really the longterm goal. Thank you, mr. Chairman. I think w my colleague, et cetera is going to be next. Just so we are clear and defeated her with the panel for being here. I think i have two questions and i want to thank you and the whole panel for the viewing. As in many you know, so many of our legs support making investments to shore up the number of Mental Health last congress senator cassidy and i willhe enter the rate for Pediatric Health effects. Behavior to help integration. Also workforce developments infrastructure. To shirk testimony indicated, so many people do not have access andom the process of finding a mental provider canan be overwhelming for people suffering from Mental Health challengesal. Writer with affordable pricing and availability. I know you have covered this. Its especially hard with a list of countless errors in them. One constituent who reached out to my office was already acquainted with a top health she indicated you get calls from family and friends for that kind of help. My first question is how we Work Together to help people find the providers both availability as well as one accepts insurance. This is by way of regulation. Most of those are in network. That is the way you can expand them. We are providers thats easy for a family with a child they would be there to get the care in network. A wide way. Of course we need these directories to be accurate. Weight audits need to be using claimsg data. There are no claims are not seeing people. A Mental Health crisis for children inn particular turned out being patients, we know they are notcl network. Need to clear up the provider directory though people find care and askie integrated care s most families would love to go to their pediatrician get their care. See otherho question i have is w can we help people find a primary practices that this integrated Mental Health care such as practices that have Telehealth Partnership with Mental Health providers. This to be helpful when a primary carete prep has capacit. Thear barriers we see are often the rates at this point spirit input more financing into integrated care as well if you want to see it happen. Thanks i wheeled back my time. I think myee colleagues for e next three in order of appearance would be cardin, brown, bennetts. Those three are not here. It mean senator cassidy is next for thinking for being here. What seems like we have two issues here. One is a network link which could be false advertising. It is my experience is so typical, thank you for sharing it. It takes courage to do so but thank you for doing so. Second is accessed itself a false advertising and lack of access pretty set the tone of the questions if you will. Think i am struck by his women mike i have a physician. Speak to my colleagues back in psychiatry they wouldey say medicaid and medicare rates were so poor they got to pay the bills et cetera. They typically went to private insurance or cash pay. The reimbursement has been mentioned. The one thing that has not been mentioned in this is traditional medicare wishes not have a Provider Panel per se but access is equally poor for traditional medicare if you are speaking something such as Mental Health providers is not a fair statement . Lexi asserted his progress i asked myself a new literature review before him but they were not sure of their medical staff if you will access for medicare patients versusou traditional Medicare Survey were not roughly the same for your thoughts on llthat . I expect that the arts are. They challenge in so many situations really is administrative burden. Its the access, the management i think versus medicare plan traditional challenges for clerks that they are a challenge to increase the Provider Panel a better than it medicare rates to achieve that. That medicare done right addresses the market issue, correct . A trooper in supply and demand us but this was built on. I do not think that has applied appropriately to Insurance Plans. Part of the challenge for us is to come up with an appropriate strategy that trick psychiatrists have told me repeatedly i wish i could afford to be in the Insurance Plan and medicare in ma. But it cost me more to deliver progress i get that believe me. I hear that too. So im not disputing that. As you represented the entirety of healthcare, at least the positions of t it you can speako this. Theres a bit of a quandary. A doctor will say medicaid patient because her friend asked her if she will see the medicaid patient. We see medicaid but she is going to see this particular medicaid patient because her friend asked her too. And so she remains on the panel. D provider something along the lines theyre not seeing patients therefore they are not, network. Its not necessarily true bible c3 patients a month on medicaid because my friend whom ive known since are both in kindergarten together simply see this patient for me. Would you accept the as a valid occasionally occurs at least . Thank you doctor senator cassidy. I have such a pride in my colleagues on the front line around the country who are doing their best every day to take care of their communities and the patientss who present with the colleagues to call to refer the patient. You identified payment rates are the issue. As we have talked about two decades of stagnant rates we have the advantage of plants and some of our visitors so consolidated their paying less and medicare. Quickly asking this my wife is a retired general surgeon if they pay you below your cost you cannot make up onn volume. But to that point knowing there are people who are on the Provider Panel because i still have some patients who might see and i will occasionally see a newll patient under certain circumstances but it seems like the need to have a threshold to analyze this. Guess theyre open for new patients about how many new patients will they receive a year for this particular payment plan . We have to bring sophistication to this analysis as opposed to insurance claims are all bad for example, your thoughts on that . Inside panels who havent seen any patients that is fixable by the health plan. Small number when he turned to the physician is a difference between contracted. As with positions in multiple locations for the contracted at the response in case they go there but they do not to be listed on the directory date literate cover for a couple of years this is a lowow burn away for physicians to have input to be able to tell the plan when and if they want to appear on the directories based on whether they are accepting new patients on the planet. For seconds send me that low burden. If ama has a way to do to add sophistication to this analysis would like to hear of the front client provider will be conveninglp stakeholders to help you to that point provokes a project that in a yield. Thank you, mr. Chairman. Thank you to the panel, great discussions the opportunity to listen in my office to a lot of discussion this morning particularly the integrated model concept so appreciative of my colleague senator cornyn asking question serenity start obviously. Let me asksk you this out us alleviate the existing Workforce Shortage, what would it . It woulddo go a long way to helping and thank you for all of your work in this domain. The opportunity is this. If we partner psychiatrists list of appropriate support staff embedding into primary care, we think the people in primary care without them having to physically be seen by psychiatry. What psychiatrist for two or three hours a week to contribute a panel of between 40 and 60 patients to provide adequate support to the primary care team and give guidance and support them. Additionally something that was already addressed was workforce burnout. Keeping people in play. Keeping satisfied with their work. It is or elite frustrating not the old to refer someone to care if you are the primary care doctors you see someone who needs care. It is beyond your scope you cannot do it. The collaborative care model and other models allow primary care to do as they want to do. Thank you for it and comments regarding the issue. The preauthorization i had some talking about the concerns of this prior preauthorizationha requirement and how frustrating it can be. Thank you. Have about five minutes but want to talk about rural nevada which is similar to northern california. We ask you this. As with the primary care telehealth has proven to be a valuable tool for overall about in my state. Such a way to Access Health workforce. I can meet telehealth and expanded primary care loaded will not meet our workforce needs. L particularly our own communities in the long term. So in your view, how are contracting issues driving the supply problem in rural areas. How do you address that . I would agree with you despite the hearst uptick is enough to solve a supply problem. Great care physicians and im one of them a certain level of Mental Health they too were burning out your stopgap, measures expense across plants and purchasers and providers asic conditions including rates but not limited to rates thatdr really drives we have heard psychiatrists which are small percentage of the Mental Health providers. Woit cost too much to do it. I would bring back the thought of integrated care for me talk to a lot of integrated care medical and behavioral integration. Theres also an integrated care model where physicians and multiple specialties practice underwent organizational Structure Organization largest to provide telehealth and Data Analytics enlargement to essentially cover shortages to better contracting or better load management within then group. Eo that his heart in a rural area. They do not concentrate that way terms or practice. Document you have a question . And when will we look at the data most areas of this country of highly concentrated insurance markets. What are two plans cover the vast majority of patients in thatn area. In rural about a big urban centers theres not meaningful contracting. We have physician so big channel of patients in a letter says thanks very much we are done with you. Ports take or leave it contracts an increase in the lower and lower of medicare. It is not a level Playing Field between the physicians who want to be contracted to be will take care of the patient on health plan. Another panel of Healthcare Providers to be able to talk too. Look forward to the opportunity thank you. Thank you pretender brown will be next to britt understand whatever colleagues on the republican side us there are people who will wrap up books thank you, mr. Chairman. Saoirse provided so many people its more important than ever. Reliving through the pandemic its more important than ever people in my estate in oregon and idaho Mental Health is fundamental basic healthcare inc. s trying to for an appointment who does not exist or does not exist at this number and is a socalled s ghost. We agree we spend too much time trying to schedule doctor visits. For most people is far too getroubling and difficult problm shirt the doctor is not listening as a practicing medicine innt the place that we think that person is. Adoctors list arent taking patients sometimes for other doctors have retired or practicing altogether different location sometimes in a differentg, state. It is infuriating its also preventable. What should congress do to make ite easier to work with plans o make sure they have the right information . How would you feel and you only realize to be very trait this is thcomplicated. Things weve heard today is critical. Congress can pass a standard that everyone shares to reduce the inconsistencies and format and reporting time and sequence. The more we can have sequencing in an operator ability making it electronic. Making it as close to real time as possible. It would be in a normative benefit to everyone. I think some of the things he doctor mentioned in one form or fashion can be transformative for our nation if we have a standard. That would produce some of the challenges. Sharing the burden between the physicians and the Insurance Plans. We own responsibility of how many patients can we see . The strict structure and guide it would help all of us. Along those lines was continued down that path. First thank you for sharing your story to this committee. That always take guts to talk about personal stories in public and in congress. No one should have to fly across the country at her own expense because she cannot find a psychiatrist to treatt them. They went they need making sure patients are held harmless when they rely upon an incorrect insurance directly. Sadly patients must file an appeal no space to ensure that mesa air this approach in this appeals process just one more annoying time consuming it is kind of a hurdle ohioans and others should not the face when they get their treatment . The processes could be very difficult for people. We talk a lot about making sure people know their rights. Women talkdi about financial protection if you somebody in a directory. That should be really clear to you have a right to that reimbursement we need to make anthings clear to pay both these procedures wind up making it difficult for the person to the Insurance Company seem to bear the burden. Thank you. Warner is next. Were going to go in order of appearance. Bricks think it mr. Chairman i am sure others have already mentioned this but a happy birthday. Really do appreciate the fact youre holding these these hearings the issues around Mental Health burden we always it was a huge issue in a post covid world i dont know any familych including mine that is not has some challenges around Mental Health. I want to acknowledge or miss in virginia they got a lot of great towns there. Quickly im going to go to a question i want to break for moment something started in virginia way back in the 90s. Virginia Health Care Foundation and subsequent to that see how my dad was trying to take care of my mom and accept services. Called senior navigator. You can provide a directory issues were talking about on a realtime basis linking up services. That senioro Navigator Program revision to something called virginia navigator. It is now up to 9000 Service Providers who provide 26000 programs. We have taken a hightech high touch approach. Its one of things that makes me crazy. Thesezy Insurance Companies this is been the focus of the whole hearing i update these directories, and how we sure there is thehe navigator role rather than simply putting out a text site. I know you had some experience in this. How do we do a better job of hightech high touch approaches . We need to get the incentives right so people can access the services in a userfriendly way. I Financial Advice and i dont think its the tech or the touch that matters with the quality of the information in the willingness of the participants before it gets published. I know there are many ways to do that. But in our experience you have to get it right before you start pushing it back to the plan providers. That if the patient is experiencing a not taking a new patient when they said they were you can resolve those i think i wore on the one on one basis. The court probably 80 is wrong to begin with i dont know technology is going to solve that. I think navigators are great. The energy of the individual to hang in there better than the patient for the answer may be byes. Even if you get the information right the amount of time that information stays right is going to be short term. A brief guide to get the information rates. But youve got to make sure theres an update process and you can experience meet make sure the data is constantly updated . Oxley update pretty much weekly us at least every three months. Imagine if youre having every health plan in every large Provider Organization asked the same physicians over and over and over again. A lot of times theyll stop providing it. You have to frequently not quite real type closer to that to get it right. This interested in your testimony when you said theres a california protection law basically said if a plan does not provide the Mental Health services is almost a Consumer Protection law because it obligation. Is that in a good way to keep the plans a bit honest . Its a relatively new requirement. The idea is they have toen arrae then if they cannot find it they have to pay the outofnetwork charge for the person they found the provider they found. Like you are saying it takes the burden to get off the person. Shifts the burden to the plan. Again it has to be really clear on your directory they can provide this help to you. Otherwise people will not know about it. Its really important people know about it. Are they actually going to be able to get that kind of help . Exhibit it with the position it got to get the information right. But lord knows there plenty of userfriendly sites that invite a user in. G opaqueness. I think again their examples across the spectrum we can look cap for best practices. To appreciate the chair and vice chair holding this hearing. Thank you your big dick and heaven forbid logic should break out over this. The reason its important issue is theres been a miss representationon not something spells out what you talk about. Going to talk about it. Senator lankford . Thinking mr. Chairman happy birthday as well. Thank you for holding the hearing. Thank you for the testimony today its exceptionally important to get out of there. We all have casework staff to try to chase through things so here is wilbur this is really important is out we find ways stick ways to be able to process this. I want to try to drill down a little bit from the physician side of this. So, Insurance Plan reaches out since were looking to build poor networks together for next year if you want to be in network or out of network they said this is what were going to pay a flat out no we will not negotiate go throw the backandforth audit. Finally resolving her by the end of the summer they put their open season plan with a list of the providers on it. People select their plant based on who the providers are near them who their own position is there. The pick up the phone and start calling people. Is there a requirement for physicians at their plant to be in the plan for the next year . Or can a physician they generally come b with deborah, marsha said society dont really think this plant really locked gift company to company it may be different is their commitment on the physician cypress is going to be the three employees been for yourom question. A general physicians contract on annual basis. Varies by state and type of plan. Plans interpret people for no rentable defect with more information for. October and why the areas you got to be able to resolve is the commitment from the physician has been the planned winter it several times for several plans are from individuals who will say byy the time to drop that last year but they are still listed. Or i just changed and shift shifted over. Earl the players in that. The view talks thatt physicians and protocol the plan just like in your state have a price set singlees disconnected. Really difficult for the patient and for the docks. Thats the challenge the next layer youre dealing with this re current regulations. Adequate horses that followed as well. I do not want a singlewe constituent call and sent out who that is ranked testimony as powerful as i do not know is that person died, sir we do not take people anymore we havent been on it for years. That is not updating and doing their work. Through all the smiling semester is answer this . What standardization across the board that is a challenge for most plans or regulate outofstate basis and states have their own regulation what they do and dont want it starts with very, very detailed aligned standard. Integrate because are so many of them and thats the problem. We do with medicaid standards, cms standards medicare standards. State are state regulations this is Medicare Advantage of falls right into the city whats happening that sets the standard for that. Earlier while carrots and sticks. I completely agree transparency would be great. Carrots are very helpful but my fear isnt going to be walking on the backpack of carrots for another 10 years. We went to rot in my backpack. The plans are so consolidated. To look for stable full network when they dont. I think in the Medicare Advantage fish of jurisdiction in the space you have jurisdiction we need sticks we need monetary fines or big plans of big resources that have the capability responsibility to put up accurate. The sense of both the chairman was saying before when of calling ath secret shopper te calls or whatever process we do from a third Party Federal and find out these folks do not actually exist they can find to commit its requirement on them to be able to fill that bird. Right always would build background noise on a few inaccuracies. When 80 of the directory isca inaccurate big issue for us in rural t oklahoma is put out a pn every select safe lending into that planner generate find out its not real. In theey go anywhere earth are going to go into the going to have to drive 150 miles to get to someone they simply people is emotionally actually existed except in the process for the person who just voted today. Quick center you have given a snapshot of when this issue so important in Rural America and i appreciate it. Senator menendez is next. Excuse me. An inert white house is next very good things will be very brief i dont senator menendez has a lot to do and wanted to flag exactly the topic of the sin but its beenan extremely important visit rhode island to have had a mental access through, through telehealth. It is been extremely important with people in recovery to be able to talk to their. Recovery coaches to the people providing them treatment. I just wanted to take a moment to see a lot of heads nodding this is a good thing. We need to extend those telehealth protect. The information i have not only did come improve, compared to having to come into the Office Behind it but over for again i have heard from the professionals in the community that the quality of the engagement increase with telehealth. Human aspect of not having to drive someplace. Not having to wait in the waiting room for not having to fill out a clipboard, instead you got your quiet place in your own residence you click on in there you are. I wanted to make that pitch. I so wanted to try to make the point required networks and should ask in essence. Its part of a suite use. Developing our current Healthcare System claimant denial and delay payment to providers going to the Health Center and finding help they had more time staff are devoted to try to get paid that the princeton communityhe provided. Administrative costs from that and i think prior authorizations are a another vehicle frequently used by the insurer to invade and avoid payment for services that are pretty clearly required. What i would really like to have anyone interested to think of this response in writing. Consider this a question for the record. I think the way out of most of those problems is comprehensive payment reform. The more we get away from feeforservice, the less ability there is to deny and delay the payment for those services to shrink networks to impose a prior authorization restrictions that followup treatment. Continuing to work to get that done here. It provided ail good lead when they show it isea possible. I like to have your careful thoughts on that. This area reducing deadweight cost inverted the administrative warfare between insurers and providers likely to be alleviated by payment reform. Orbs are likely to alleviate it most . With that i yield back senator menendez i guess classwork im not sure who is first. Right right up the line. First i want to thank you all for your testimony. What one other dimension to these ghostly networks. My colleagues have heard me talk frequently the tragedy in dental care losing his life in 2007 a 12yearold because he could not get access to dental care. Oai know our focus here is on a broad range of services. Particularly Mental Health services. Many consuming factors. One was his mount really could not find a dentist who would treat him. There is not an accurate directory available that could provide guidance you can find a dentist who will be willing to provide services. When i want to underscore is that this topic is critically important for care throughout our country but particularly in underserved communities. They need help up we do not have accurate directories that they have a lister thats not accurae numbers for the provider is not taking any new patients may be somewhat redlined that makes it even more challenging. I really wanted to add that into the record and i thank you all for your participation. But as we look at issues and of the less not lose sight its not equal throughout the country underserved are the most with that meal back. Thank you very much. The problem of Ghost Networks is harmful and Mental Health. Arguably itio made worse in rect years amid the nations ongoing Mental Health crisis a pandemic and beyond those in desperate help continue to get ghost in. The reality is there just areal not enough providers. I was proud to secure my colleagues on the committee 100 new graduate slots reserve for psychiatry last years consolidated appropriations act. Last week i reintroduced my resident physician shortage reduction act alongside receiver positions by additional 14000 which you agree increasing graduate positions would complement efforts to improve provider directory Mental Health access . Et ceterame cannot think what traditional slots for psychiatry every little bit helps. The larger active absolute necessaries we face an aging population would need more physicians for this country. So thank you. Thank you. For children in care once the data by the psychological dassociation only 4000 of more than 100,000 u. S. And clinical psychiatrist and adolescent clinicians one can congress do to specifically address the Workforce Shortage of child and adolescent Mental Health clinicians . You and your colleagues has started has been wonderful. Probably about the needs of healthcare in this society. And so training, the Community College level for the college level. Getting people in the pipeline for allied Health Health workers. As well as psychologists andsi physicians need to think broadly need to provide adequate care for many physicians can be trained in a more timely way in any of the ability they have two provide care whether through social work or others can make a profound difference can really expand and leverage the care only physicians can provide thank you. A mountain for moment you are so many love is in the midst of it Mental Health crisis. You call 70 plusst doctors listd here Insurance Plans network. Not one is available for an appointment within twoon months. Most never call youre back. Some are retired. Others are deceased. Some bullets are disconnected reality for far too many people seeking Mental Health services in new jersey and across the country. It is critical people seeking Mental Health services have access to accurate uptodate provider directories. This outdated information hurts people when they are desperate to get help regulators used to hold those responsible for providing a list of accounts . Highlight how cms can better enforce regulation and oversight of provider directors . We could have audits of these plans. For the Behavioral Health network this audits could be done transparency results about make sure its included get incentivized to make those changes but we talked about monetary penalty which currently do not exist. That is another way to have to beat sufficient to affect behavior but those are an array of choices that could make a difference if they were combined together. Finally, we have to address the challenges of Ghost Networks but we also must prioritize policy that support low income and marginalizedd populations. Last week hhs released brose access and quality standards for medicaid among other things his proposals require states to conduct secret shopper surveys of medicaid and chip managedcare plans to verify compliance with appointment wait timeme standards to identify whe provider directories are in accurate. How would these requirements mitigate impact Ghost Networks for low income communities . Thank you very much for asking that question. I think anything that can help especially people in low income communitiesne be able to get the Accurate Information need to get the care when, where, how they critical. Going to be i also added being able to empower the consumer. I actually like evernote our community some people dont like it. The reason i like it is in think of jon f. Kennedys Consumer Rights built into it he talked about in 1962 about the consumers rates to be heard. The consumers rights to that information to make a choice and lastlyly the added to address te things you are talking about give us those rights but especially for Something Like a 1800 Number Online portal to report when we are not able to get our needs met because of the Ghost Network. We want to inform we want to be the power to inform into the carrots for the six can happen so thank you. Quick thinking richer insights. Act on behalf of the chairman senator blackburn for. Thank you so much. Thank you to eat to be for being here. Thank you for sharing your story appreciate hearing. No we are talk about Medicare Advantage. But senator blumenthal and i have been busyy today and its ongoing safety act. Is i was listening to your testimony, i thought how closely it mirrors what i hear not only from loans and parents but the teenss them selves. I hear from the psychiatrist and psychologist. From principles that there is not enough access. And there seems to be complete confusion when you call the Insurance Company and state we are desperate for help i have my child, we are here at the emergency room. We are not getting any answers. It is just so imperative we look holistically at the system. I appreciate hearing from you on this h issue. Let me come to you because telehealth is something even when i was in the house work on 21st century towards eyeds not going telehealth bill in there but we got it across the line during covid. During covid people really began to use telehealth. When you hear from providers, especially down in shelby county, memphis that area for your doing with mississippi, arkansas and of course the med is there in memphis. They talk a lot about interstate licensure requirements. Just very briefly would you talk to me a minute you are hearing from providers when it comes to the licensure issue . It also what youre hearing about the Digital Therapeutics and their utilization. My dad grew up in clarksville, this is a bit of the memphis area well even though im now californian. Im always reluctant to suture bright spot about anything in the pandemic but telehealth clearly opening up coverage with its medicare or commercial ensures a huge and bright spot your leadership in that area. We have seen not only patients learn how to use it well and discover what it can be seen physicians in several specialty how to use it seamlessly into her care plan sometimes patients seem to be seen in person and now we know about when those instances are and when they are not. You mentionedos licensure. We still believe in maintaining state licensure who believes in that place with a patient is for the reason we believe and that is because if i am taking care of a patient in florida i believe i have a responsibility to follow floridas rules that patient needs to be able to go to the state insurance commissioner if i provide lousy care to seek redress for it we cool stuff going on to aid people doing telehealth in multiple states we have medical licensurey compact makes it much easier for many physicians to click off several states they licensed in and agreed to follow those rules. Is that a reciprocity model . What does not. Reciprocity but is not the nursing reciprocity model individualal states to maintain the ability to police what happens inn their state and take your license away. But it makes it much easier to get multiple licenses for the other thing is facing the medical boards agree unanimously and actually has to be implement on the unreasonable exceptions. If im taking care of a patient take off to college and happen to be on this date or vacationing or spending three material arizona is notot practicing across state lines they have establishedt within Buddhist Center of excellence was to do when previsit telehealth that should be okay. But we doing to to protect patients for local care. Next you want to weigh in on this . Either of you . Go ahead. Ill has been transformative. Were nodding your head i thought you meant avila something to say. Lexi continuing availability particularly in rural areas is extraordinarily valuable. But also itan urban areas it may take people to hours to take three buses to get to us. And by themo way i trained at te Elvis Pressley Memorial Trauma Center in memphis. God bless you. See that in your head. This does glenn hear of the College Students we hear that all the time about College Student so provider than this access to it. It really needs to be thought through particular for mentall health. The issues of the state i dont understand my we cannot get more reciprocity. More ability to go across state lines with Mental Health care it is very problematic. I was increasing access as we got to do. Thank you madam chairman. Thank you. America is facing a Mental Health crisis. One in five americans live with a Mental Illness. For Medicare Beneficiaries its one in four. Federal law requires an medicare to cover Mental Health services in both traditional medicare and Medicare Advantage. A program that most private Insurance Companies to offer medicare coverage. Now, unlike traditional medicare the private m insurance companis and it Medicare Advantage can establish networks to restrict the doctors or facility beneficiaries can use it with your doctor is in networking plan will cover the services for a small copay out of neck work doctoris cant leave doc patiens with skyrocketing costs this can be especially devastating for seniors or people with disabilities were more likely to be living on fixed incomes. To help beneficiaries avoid the suppressed costs in as plan to require to publish directories which enrollees can used to find new doctors or make sure their existing doctors are covered. So, lets start with what we know about the accuracy of these directories for there have been some references to them. Say it right . What do we know about the accuracy of the provider directories and Medicare Advantage . Cms assistance of audits, senator. What they found was on average the accuracy rate was about 45 sprinkler design in the accuracy rate is 45 cost requested in 2018 almost 50 one in accuracy. A good build in accuracies thats physical health care theres a gap in data because they have not done this for Behavioral Health. What might we surmise Behavioral Health always worse its always worse. So you think you have a list of people and go to the odds are actually in favor the list is wrong and probably even worse on Behavioral Health. Rights of here weve got a patient who does everything right. They still may be hit with a huge rectory has outdated or inaccuratein information. They might call up every dr. Only to find that weve heard some phone numbers dont work, theyre not acceptingen nw patients. We have heard the story aboutry this and appreciate you being here to talk about your story. You dont have any plans use all kinds of tricks and traps to squeeze more money out of medicare theyve got a lot of different ways they do this to boost their numbers. Heres the one i want to focus on. These plans stand to gain any make it Accurate Information. In other words is it accurate because youve not spent enough money to make it accurate . Or is it an accurate by design . Are advantages that they have on the directories are inaccurate. They use those directories for Network Adequacy standards for example they might meet the standards but they are not accurate. People make choices based on what they see as their network. So if it looks like a Bigger Network is not real people are choosing aud plan. Consumers to see and this really you could go to if you had a problem it turns out the really big soliciting work accurate is this little tiny list when we it is to the advantage of Medicare Advantage plan. In order to be an accurate. Thank make more money by being inaccurate. Inch of another one . Click 60 of the plants do not have outofnetwork coverage. If you get really frustrated and get on your own theyre notot paying anything. The more i can frustrate you i Medicare Advantage plan can frustrate the more you will just note or else and that means is not many of their pockets. Can be gifted to maidens . Suspend the senator, yes. We see this all of the time. This is health plans delaying and denying care. E that same patient with and finally find the needle in the hague haystack into a physician and network to sit down and then goes to the pharmacy discovers the health plan has prior for the treatment for that condition which then it takes weeks to get approved sometimes in every back to the farmers, they give up their health or other chronic condition get worse things you have to pay for the treatment the Medicare Advantage plan. N saying hereally is its in the financial interests of the Medicare Advantage plans to discourage beneficiaries from accessing care. We also dont Medicare Advantage plans are paid a set amount per beneficiary which can be dialed up if the beneficiary is sicker. The word diagnosis codes for charging taxpayers bike hundreds of billions of dollars. Here is the key that underlines this. Whatever insurers do not spent on care as a result of tactics overly restrictive networks or in Accurate Information, whatever they and on care they get to keep. Let me ask you one last question on this. What penalties you plans of face for being out of compliance Network Adequacy. Got a bunch of rules when they are in violation of the rules whats the consequence . Courts are not aware of anyle penalties senator warning letters they dont anything abou penalties for the habit legislative proposals that effective just not aware of any penalties being assessed. Noticed jumping in with any other answer. This is the part that drives me crazy but people look at the regulations we are going to be okay. We are not okay if theres no enforcement to the extent they have enforcement really needs to step up. Minimum, beneficiaries should not be on the hook for outofnetwork cost incurred because of an accurateng directories. Toby and i starting place on this. Cms should penalize plans out of compliance. Just put penalties on these guys. Its congresses job to put in place. I also want to say this at this medic just plans continue to mislead and beneficiaries about covered providers at the same time they are overcharging taxpayers for this crummy coverage, we should be taking another look at whether or not plans should continue to enjoy the privilege of restricting Provider Networks they cant get better at managing the restrictive networks that may be the path toat have to cover any web who is a licensed practitioner. Without say i am finished. Ill put on the half of the chair and say without objection is to bid the majority staff report into the record. Anybody objects . No. The centers i wanted from today just in ites the record for thoe will be due 5 00 p. M. In this series below. Uncooperative. [inaudible conversations] [inaudible conversations] [inaudible conversations] tonight testified for the acting director of the anti age and other officials on the president s 2024 budget request for Senate Appropriations subcommittee at 8 00 p. M. Eastern on cspan2 burn you can also watch out our free mobile video at cspan now or onsite at cspan. Org. This returns to state for legislative business and boats. The house and gaveled back in at noon eastern. Laterawkers will consider the republicans f the security bill. Off t floors house and Senate Leaders are scabs with binding tuesday at the white hou t talk about that limit. These three key a eastern