Encourage Collaborative Care Model implementation
Recommendation
The Centers for Medicare and Medicaid Services (CMS) should provide detailed guidance to states on implementing the CoCM in Medicaid[1] and ensure universal access to CoCM billing codes, including technical support to practices.[2] CMS should establish enhanced reimbursement rates for the existing behavioral health integration (BHI) and CoCM G-codes (G0502, G0503, G0504, G0507) to increase the use of integrated care, which generates a strong return on investment and successful outcomes.[3]
Background/summary
In 2017, the Centers for Medicare and Medicaid Services (CMS) began paying physicians and non-physician practitioners separately for supplying patients with Behavioral Health Integrated Services (BHI).[4] These services involve a closer partnership between treating physicians and mental health and substance use disorder (MH/SUD) professionals, which has proven beneficial to patients and has evolved into the Collaborative Care Model (CoCM). This model has been demonstrated effective by more than 90 randomized-controlled trials and can help to more effectively utilize limited MH/SUD provider capacity.[5]
Critical infrastructure is required to effectively implement BHI/CoCM services.[4] When properly incentivized, BHI/CoCM approaches to care have a demonstrated potential to improve care for individuals with MH/SUD. CMS uses G-codes to assess and address functional limitations in patients, including difficulty seeing, hearing, mobility, communication, cognition, and self-care.[6][7] These billing codes include approvals for reimbursement of services using CoCM approaches, but reimbursement levels have been insufficient to scale adoption more broadly.[3] Insufficient compensation for training and technical support has effectively contributed to continued payment silos between MH/SUD care and primary care.[1]
citations
1. Bipartisan Policy Center. Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration. Last Updated March 2021.
2. CEO Alliance for Mental Health. A Unified Vision for Transforming Mental Health and Substance Use Care. Last Accessed August 2022.
3. The Kennedy Forum. Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combatting Drug Addiction and the Opioid Crisis. October 2017.
4. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Behavioral Health Integration Services. Last Updated March 2021.
5. The University of Washington AIMS Center. Collaborative care. (n.d.)
6. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Functional Reporting. Last Updated December 2021.
7. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Functional Limitations. Last Updated June 26, 2023.