CMS Announces New Behavioral Health Model

States will soon be able to apply to participate in a new initiative intended to bridge the care gap between physical health needs and behavioral health needs. On Jan. 18, the Centers for Medicare and Medicaid Services (CMS) announced the launch of the Innovation in Behavioral Health (IBH) model.

Why It’s Needed

The goal of the model is to improve behavioral and physical health outcomes for Medicare and Medicaid beneficiaries with moderate-to-severe mental health conditions or substance use disorder. Nearly a quarter of Medicare beneficiaries experience mental illness, while 40% of all adults enrolled in Medicaid experience mental illness or substance use disorder. These populations are more likely to have frequent emergency room visits and hospitalizations, experience poor health outcomes, and have increased risk of premature death, according to CMS.

Studies have also identified racial and ethnic disparities in behavioral health and substance abuse treatment access, including less access to mental health providers and less use of medications to treat such conditions among certain racial and ethnic minorities compared with White patients. Geographic disparities also represent a key challenge, with individuals residing in rural areas less likely to receive treatment and less likely to have access to providers with specialized behavioral health training compared to those residing in metropolitan areas.

Key Components

IBH is a state-based model that will be led by state Medicaid agencies, focusing on community-based behavioral health practices that provide care to both Medicaid and Medicare beneficiaries.  The IBH model seeks to support behavioral health practices in coordinating care across different types of providers to address beneficiaries’ behavioral and physical health and health-related social needs. It also aims to reduce emergency room utilization while improving physical and behavioral health outcomes.

The model is centered on four key pillars:

• Care integration. Participating behavioral health practices will screen, assess, refer, and treat patients, as needed, for the services they require.
• Care management. Interprofessional care teams, each led by a participating behavioral health practice, will identify, and as appropriate address, the multi-faceted needs of patients and provide ongoing care management.
• Health equity. Participating behavioral health practices will conduct screenings for health-related social needs and refer patients to appropriate community-based services. Each practice will also develop a health equity plan to describe how it will address disparities that impact the populations it serves.
• Health information technology. Expansion of technology to improve the quality of reporting and data sharing.

The IBH model will launch in the fall and may be awarded to up to eight states for up to eight years. States will build capacity and recruit practices during years one through three and implement a Medicaid payment model that incentivizes the delivery of integrated care in years four through eight. States will also have the option to participate in a Medicare payment model during the implementation phase. The application for the model will be released this spring.