The Centers for Medicare & Medicaid Services introduced the Innovation in Behavioral Health Model (IBH), a novel strategy aimed at enhancing outcomes for adults dealing with mental health and drug use problems.

What the New Model Entails

The model is set to launch this fall. Here are some facts about it:

  • It aims to guide adults covered by Medicare and Medicaid toward the essential physical, psychological, and social support they require, as outlined in a press release. 
  • Within the Innovation in Behavioral Health Model, community-based practices will establish care teams comprising both behavioral and physical health providers. 
  • The initiative adopts a “no wrong door” approach, ensuring individuals can access all necessary services, regardless of their initial point of contact for care. 
  • The program includes screenings, assessments, and referrals to additional services.

The enrollment period for practice participants commences this year, with the implementation phase scheduled between 2027 and 2032, as outlined in a fact sheet (PDF) shared by CMS. At present, the states slated to participate have not been finalized.

Likening the model to reverse integration, Liz Fowler, CMS Deputy Administrator, explained, “Typically, behavioral health is shoehorned into primary care settings. Since this is a community-based effort, the model calls for “weaving” physical health needs into behavioral health organizations.”

Andrea Palm, the Deputy Secretary of HHS, underscored the agency’s prior initiatives, including workforce recruitment of primary care providers, narrowing the technology gap among providers, and aligning primary care with behavioral health. Officials highlighted that the newly introduced model is state-based and overseen by Medicaid agencies.

In a press release, CMS Administrator Chiquita Brooks-LaSure expressed that through the model, CMS would support behavioral health practices in delivering integrated care and addressing individuals’ behavioral, health and social needs encompassing transport, food and housing.

CMS expects that the model will lead to a reduction in overall program expenditures while simultaneously enhancing the development of health IT capacity via infrastructure payments.

It is reported by KFF that around 25% of individuals covered by Medicare face mental illness, and 40% of those covered by Medicaid grapple with mental illness or substance use disorder. Officials from CMS argue that fragmented care and elevated out-of-pocket expenses have adverse effects on enrollees, especially those situated in rural areas, low-income communities, or belonging to marginalized groups.

IBH is set to undergo testing by the Center for Medicare and Medicaid Innovation, with a projected duration of up to eight years and potential implementation in as many as eight states. States presently engaged in CMS-administered programs are eligible to partake in IBH.

Entities interested in participating in the IBH initiative must qualify as community-based groups or safety net givers. Eligibility criteria include state licensure for delivering behavioral health services, compliance with Medicaid provider enrollment prerequisites, eligibility for Medicaid reimbursement, and the provision of outpatient mental health or substance use therapy services to Medicaid beneficiaries.

On the same note, CMS Deputy Administrator Meena Seshamani, M.D., underscored a proposal to mandate Medicare Advantage plans to incorporate a sufficient number of in-network behavioral health practitioners. This proposal aims to enhance behavioral health outcomes nationwide.

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