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CMS Launches New Program for Mental Health, OUD Treatment

Analysis  |  By Eric Wicklund  
   December 19, 2024

The 8-year Innovation in Behavioral Health (IBH) Model focuses on care integration and coordination, alongside screening for health inequities, to bridge behavioral and primary care services.

Federal officials have launched a new behavioral health program aimed at creating care management programs for Medicare and Medicaid patients dealing with severe mental health conditions and substance abuse disorder (SUD).

The Centers for Medicare & Medicaid Services (CMS) Innovation in Behavioral Health (IBH) Model seeks to bridge the gap between behavioral health and primary care by enabling specialty behavioral health practices, including community mental health centers, opioid treatment programs and private or public practices, to create interprofessional care teams to coordinate care.

The goal of the new program is to improve care and outcomes for the estimated 25% of all Medicare patients experiencing mental illness and the 40% of Medicaid patients dealing with a mental illness or SUD. Those patients often face barriers accessing care, resulting in poor health outcomes, and either don’t get care or wind up in emergency rooms.

The eight-year program will be launched through state Medicaid agencies in Michigan, New York, Oklahoma and South Carolina.

“Specialty behavioral health practices will be responsible for conducting screenings and assessments of behavioral and physical health, and health-related social needs, offering treatment as appropriate within their scope of practice, providing closed-loop referrals to other primary care providers, specialists, and community-based resources, and monitoring ongoing conditions,” CMS said in its announcement. “Since people with moderate to severe behavioral health conditions frequently visit behavioral health settings, this approach uses the behavioral health setting as a point of entry to identify and secure further care and facilitate close collaboration with primary and specialty care providers.”

While the practices will be developing care integration and care management strategies, they’ll also target health inequities through screenings for social determinants of health (SDOH).

“Practice participants are required to create a health equity plan (HEP) using a needs assessment of the population they serve,” CMS said. “The HEP should detail steps that practice participants will take to address the population needs and stipulate how the practice participant will address disparities that disproportionately impact their service populations.”

Additionally, the IBH Model will require practice participants to annually screen and monitor patients for underlying and/or unmet health-related social needs and make necessary referrals to other health care providers or local safety-net services,” the agency continued. “The required care management component will help ensure that eligible individuals receive the services needed to address their health-related social needs.”

They’ll also be supported with targeted investments in health information technology to improve quality reporting and data sharing.

Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.


KEY TAKEAWAYS

One quarter of all Medicare patients and 40% of Medicaid patients are dealing with a mental health issue and/or opioid use disorder (OUD), and many face barriers accessing the care they need.

CMS’ new 8-year program, to be launched in 4 states, aims to create a care management plan around those patients.

The program will empower specialty behavioral care providers to develop and manage the care through interprofessional teams.


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