CMS announces new model to address the national behavioral care gap
Behavioral health conditions significantly impact the Medicare and Medicaid populations, with 25% of people with Medicare experiencing mental illness, and 40% of adult people with Medicaid experiencing mental illness or substance use disorder, according to the Centers for Medicare and Medicaid Services (CMS). High costs for care, lack of access to quality behavioral health treatment, and fragmented care systems often make it difficult for individuals to receive the proper behavioral care that they need. According to CMS, this is especially true for historically marginalized racial and ethnic groups, low-income populations, and individuals living in rural areas.
The U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services (CMS), is announcing a new model to address the national behavioral care gap, called The Innovation in Behavioral Health (IBH) model. The IBH model is a new approach to improve behavioral and physical healthcare services for individuals with Medicaid and Medicare. The goal of the IBH model is to improve overall quality of care and outcomes for adults with mental health conditions and/or substance use disorders.
The IBH model will connect individuals with the physical, behavioral, and social support to address their healthcare. Through interprofessional care teams, patients will have service integration that aims to bridge the gap between their physical and behavioral care needs. Regardless of how patients enter care, they will have access to all available CMS services, referred to as a “no wrong door” approach.
Practice participants in the redesigned IBH model will be Community Mental Health Centers, public and private practices, opioid treatment programs, and safety net providers that provide outpatient mental health and SUD services. The model’s goal is to integrate each practice along the process of screening, assessing, and coordinating individuals’ physical and mental health needs. Care integration will include person-centered treatment and planning of behavioral conditions, monitoring of conditions, and care plan adjustments, according to CMS.
The IBH model will equip participating practices with the resources needed to collaborate care, such as through infrastructure payments in support of health center’s IT capacity, technical resources, and value-based payment models, coordinated through CMS.
The new IBH model builds on earlier CMS efforts to include behavioral health practices in health programming. The IBH model is based on the lessons learned from Innovation Center models including the Maternal Opioid Misuse Model, Integrated Care for Kids Model, and the Value in Opioid Use Disorder Treatment Demonstration.
The IBH model is planned to begin in Fall of 2024 and will operate for eight years in up to eight states. A Notice of Funding Opportunity, with further information on the model’s financial plan, will be released in Spring 2024 prior to the model launch.