New model aims to improve quality of care, access and outcomes for people with mental health issues and substance use disorders in Medicaid and Medicare
Today, the U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services (CMS), announced a new model for testing ways to address people’s behavioral and physical health and health-related social needs with Medicaid and Medicare . The goal of the Innovations in Behavioral Health (IBH) model is to improve the overall quality of care and outcomes for adults with mental health issues and/or substance use disorders by connecting them with the physical, behavioral and social supports they need to manage their care. The model will also promote health IT capacity building through infrastructure payments and other activities.
The IBH model will be tested by the Center for Medicare & Medicaid Innovation (CMS Innovation Center). According to IBH, community-based behavioral health practices will form interprofessional care teams composed of behavioral and physical health providers as well as community-based supports. This new model supports the President’s mental health strategy and implements the BH Integrated Action Items in the HHS Roadmap.
“I’m proud of all the work we’re doing to improve how mental health is treated in this country. This new behavioral health model released today will help states advance that goal, consistent with the President’s Unified Agenda priorities to address the mental health crisis ,” said U.S. Department of Health and Human Services Secretary Xavier Becerra. “The Biden-Harris Administration will continue to explore innovative ways to help people living with mental health issues and/or substance use disorders. Simply put, mental health is health — by expanding access to the high-quality care people need , we are changing lives.”
Through interprofessional care teams, people will experience integrated services that bridge the gap between physical health and behavioral health. The model enables a “no wrong door” approach, meaning patients have access to all available services regardless of how they enter care. Through this approach, IBH also aims to reduce overall program expenditures.
“The Biden-Harris Administration believes that treating mental health and substance use disorders requires a ‘no wrong door’ approach. This new model ensures that anyone can get the services they need, regardless of how they enter a care facility,” Andrea Palm, deputy secretary of the U.S. Department of Health and Human Services, said. “We will continue to test ways to close the gap between behavioral health and physical health treatment. Our goal has always been to improve the overall quality of care and outcomes for our patients, and this model brings us one step closer.”
“Addressing the nation’s behavioral health crisis remains a top priority for CMS,” said CMS Administrator Chiquita Brooks-LaSure. “Through this model, CMS will support behavioral health practices that provide comprehensive care that helps address people’s behavioral and physical health as well as health-related social needs such as housing, food and transportation, all of which have an impact on a person’s ability to manage themselves Have a negative impact. Care.”
“The IBH model will help improve the quality of care and health outcomes for people with moderate to severe behavioral health problems,” said HHS Assistant Secretary for Mental Health and Substance Use, Substance Abuse and Mental Health Services Administration (SAMHSA) said the man. , Dr. Miriam E. Delphin-Rittmon. “Additionally, this model will enhance behavioral health system infrastructure and the staffing that supports it.”
The impact of behavioral health conditions on the Medicare and Medicaid populations is significant, with 25% of Medicare enrollees living with a mental illness and 40% of Medicaid adults living with a mental illness or substance use disorder (SUD). High out-of-pocket costs, a lack of high-quality behavioral health treatment in some areas, and an often fragmented care system can make it difficult for people to get the care they need. This is especially true for historically marginalized racial and ethnic groups, low-income populations, and individuals living in rural areas.
“Systems of care that address physical and behavioral health issues have historically been siled, but there is a direct correlation between people living with mental health issues or substance use disorders and poor physical health,” said Liz Fowler, CMS deputy administrator and director of the Center for Innovation. sex.” “This model will bring together historically siled parts of the health system to deliver whole-person care – designed to keep people out of the emergency room, ensure better care management and coordination, and improve their overall health. .”
Practice participants in the IBH model will be community-based behavioral health organizations and providers, including community mental health centers, public or private clinics, opioid treatment programs, and safety net providers where individuals can receive outpatient mental health and SUD services. This model will incentivize these practice participants to collaboratively screen, assess, and coordinate an individual’s physical and behavioral health needs. Practice participants will be equipped with the necessary resources to promote integrated care, including infrastructure payments to support health information technology capacity building, electronic health records, and practice transformation; technical assistance; and a predictable value-based payment model.
The IBH model builds on the Innovation Center’s earlier efforts to integrate community-based behavioral health practices, including mental health providers and substance use disorder providers, into value-based care. The IBH model builds on lessons learned from previous Innovation Center models, such as the Maternal Opioid Abuse Model, the Comprehensive Care Model for Children, and the Value of Opioid Use Disorder Treatment Demonstrations.
The model will be launched in the fall of 2024 and is expected to operate in up to eight states for eight years. CMS will publish a notice of funding opportunities for this model in spring 2024.
Please visit the IBH Model webpage for more information: https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model
For frequently asked questions about innovation in behavioral health models, please visit: https://www.cms.gov/ibh-model-frequently-asked-questions
A fact sheet for the model is available at: https://www.cms.gov/files/document/ibh-fact-sheet.pdf
View a fact sheet on HHS Behavioral Health Integration Roadmap achievements to date: https://www.hhs.gov/about/news/2024/01/18/hhs-roadmap-for-behavioral-health-integration-factsheet -accomplishments.html
 In 2020, nearly 40% of the nonelderly Medicaid population had a mental health condition or SUD.
Source: https://www.kff.org/mental-health/issue-brief/medicaid-coverage-of-behavioral-health-services-in-2022-findings-from-a-survey-of-state-medicaid -program/#:~:text=Medicaid%20plays%20a%20key%20role,disorder%20(SUD)%20in%202020; About a quarter of Medicare beneficiaries have a mental illness (31% in traditional Medicare , 28% in Medicare Advantage plans)
Source: https://www.commonwealthfund.org/publications/explainer/2023/mar/medicare-mental-health-coverage-included-changed-gaps-remain#:~:text=How%20prevalent%20are%20mental% 20health, go to%2050%20%20 to receive%20 treatment