Reimbursement of mental health services in primary care settings

Mauch, Danna; Kautz, Cori; Smith, Shelagh A.

doi:10.1037/e476472008-001

Cited by 30 publications

(30 citation statements)

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“…The fee-for-service (FFS) model is the predominant provider payment system for individuals with mental disorders. 13 Table 1 provides examples of billing codes [14][15][16][17][19][20][21][22][23] under the current FFS system that could potentially be used to reimburse CCM components; notably, selfmanagement, care management, and measurement-based care. However, current FFS codes are inadequate for reimbursing providers for the integration of guidelinebased behavioral health specialist consultation, a core CCM component.…”

Section: Limitations Of Current Reimbursement Strategies For Ccm Compmentioning

confidence: 99%

Overcoming Roadblocks: Current and Emerging Reimbursement Strategies for Integrated Mental Health Services in Primary Care

2013

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The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.

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Section: Limitations Of Current Reimbursement Strategies For Ccm Compmentioning

confidence: 99%

Overcoming Roadblocks: Current and Emerging Reimbursement Strategies for Integrated Mental Health Services in Primary Care

2013

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“…SAMHSA has stated that integrating primary care and mental health services provides a valuable opportunity to improve access to mental health services (Mauch, Kautz, & Smith, 2008). In addition, HRSA has called upon rural health providers to develop and implement behavioral health initiatives as Medicaid providers to increase access and utilization of mental health services (National Association of State Medicaid Directors [NASMD], 2008), and the NASMD has strongly backed integrated care, stating that ''providing behavioral health services in primary care settings may facilitate the provision of preventive and early intervention services, primarily as a result of close proximity and the development of working relationships between primary care and behavioral health providers'' (p. 3).…”

Section: Integrating Primary Care and Mental Health Carementioning

confidence: 99%

Rural mental health and psychological treatment: a review for practitioners

et al. 2010

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Practitioners in rural areas face particular challenges in providing psychological services, ranging from disparate rates of mental disorders to unique circumstances in treating special populations. In this article, we discuss the burden of mental disorders in rural areas, current trends in integration of mental health care and primary care, and unique concerns practitioners face in treating two special populations in rural areas (children and families, and older adults and their caregivers). Implications for practice are also discussed.

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“…The final report contains recommendations regarding reimbursement policy clarification, government and stakeholder collaboration, education and technical assistance, and provision of additional services. 55 This work needs to happen simultaneously and at multiple levels. At a federal level, there needs to be support for billing key service components such as screening, care management and psychiatric consultation under Medicare, and clarification for the states regarding what they may do under Medicaid.…”

Section: Financingmentioning

confidence: 99%

Mind and Body Reunited: Improving Care at the Behavioral and Primary Healthcare Interface

Mauer¹,

Druss

2009

J Behav Health Serv Res

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This paper reviews current models, research, and approaches to improving care on the primary care/behavioral health interface in the USA. We focus on care in the public sector where high rates of comorbidity, regulatory burdens, and lack of resources create particular challenges to collaboration and coordination. To achieve the goals of improved coordination and collaboration, it will be critical to address key financing, workforce, information technology, performance assessment, and research issues. It will also be critical to engage multiple stakeholders including consumers, mental health and health providers, and policymakers and public sector funders.

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Reimbursement of mental health services in primary care settings

Cited by 30 publications

References 0 publications

Overcoming Roadblocks: Current and Emerging Reimbursement Strategies for Integrated Mental Health Services in Primary Care

Overcoming Roadblocks: Current and Emerging Reimbursement Strategies for Integrated Mental Health Services in Primary Care

Rural mental health and psychological treatment: a review for practitioners

Mind and Body Reunited: Improving Care at the Behavioral and Primary Healthcare Interface

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