Uptake of Medicare Behavioral Health Integration Billing Codes in 2017 and 2018

Brown, J.; Urato, Carol; Ogbuefi, Precious

doi:10.1007/s11606-020-06232-z

Cited by 7 publications

(8 citation statements)

References 4 publications

(4 reference statements)

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“…Despite codes being available since 2017, this study substantiates that the CoCM/BHI codes are not being used to the extent intended to increase access to this model (Brown et al, 2021;Copeland et al, 2022;Raney, 2020). Many administrators in this study were unaware of the codes that could be used.…”

Section: Discussionmentioning

confidence: 59%

Examining the use of psychiatric collaborative care and behavioral health integration codes at federally qualified health centers: A mixed-methods study.

Lombardi,

Greeno,

de Saxe Zerden

2023

Families, Systems, & Health

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Introduction: Despite evidence to support the integration of behavioral health and physical health care, the adoption of Integrated Behavioral Health (IBH) has been stymied by a lack of reliable and sustainable financing mechanisms. This study aimed to provide information on the use of Psychiatric Collaborative Care Model (CoCM) and behavioral health integration (BHI) codes and the implementation of IBH in federally qualified health centers (FQHCs). Method: This cross-sectional, mixed-methods study involved an electronic survey of administrators and follow-up qualitative interviews from a subset of survey respondents. Quantitative data were analyzed using descriptive analysis and thematic coding was used to analyze qualitative data to identify salient themes. Results: Administrators (N = 52) from 11 states completed the survey. Use of CoCM (13%) or BHI codes (17.4%) was low. Most administrators were not aware that CoCM (72%) or BHI codes (70%) existed. Qualitative interviews (n = 9) described barriers that further complicate IBH and code use like workforce shortages and insufficient reimbursement for the cost to deliver CoCM services. Discussion: Although FQHCs are working to meet the needs of the communities they serve, a lack of billing clarity and awareness and workforce issues hinder the adoption of the CoCM. FQHCs face many demands to provide care to safety net populations, yet are not fully equipped with the resources, workflows, staffing, and payment structures to support CoCM/BHI billing. Increased financial and logistical support to build practice infrastructure is needed to reduce the administrative complexity and inadequate reimbursement mechanisms that currently hinder the implementation of the CoCM and integrated care delivery. Public Significance StatementFederally qualified health centers (FQHCs) are increasingly delivering behavioral health treatment, in part through integrated behavioral health (IBH) service delivery; yet financing structures like CMS (Center for Medicare and Medicaid Services) codes for the Collaborative Care Model (CoCM) and behavioral health integration may not be widely understood due to administrative complexity, nor may it be sufficient enough to incentivize their use. FQHCs need financial, logistical, and technical assistance to jump-start use of CMS codes for IBH, as well as needing payment reform to support use of these codes.This article was published Online First September 28, 2023.This publication was supported by the Health Resources and Services Administration (HRSA) of Health and Human Services (HHS) as part of an award totaling $1.1 million. The contents are those of the authors and do not necessarily represent the official views of, nor are an endorsement by, HRSA, HHS, or the U.S. government. No potential conflict of interest was reported by the authors.Brianna M. Lombardi served as lead for conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, and writing-original draft. Catherine Greeno cont...

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Section: Discussionmentioning

confidence: 59%

Examining the use of psychiatric collaborative care and behavioral health integration codes at federally qualified health centers: A mixed-methods study.

Lombardi,

Greeno,

de Saxe Zerden

2023

Families, Systems, & Health

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“…We also found limited adoption of CoCM codes, which was consistent with other studies and in line with findings that suggested a substantial time lag between the availability of new billing codes for CoCM and the widespread use of such codes in practice. [27][28][29][30][31][32][33][34][35][36] The low uptake in Washington State is noteworthy, given the presence of the University of Washington's Advancing Integrated Mental Health Solutions Center, which works to advance the implementation of CoCM. Even with local facilitation available, changes at the administrative or billing levels may be insufficient to drive shortterm improvements in the provision of mental health services.…”

Section: Discussionmentioning

confidence: 99%

“…We also found limited adoption of CoCM codes, which was consistent with other studies and in line with findings that suggested a substantial time lag between the availability of new billing codes for CoCM and the widespread use of such codes in practice . The low uptake in Washington State is noteworthy, given the presence of the University of Washington’s Advancing Integrated Mental Health Solutions Center, which works to advance the implementation of CoCM.…”

Section: Discussionmentioning

confidence: 99%

Access, Utilization, and Quality of Behavioral Health Integration in Medicaid Managed Care

McConnell,

Edelstein,

Hall

et al. 2023

JAMA Health Forum

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ImportanceMany states have moved from models that carve out to those that carve in or integrate behavioral health in their Medicaid managed care organizations (MCOs), but little evidence exists about the effect of this change.ObjectiveTo assess the association of the transition to integrated managed care (IMC) in Washington Medicaid with health services use, quality, health-related outcomes, and measures associated with social determinants of health.Design, Setting, and ParticipantsThis cohort study used difference-in-differences analyses of Washington State’s 2014 to 2019 staggered rollout of IMC on claims-based measures for enrollees in Washington’s Medicaid MCO. It was supplemented with interviews of 24 behavioral health agency leaders, managed care administrators, and individuals who were participating in the IMC transition. The data were analyzed between February 1, 2023, and September 30, 2023.Main Outcomes and MeasuresClaims-based measures of utilization (including specialty mental health visits and primary care visits); health-related outcomes (including self-harm events); rates of arrests, employment, and homelessness; and additional quality measures.ResultsThis cohort study included 1 454 185 individuals ages 13 to 64 years (743 668 female [51.1%]; 14 306 American Indian and Alaska Native [1.0%], 132 804 Asian American and Pacific Islander [9.1%], 112 442 Black [7.7%], 258 389 Hispanic [17.8%], and 810 304 White [55.7%] individuals). Financial integration was not associated with changes in claims-based measures of utilization and quality. Most claims-based measures of outcomes were also unchanged, although enrollees with mild or moderate mental illness experienced a slight decrease in cardiac events (−0.8%; 95% CI, −1.4 to −0.2), while enrollees with serious mental illness experienced small decreases in employment (−1.2%; 95% CI −1.9 to −0.5) and small increases in arrests (0.5%; 95% CI, 0.1 to 1.0). Interviews with key informants suggested that financial integration was perceived as an administrative change and did not have substantial implications for how practices delivered care; behavioral health agencies lacked guidance on how to integrate care in behavioral health settings and struggled with new contracts and regulatory policies that may have inhibited the ability to provide integrated care.Conclusions and RelevanceThe results of this cohort study suggest that financial integration at the MCO level was not associated with significant changes in most measures of utilization, quality, outcomes, and social determinants of health. Additional support, including monitoring, training, and funding, may be necessary to drive delivery system changes to improve access, quality, and outcomes.

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“…That is beginning to change, most prominently through the recent introduction of the Centers for Medicare and Medicaid Services behavioral health integration billing codes, but uptake of these codes is very low; in 2017 and 2018, the first 2 years these codes were rolled out, only 0.1% of Medicare beneficiaries with mental illness or substance use disorder received services through these codes. 49 Qualitative research suggests that practices often do not have the infrastructure that is required to be in place to bill for care integration services, such as a psychiatric consultant on staff and an electronic patient registry. 50 Further, the primary care workforce receives minimal training in mental health, the mental health workforce receives minimal training in primary care, and neither group receives robust training in the type of team-based care required to coordinate mental and physical health care for people with mental illness.…”

Section: Continuing Problemsmentioning

confidence: 99%

“…Historically, a key barrier to the implementation of integrated mental–physical health care models like Collaborative Care has been a lack of insurance reimbursement mechanisms for the care coordination and management services central to these models. That is beginning to change, most prominently through the recent introduction of the Centers for Medicare and Medicaid Services behavioral health integration billing codes, but uptake of these codes is very low; in 2017 and 2018, the first 2 years these codes were rolled out, only 0.1% of Medicare beneficiaries with mental illness or substance use disorder received services through these codes 49 . Qualitative research suggests that practices often do not have the infrastructure that is required to be in place to bill for care integration services, such as a psychiatric consultant on staff and an electronic patient registry 50 .…”

Section: Continuing Problemsmentioning

confidence: 99%

The Future of Public Mental Health: Challenges and Opportunities

McGinty

2023

Milbank Quarterly

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Social policies such as policies advancing universal childcare to expand Medicaid coverage of home‐ and community‐based care for seniors and people with disabilities and for universal preschool are the types of policies needed to address social determinants of poor mental health. Population‐based global budgeting approaches like accountable care and total cost of care models have the potential to improve population mental health by incentivizing health systems to control costs while simultaneously improving outcomes for the populations they serve. Policies expanding reimbursement for services delivered by peer support specialists are needed. People with lived experience of mental illness are uniquely well suited to helping their peers navigate treatment and other support services.

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Uptake of Medicare Behavioral Health Integration Billing Codes in 2017 and 2018

Cited by 7 publications

References 4 publications

Examining the use of psychiatric collaborative care and behavioral health integration codes at federally qualified health centers: A mixed-methods study.

Examining the use of psychiatric collaborative care and behavioral health integration codes at federally qualified health centers: A mixed-methods study.

Access, Utilization, and Quality of Behavioral Health Integration in Medicaid Managed Care

The Future of Public Mental Health: Challenges and Opportunities

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