New Guidance From CMS prioritizes Integrated Care, CoCM and Measurement-Based Care as Best Practices
The Biden administration recently unveiled CMS’ most comprehensive guidance in over a decade. The guidance focuses on Medicaid’s early and periodic screening, diagnostic, and treatment (EPSDT) requirements. This is a major step forward in Path Forward’s mission to increase access to mental health and substance use care in the U.S.
The collective work of our partners has been instrumental in advocating for Integrated Care, the Collaborative Care Model and Measurement-Based Care as a way to resolve the mental health crisis in the US.
Federal support of these evidence-based approaches will have a profound impact, particularly in Medicaid programs, and will help accelerate the adoption of these models nationwide. As the Collaborative Care Model is one of our key areas of focus, this recognition and endorsement marks a significant milestone in our ongoing efforts to expand access to high-quality, equitable mental health and substance care.
Key recommendations from the CMS letter to increase CoCM adoption:
1. Medicaid Coverage and Reimbursement Expansion
States are encouraged to modify their Medicaid state plans to include coverage for CoCM services, particularly for those with mild to moderate behavioral health conditions. Enhancing reimbursement rates and ensuring that CoCM services are covered under both fee-for-service and managed care plans can reduce barriers for providers.
2. Training and Technical Assistance
Expanding training for primary care providers, behavioral health specialists, and care managers is essential. CMS recommends leveraging Medicaid funding for technical assistance to help providers implement CoCM and ensure they are equipped with the right tools, like EHR integration for CoCM billing.
3. Provider Incentives
States should consider creating financial and non-financial incentives for healthcare providers adopting CoCM. This could include payment reforms that reward high-quality care, outcomes-based payments, and additional support for providers serving rural or underserved areas.
4. Telehealth and Technology Integration
The recommendations emphasize increasing access to CoCM via telehealth, particularly for rural and underserved populations. Expanding broadband infrastructure and supporting the use of digital health tools are key strategies to facilitate this.
5. Streamlining Billing and Administrative Requirements
CMS encourages simplifying the billing process for CoCM services, removing administrative hurdles, and clarifying billing codes to promote more widespread provider participation. Medicaid agencies are advised to work closely with providers to address any challenges.