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Below are resources for psychiatrists advocating for Medicaid payment for the Collaborative Care Model. This includes:
Learn about the key components and evidence supporting the use of the Collaborative Care Model.
Review and use talking points on advocating for the Collaborative Care Model with payers.
Learn about reimbursement and funding opportunities available.
Find the most recent action states are taking to implement Medicaid codes for the Collaborative Care.
Over the past decade, the integration of behavioral health and general medical services has been shown to improve patient outcomes, save money, and reduce stigma related to mental health. Significant research spanning three decades has identified one model — the Collaborative Care Model — in particular, as being effective and efficient in delivering integrated care. Below are handouts to share with an overview of the model, as well as information about billing codes that have been developed to receiving payment for services provided through the model.
However, successfully expanding use of the model depends on appropriate reimbursement for services related to care management and psychiatric consultation, and infrastructure support for staffing changes and implementation of data tracking tools. New CPT codes are available to submit for reimbursement under those plans, such as Medicare, that provide coverage. FQHCs and RHCs can also receive reimbursement using specific HCPCS codes.
Primary care practices that are providing collaborative care services can now bill for those services using CPT® codes for Psychiatric collaborative care management services (99492, 99493, 99494). Medicare, and some commercial payers, and Medicaid plans are also providing coverage — check the local coverage policies in your area to determine coverage. Federally Qualified Health Centers and Rural Health Clinics can bill for these services using HCPCS code G0512 (for the initial 70 minute or subsequent 60 minute visits).
The Centers for Medicare and Medicaid Services (CMS) has provided a fact sheet and a short list of FAQs that describe CoCM services and their associated billing requirements as well as provides a information on a brief care management service, General behavioral health integration care management (99484). They have classified all of these as Behavioral Health Integration (BHI) services on their care management site: Care Management – Behavioral Health Integration.
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We urge you to support coverage and reimbursement for the Collaborative Care Model as approved in the 2018 Medicare Physician Fee Schedule.
References
This section provides background information for speaking with your state officials about what funding opportunities may be available to incorporate the Collaborative Care Model into existing or future efforts.
Increasingly more states are reforming their Medicaid programs and working to integrate behavioral health services (including mental health and substance use disorder services) with general medical care through Medicaid waivers and funding streams available from the Substance Abuse and Mental Health Services Administration and Centers for Medicare and Medicaid Services Innovation Center.
Below is a list of funding streams available that may be used to integrate services, including by implementing the Collaborative Care Model. We’ve also included a chart of certain states approved for an 1115 waiver, which states may use to test new or existing ways to deliver and pay for health care services in Medicaid and the Children’s Health Insurance Program.
New York
New York started implementing the Collaborative Care Model through a statewide grant in 2012. Following its success, the State turned on a Medicaid code to reimburse a limited number of practices in the model in 2015.
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Maryland
The Maryland legislature has shown interest in the Collaborative Care Model by requesting the Department of Health and Mental Hygiene examine the model as a way to better integrate the delivery of physical and behavioral health services.
Washington State
Washington State has been implementing the Collaborative Care Model statewide since 2009.
Hawaii
During the 2016-2017 legislative session, House Bill 1272, Relating To Improving Access To Psychiatric Care for Medicaid Patients, was introduced in the Hawaii State Legislature to include Medicaid reimbursement for the Collaborative Care Model. The bill was approved by both the House and Senate but was stalled in the final days of the legislative session and not ultimately approved. Discussions are now underway with the State Medicaid office on the potential of implementing the model through the state’s 1115 waiver.
Start a discussion with either members of your state legislature or Medicaid office on how to advance the use of the Collaborative Care Model. To begin discussions, draft legislation is available to use with your state legislature. Also available is draft waiver amendment language you may use to start a discussion with your Medicaid office to advocate for the Collaborative Care codes. Check our chart on 1115 waivers to see if your state has one.