New Medicare reimbursement codes will move the process forward

As of Jan. 1, 2017, Medicare is paying for care management services relating to mental or behavioral health, including substance abuse disorders. The Centers for Medicare and Medicaid Services (CMS) included four new behavioral health integration billing codes in the 2017 Medicare Physician Fee Schedule final rule issued on Nov. 2, 2016.

Three of the four new payment codes (G0502, G0503 and G0504) are for services provided using the Collaborative Care Model (CoCM), which research has shown improves patient outcomes. Under the CoCM, patients are cared for by a team consisting of a primary care physician (or other qualified health care professional, such as a nurse practitioner or physician assistant who oversees the beneficiary’s care); a behavioral health care manager, who must have formal education or specialized training in behavioral health; and a psychiatric consultant or other behavioral health specialist who is qualified to prescribe medications. The team develops and implements a patient-centered care plan using evidence-based practice guidelines.

The fourth new code (G0507) is for behavioral health integration services provided using other approaches and for practices that have not yet implemented the CoCM.


Improved access to behavioral health care

 Dr. Maria Oquendo, president of the American Psychiatric Association (APA), applauded CMS’ decision to cover these services in a blog post on the APA website. She noted that the CoCM will help address the “shortage in the psychiatric workforce” by making it more feasible for psychiatrists to work with primary care physicians “to ensure access and quality of care” for patients. The association expanded on this in its July 8 online issue of Psychiatric News: “[A] scarce resource is leveraged to improve quality of care for an entire population of patients being treated in primary care—which is not feasible if the psychiatrist sees each patient directly, even for a one-time consultation.”

Dr. Oquendo explained that under the CoCM consulting psychiatrists provide primary care practices with specialized expertise “through regular case review and recommendations for therapeutic and pharmacologic treatment, medication adjustments and the need for additional specialty care.”


Integrated care could save nearly $50 billion annually

The APA stated that depression, anxiety, substance use disorders and other mental illnesses are responsible for 25 percent of all disabilities globally, and as such are a major driver of health care costs. A 2014 study commissioned by the APA and conducted by Milliman Inc. estimated that Medicare and Medicaid could save $10 billion to $16 billion annually and commercial insurers could save $16 billion to $32 billion each year through the effective integration of behavioral health care with medical care.

“The CoCM differs from other attempts to integrate behavioral health services because of the replicated evidence supporting its outcomes, its steady reliance on consistence principles of chronic care delivery, and attention to accountability and quality improvement,” the APA noted in the July 8 issue of Psychiatric News.

The association worked with CMS and other physician groups to design the new reimbursement codes. Previously, CoCM services were usually covered by grants and state Medicaid programs.

In October 2015, CMS awarded the APA a $2.9 million grant through the Transforming Clinical Practice Initiative to train psychiatrists “in the clinical and leadership skills needed to support primary care practices that are implementing integrated behavioral health programs.” According to Dr. Oquendo’s post, nearly 550 psychiatrists had been trained as of last July. The ultimate goal of the four-year grant program is to train 3,500.

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