Mental health and its treatment are hot topics right now within the healthcare industry. Providers know now more than ever before about the inner workings of the brain and how mental illness works. The more information that is gathered leads to innovations in the way physicians approach mental health. It also aids in how they treat it. Up to this point, Chronic Care Management (CCM) has failed to include mental health in its workings. The Centers for Medicare and Medicaid Services (CMS) defines CCM as the treatment of 2 or more chronic conditions that last at least 12 months or until patient death. This is where the patient is at a significant risk of death or decline in their function, and a patient’s care team puts a comprehensive care plan in place. This is all while a physician maintains and monitors its progress. Behavior Health Integration (BHI) is CMS’s new strategy for improving the lives and outcomes for Americans struggling with behavioral/mental health conditions. They do this by following the structure of CCM. CMS is offering separate payments to providers for BHI services with new Medicare billing codes.
Psychiatric Collaborative Care Services (CoCM) BHI
Out of the four new codes used for billing with BHI, the CoCM is a model that aims to augment standard primary care with extra services. According to CMS, these services include “care management support for patients receiving behavioral health treatment: and regular psychiatric inter-specialty consultation to the primary care team, particularly regarding patients whose conditions are not improving.” This is where the parallels to CCM come into play. While the word chronic is not used, BHI talks about behavioral health conditions and treatments that are not improving, involving long-term treatments. CoCM includes components of care that involves an assessment by a primary care team made up of 4 individuals. This includes the Treating practitioner, Behavioral Health Care Manager, Psychiatric Consultant, and Beneficiary. A care plan is set in place and is required to follow certain guidelines set into place by CMS and it to be maintained and monitored by the primary care team.
That last of the four codes used for billing BHI is for all behavioral health services not included under CoCM. According to CMS, this includes services like “systematic assessment and monitoring, care plan revision” as well as “a continuous relationship with a designated care team member.” This is also set in place for patients whose mental health conditions are not improving in a chronic or long-term way. CMS is planning to improve this code in the future since they are consistently reviewing BHI models and learning from them. The General Behavioral Health Integration model also includes an assessment by a care team made up of 3 people. This is the beneficiary, Clinical staff member, and treating physician. A member of the care team follows up with the patient. They also monitor and maintain the relationship.
CMS has released an overview of the models as well as the description of the care team roles, eligible conditions, and a coding summary for BHI. CMS plans to review these models and structure consistently in the future to keep improving the process. Ultimately, the fact that Chronic Care Management is moving into mental health treatment, is an exciting movement for the healthcare industry overall.