Cracking the Codes: State Medicaid Approaches to Reimbursing Psychiatric Collaborative Care

Health Management Associates


Downloads

Integrating behavioral health into primary care is an important way to increase access to effective behavioral health treatment while maximizing the capacity of our very limited behavioral health workforce. There are many approaches to integration, but the Collaborative Care Model (CoCM) has the most robust evidence base, especially for anxiety and depression. CoCM adds two new members with behavioral health expertise to the primary care team, expanding the team’s capability to identify and treat people with common behavioral conditions.

Schematic of the CoCM Team
Source: “Team Structure,” Univ. of Washington.

Despite an evidence base including more than 80 randomized controlled trials, CoCM has struggled to scale nationally. A key barrier has been reimbursement — many of the activities required by CoCM do not neatly map to traditional billing codes. Recognizing both this barrier and the clinical potential of CoCM, the Centers for Medicare & Medicaid Services (CMS) introduced unique CoCM billing codes in 2016.

Although CMS established requirements for providers billing the CoCM codes for Medicare enrollees, other payers, including state Medicaid authorities and managed care plans, can choose either to copy the CMS guidance, to revise the guidance, or to decline to implement the codes altogether. This paper examines the state-by-state differences in how Medicaid agencies are choosing to implement and reimburse the CoCM codes, and summarizes the lessons and best practices gleaned to date.

Note: Corrected version posted on September 22, 2020. This publication previously included out-of-date information regarding the number of state Medicaid agencies reimbursing CoCM and the rates they are paying. Those details have been corrected, but may change again as more states adopt these codes or revise their reimbursement policies. For the most up-to-date information on a given state, please refer to its Physician Fee Schedule.