CMS' Innovation in Behavioral Health (IBH) Model
by Ellen Van Roekel,
MHA candidate May 2024
On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) unveiled a transformative new model to support Medicaid and Medicare populations with behavioral health needs. The Innovation in Behavioral Health (IBH) Model was designed to enhance mental health and substance use care for individuals grappling with moderate to severe mental health conditions and/or substance use disorders and bridge the gap between behavioral and physical health.
Who Can Participate?
The IBH Model intends to engage community-based behavioral health practices in person-centered, integrated care. These practices, including Community Mental Health Centers, opioid treatment programs, safety net providers, and public or private practices, are central to delivering outpatient mental health and substance use disorder services. Practice participants will lead interprofessional care teams to deliver care that addresses behavioral and physical health needs as well as health-related social needs (HRSN) like housing, food, and transportation.
The IBH Model will operate via a state-based approach, led by state Medicaid Agencies, to ensure aligned payment between Medicaid and Medicare for integrated services. States interested in participating, including U.S. territories and the District of Columbia, can apply either as a whole state or a specified sub-state region. CMS will select up to eight states who will partner with their state’s agencies for mental health and/or SUD and work with at least one partnering Medicaid Managed Care Organization (MCO) or another intermediary partner to develop and implement the IBH Model.
Timeline: The Journey to Integrated Care
CMS is set to release a Notice of Funding Opportunity (NOFO) in Spring 2024, followed by their selection of up to eight states. With a projected launch in Fall 2024, the IBH Model is anticipated to run for eight years, encompassing a pre-implementation period spanning the first three years, followed by the implementation period (years 4-8). During the pre-implementation phase, states and practice participants will receive funding for model activities, capacity building, and necessary upgrades to health IT and EHRs. In the fourth year, states will implement a Medicaid payment model, providing support to practice participants in executing the care delivery framework; states participating in the additional Medicare payment model will receive a per-beneficiary-per-month payment to facilitate implementation.
How will this Model Work? A Holistic Approach
At its core, the IBH Model aims to deliver person-centered, integrated care that breaks down the silos between behavioral and physical healthcare services. Practice participants will conduct initial screenings and assessments, offer treatment or referrals, and monitor ongoing conditions. A key concept behind the program is the "no wrong door" approach, which is meant to ensure that individuals, regardless of their initial point of contact within the system, have access to all available and appropriate services (physical, behavioral, and/or SUD). The IBH Model seeks to address the issue of fragmented care by empowering behavioral health practices to lead interprofessional care teams responsible for managing patient care through the healthcare ecosystem. State Medicaid Agencies will receive funding during pre-implementation to develop a Medicaid Alternative Payment Model. Practice participants will use infrastructure funding to support health IT and population health infrastructure.
Why it matters
Behavioral health is a key component of holistic patient care but is often siloed from other types of health care. Medicaid is the largest payer for mental health services in the United States. In most states, mental health benefits are administered separately through a different agency or department within the state than other health benefits resulting in a labyrinth of coverage that can be confusing and lead to fragmented care. While behavioral health integration is a buzzword in value-based care and has been a feature of many CMMI primary care models, behavioral health providers have not had much opportunity to participate in value-based care designed for the populations they serve. Similar to infrastructure payments for rural and smaller providers in the ACO movement which spurred a movement towards value, investing in the resources needed to support behavioral health providers as they build population health capabilities and take on greater accountability will hopefully create some momentum towards value-based care and support their integration into the larger healthcare ecosystem.
Go to the source(s):
CMS Announces New Model to Advance Integration in Behavioral Health
More detailed information: Innovation in Behavioral Health (IBH) Model