Policy & Regulation News

CMS to Drive Community Care Coordination for Behavioral Health

The model will create state-specific payment programs to drive better care coordination to address behavioral health needs and opioid misuse risks.

behavioral health care coordination

By Sara Heath

- CMS has announced a new care delivery model that aims to improve preventive care, early detection, and care access for pediatric patients at-risk of having an opioid addiction or behavioral health issue.

The Integrate Care for Kids (IncK) model will benefit children under age 21 who are covered by Medicaid or the Children’s Health Insurance Program (CHIP).

IncK will work with and empower state Medicaid agencies to forge better community partnerships as to develop better early detection programs for behavioral health or substance abuse needs.

Warning signs for behavioral health and substance abuse disorders tend to present themselves outside of the clinic walls, meaning community members in schools, places of worship, community groups, and other social service providers may be better equipped to identify key risk factors.

Through community partnerships and communication, providers may become privy to patient needs.

The IncK model also aims to drive coordination between healthcare providers and other services that address the social determinants of health, including school-based health programs and housing programs. Patient access to behavioral health screenings is often disjointed, but creating better care coordination will enable all key stakeholders to address potential issues.

CMS aims to foster better care coordination through a unique, state-specific payment model that would reimburse providers for their community health work and for their work in coordinating care. Using state-specific payment models will allow Medicaid policymakers to tailor approaches to specific community needs, CMS said.

More details are set to emerge come fall 2018 once CMS has issued its official Notice of Funding Opportunity. The agency plans to rollout IncK in eight states, each of which will see a maximum of $16 million in grant funding. Participating states are slated to begin the model in spring 2019 carry it through a seven-year model.


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