Feds announces new model for mental health, substance use disorder treatment in Medicare, Medicaid

The Centers for Medicare & Medicaid Services announced Thursday the Innovation in Behavioral Health Model, a new approach that is designed to test for improving outcomes for adults with mental health and substance use disorder (Source: “CMS unveils new behavioral health model using a 'no wrong door' approach,” Fierce Healthcare, Jan. 18).

Beginning this fall, the model is intended to funnel adults in Medicare and Medicaid to the "physical, behavioral and social supports" they need, according to a press release. Community-based practices under IBH will create care teams with behavioral and physical health providers. The proposal embraces a “no wrong door” approach that allows people to obtain all services they need no matter how they first seek out care. Screenings, assessments and referrals to other services will be available.

While the practice participant enrollment period begins this year, the implementation period takes place from 2027 to 2032, a fact sheet released by CMS says. States have not yet been selected to participate.

One quarter of people with Medicare experience mental illness and 40% of people with Medicaid experience mental illness or substance use disorder, according to KFF. CMS officials say fragmented care and high out-of-pocket costs negatively impact enrollees, particularly those in rural settings, low-income populations or part of marginalized groups.