CMS Behavioral Health Strategy
The CMS Behavioral Health Strategy covers multiple elements including access to prevention and treatment services for substance use disorders, mental health services, crisis intervention and pain care; and further enable care that is well-coordinated and effectively integrated.
The CMS Behavioral Health Strategy also seeks to remove barriers to care and services, and to adopt a data-informed approach to evaluate our behavioral health programs and policies. The CMS Behavioral Health Strategy will strive to support a person’s whole emotional and mental well-being and promotes person-centered behavioral health care.
CMS Behavioral Health Strategy: Goals, Objectives and Supporting Activities
Goal 1: Strengthen Equity and Quality in Behavioral Health Care
- Reduce disparities in health and health care among individuals CMS serves to improve access to high quality, affordable, person-centered behavioral health care, and ensure parity in access, coverage, and quality for physical and mental health services, including care enabled through telehealth and technology.
- Incorporate Health Equity into new care and payment models and optimize whole-person care for beneficiaries with and at risk of behavioral health conditions.
- Provide Effective Outreach and Education on CMS’s behavioral health services to inform beneficiaries, caregivers and providers utilizing culturally and linguistically appropriate materials that meet the needs of individuals with low literacy, low health literacy, and limited-English proficiency.
- Improve Quality Measurement in behavioral health and pain management across CMS programs.
- Consider Quality and Equity Implications across all objectives of the CMS Behavioral Health Strategy to ensure both underpin the CMS approach to improving substance use disorder services, pain management, behavioral health services and supports, and data and measurement.
- Quality Measurement: CMS uses quality measures across health care to drive health systems, providers, practices and clinicians, and community-based providers toward delivery of high value care for people covered by Medicare, Medicaid and private health insurance.
- CMS released Final Report that summarizes National Quality Forum convened technical experts’ consideration of issues related to acute and chronic pain management and substance use disorders
- CMS maintains the CMS Quality Measures Inventory which is a compilation of measures used by CMS in various quality, reporting and payment programs, including those measures for behavioral health to include depression, suicide risk and alcohol use.
- include depression, suicide risk and alcohol use.
- Health Equity: CMS is advancing health equity and addressing disparities in opioid use disorders (OUD) treatment. CMS recently released:
- Access to Medication for Opioid Use Disorder (MOUD) Among Medicare Fee-for-Service Beneficiaries: Influence of CARES Act Implementation (2020) (PDF)which looks at access to medication treatment for Medicare beneficiaries diagnosed with opioid use disorder before and after COVID-19 telehealth expansion; and
- Changes in Access to Medication Treatment during COVID-19 Telehealth Expansion and Disparities in Telehealth Use for Medicare Beneficiaries with Opioid Use Disorder (PDF) which compares access to medication treatment for Medicare beneficiaries diagnosed with opioid use disorder before and after COVID-19 telehealth expansion was implemented.
Goal 2: Improve access to substance use disorders prevention, treatment and recovery services
- Improve the Care Experience for beneficiaries and consumers with substance use disorders and increase strategic opportunities for enhanced access to high quality, affordable, whole-person care.
- Identify and Address Barriers that impede access for people with or at risk of substance use disorders to evidence-based treatment and recovery services for better detection, diagnosis, and management of such conditions.
- Strengthen Treatment and Recovery Services through innovative care and payment models, and dissemination of promising and best practices.
- Expand workforce capacity across provider types, including exploring options for training of residents and clinicians in the detection, diagnosis and management of substance use disorders.
- Report to Congress (PDF): Summary of Review and Recommendations for the Medicare and Medicaid Programs to Prevent Opioid Addictions and Enhance Access to Medication-Assisted Treatment with a CMS Action Plan (PDF) on suggested improvements to substance use disorders and pain care in Medicare and Medicaid.
- Medicaid 1115 Substance Use Disorders Demonstrations -CMS created an opportunity under the authority of section 1115(a) of the Social Security Act (Act) for states to demonstrate and test flexibilities to improve the continuum of care for beneficiaries with substance use disorders (SUDs). CMS created similar flexibility to test more comprehensive approaches to care for beneficiaries with serious mental illness (SMI) or serious emotional disturbance (SED). The states listed on this page have section 1115(a) demonstration programs approved in accordance with these new opportunities to address particular challenges raised the overdose crisis.
- Opioid Treatment Programs - CMS covers Opioid Treatment Programs through bundled payments for opioid use disorder treatment services in an episode of care provided to people with Medicare Part B.
- Innovative Models - CMS’s Innovation Center is testing models to improve behavioral health care and improve quality while reducing cost, including the Integrated Care for Kids Model, which aims to meet physical and behavioral health needs in children, and the Value in Treatment Model, to increase access to OUD services and improve health outcomes in people with OUD.
Goal 3: Ensure effective pain treatment and management
- Improve the care experience for individuals with acute and chronic pain to identify strategic opportunities for enhanced access to high quality, equitable, affordable whole-person care.
- Expand access to evidence-based treatments for acute and chronic pain, including through guidance to states, exploration of new coverage pathways, and sharing practices that ensure individualized, effective care.
- Increase coordination between primary and specialty care through payment episodes, incentives, and care and payment models.
- Expand workforce capacity and capability including options for training residents and clinicians in the diagnosis and management of acute and chronic pain.
- CMS recognizes the impact of pain across its programs and has released the Chronic Pain Experience Journey Map to highlight the most prominent barriers experienced by people accessing care and the influencers acting on providers, ultimately affecting the person with chronic pain, their quality of care, and their quality of life.
- CMS released a Final Report that summarizes National Quality Forum convened technical experts’ consideration of issues related to acute and chronic pain management and substance use disorders as part of the SUPPORT Act Section 6093.
- CMS is working with its HHS partners to prepare a Report to Congress that will contain key information about acute and chronic pain, help in understanding the current landscape of pain relief options for Medicare beneficiaries, and inform decisions about payment and overage for pain management interventions.
Goal 4: Improve access and quality of mental health care and services
- Increase detection, effective management and/or recovery of mental health conditions through coordination and integration between primary and specialty care providers.
- Expand access to community-based mental health services and resources such as peer supports, community health workers, housing, home and community-based services, and social supports.
- Mitigate the adverse effects of emergencies and disasters such as the COVID-19 pandemic on the mental health of beneficiaries, consumers, and care providers.
- Expand workforce capacity and capability including exploring options for training of residents and clinicians in the detection, diagnosis and management of mental disorders.
- Medicaid Community-Based Mobile Crisis Services - CMS has launched community-based mobile crisis intervention services for people with Medicaid, helping states integrate these services into their programs - a critical component in establishing a sustainable and public health-focused support network. In 2021, CMS awarded $15 million in planning grants to 20 states to support development of these crisis intervention services.
- Connecting Kids to Coverage – The Connecting Kids to Coverage Campaign launched a Mental Health Initiative to share information on the Medicaid and the Children’s Health Insurance Program (CHIP) and coverage of essential mental and behavioral health services for children and youth.
- Certified Community Behavioral Health Clinics (CCBHC's)- CCBHCs are part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental health and substance use disorders.
- Medicare and Behavioral Health- Medicare covers many behavioral health services (PDF) to include depression screening, psychological tests, alcohol screening and counseling, and treatment for substance use disorders. Medicare also covers the Annual Wellness Visit with no deductible.
Goal 5: Utilize data for effective actions and impact on behavioral health
- Evaluate the CMS Behavioral Health Strategy across Medicare, Medicaid, the Children’s Health Insurance Program and private health insurance including equity and quality; supplement evaluation with external data sources where necessary.
- Build on and Support Cross-Departmental & Interagency Collaborations related to data such as the HHS Behavioral Health Coordinating Council actions, Agency Priority Goals, and other federal partnerships.
- Support evidence generation and research through enhanced access to high quality data that improves health outcomes.
- Medicaid Substance Use Disorders Data - CMS released the third annual Substance Use Disorder (SUD) Data Book with data on Medicaid beneficiaries treated for any SUD, and the services they received. An interactive T-MSIS SUD Data Book data analytics interactive tool has static display of information in the Report.
- Mapping Medicare Disparities Tool – CMS has designed an interactive map, the Mapping Medicare Disparities Tool, to identify areas of disparities between subgroups of Medicare beneficiaries (e.g., racial and ethnic groups) in health outcomes, utilization, and spending. The tool includes options to search for depression, psychotic disorders and dementia