On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) announced the Innovation in Behavioral Health (IBH) Model.
The IBH Model is focused on improving the quality of care and behavioral and physical health outcomes for adults enrolled in Medicaid and Medicare with moderate to severe mental health conditions and substance use disorder (SUD). Medicare and Medicaid populations experience disproportionately high rates of mental health conditions or substance use disorders (SUDs), or both. As a result, they are more likely to experience poor health outcomes such as frequent visits to the emergency department and hospitalizations, or premature death.
The IBH Model seeks to bridge the gap between behavioral and physical health. Specialty behavioral health practices under the IBH Model will screen and assess patients for select health conditions, as well as mental health conditions or SUD, or both. The IBH Model is a state-based model, led by state Medicaid agencies, with a goal of aligning payment between Medicaid and Medicare for integrated services.
The model is expected to launch January 1, 2025 and the period of performance will be for eight years.
Model Overview
The Innovation in Behavioral Health (IBH) Model is designed to deliver person-centered, integrated care to Medicaid and Medicare populations, including those who are dually eligible, with moderate to severe mental health conditions or substance use disorder (SUD), or both. Participants in the IBH Model (“Practice Participants”) will be specialty behavioral health practices, including community mental health centers, opioid treatment programs, and public or private practices, where individuals can receive outpatient mental health or SUD services, or both. Practice Participants may include safety net providers who ensure that the IBH Model’s priority population, who are at higher risk of poor health outcomes, has access to needed care.
Practice Participants will lead an interprofessional care team and will be responsible for coordinating with other members of the care team to comprehensively address a patient’s care to include behavioral and physical health, and health-related social needs (HRSN), such as housing, food, and transportation.
The Practice Participants will conduct an initial screening and assessment, offer treatment or referrals to other care specialists and community-based resources, and monitor ongoing behavioral and physical health conditions, and HRSNs. In this value-based care approach, the Practice Participants will be compensated based on the quality of care provided and improved patient outcomes.
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Model Purpose
Medicaid populations experience disproportionately high rates of mental health conditions or substance use disorders (SUD), or both, and account for nearly half of all Medicaid expenditures. Medicare populations also experience higher than average rates of mental illness or SUD, or both. Consequently, both populations are more likely to experience frequent visits to the emergency department and hospitalizations, have poor health outcomes, and premature death.
Limited access to care, stigma, and untreated or poorly managed priority health conditions like diabetes and heart disease can contribute to worsening health outcomes for these populations. Behavioral health providers face significant barriers to deliver care due to a lack of resources and a fragmented health care delivery system that does not systematically integrate behavioral and physical health care. The IBH Model aims to help participating practices improve access to and promote high-quality integrated care. By supporting specialty behavioral health practices to lead an interprofessional care team, the model will address patients’ behavioral and physical health, and HRSNs.
Model Design
The IBH Model is a state-based model focused on specialty behavioral health practices that treat people with Medicaid and Medicare and includes both Medicaid and Medicare-aligned Payment Approaches. CMS will first issue awards in up to eight state Medicaid agencies (SMAs) to implement the IBH Model. States will then recruit Practice Participants that will be eligible to participate in both the Medicaid and Medicare components of the IBH Model. The selected states will partner with their state’s mental health, SUD authorities, or both to ensure alignment in clinical policies. Selected states will also work with at least one partnering Medicaid managed care organization (MCO) or another intermediary partner, where applicable, to develop and implement the IBH Model in their state. States delivering Medicaid services through the fee-for-service system are also eligible to participate.
The IBH Model supports specialty behavioral health practices in delivering integrated care in outpatient settings. This person-centered approach to addressing whole-person health prioritizes close collaboration with primary care and other physical health providers to support all aspects of a patient’s care.
Specialty behavioral health practices will be responsible for conducting screenings and assessments of behavioral and physical health, and health-related social needs, offering treatment as appropriate within their scope of practice, providing closed-loop referrals to other primary care providers, specialists, and community-based resources, and monitoring ongoing conditions. Since people with moderate to severe behavioral health conditions frequently visit behavioral health settings, this approach uses the behavioral health setting as a point of entry to identify and secure further care and facilitate close collaboration with primary and specialty care providers.
The model works to improve care through four key program elements:
- Care Integration: Behavioral health Practice Participants will screen, assess, refer, and treat patients, as needed, for the services they require.
- Care Management: An interprofessional care team, led by the behavioral health practice participant, will identify, and as appropriate address, the multi-faceted needs of patients and provide ongoing care management.
- Health Equity: Behavioral health Practice Participants will conduct screenings for HRSNs and refer patients to appropriate specialty-based services. Participating practices will be required to develop a health equity plan. The HEP should stipulate how the practice participant will address disparities that impact their service populations.
- Health Information Technology: Expansion of health IT capacity through targeted investments in interoperability and tools (including electronic health records) will allow participants to improve quality reporting and data sharing.
The IBH Model will have eight performance years, including a pre-implementation period (model years 1 – 3). During this period and throughout the implementation period, states and Practice Participants will receive funding to develop and implement model activities and capacity building. During model year 1, states will conduct outreach and recruit specialty behavioral health practices, to the model. Practice Participants will receive funding to support necessary upgrades to health IT and electronic health records, as well as practice transformation activities, and staffing to implement the model. Practice Participants who elect to participate in the Medicare Payment Approach will also be eligible for additional funding to support model activities.
By the start of model year 4 (the first implementation period) states will implement a Medicaid Payment Approach that supports Practice Participants in implementing the care delivery framework for people with Medicaid. Practice Participants in selected states who also serve people with Medicare and those who are dually eligible may participate in the additional Medicare Payment Approach. They will receive a per-person-per-month payment from CMS to support their implementation of the care delivery framework. These payments will be further supplemented with additional performance-based payments throughout the implementation period (model years 4 – 8). Additional information about eligibility to receive these payments is detailed in the NOFO.
The IBH Model is intended to prepare Practice Participants for advanced payment approaches and accountable care arrangements in the future.
Model Participation
CMS will award cooperative agreements to up to eight state Medicaid agencies (SMAs).
State Medicaid agencies (SMAs) from all U.S. states, territories, and the District of Columbia were eligible to apply to participate in the IBH Model If selected, a participating state is required to select Practice Participants that are specialty behavioral health practices that, at the time of application, meet all the following criteria:
- Are licensed by the state awardee to deliver behavioral services, either mental health and/or substance use disorders;
- Meet all state-specific Medicaid provider enrollment requirements;
- Are eligible for Medicaid reimbursement;
- Serve at the outpatient level of care, at least 25 people enrolled in Medicaid on average per month (age 18 or older) with moderate to severe behavioral health conditions; and
- Provide mental health and/or substance use disorder services at the outpatient level of care.
People enrolled in Medicare and Medicaid, including those who are dually eligible, who receive behavioral health care from a Practice Participant are eligible to receive services as part of the IBH Model. All applications will be reviewed by a panel of technical experts.
Health Equity Strategy
The IBH Model supports CMS’ broader efforts to promote health equity and ensure all populations can achieve optimal health outcomes.
People with mental health conditions, substance use disorder, or both often experience health disparities. These health disparities are further exacerbated among historically marginalized racial and ethnic groups, low-income, and rural populations.
Practice Participants are required to create a health equity plan (HEP) using a needs assessment of the population they serve. The HEP should detail steps that Practice Participants will take to address the population needs and stipulate how the practice participant will address disparities that disproportionately impact their service populations.
Additionally, the IBH Model will require Practice Participants to annually screen and monitor patients for underlying and/or unmet health-related social needs and make necessary referrals to other health care providers or local safety-net services. The required care management component will help ensure that eligible individuals receive the services needed to address their health-related social needs.
Additional Information
Background Resources
- IBH Model Fact Sheet (PDF)
- IBH Model Press Release
- IBH Model Fact Sheet on Model Benefits for State Medicaid Agencies (PDF)
- IBH Model Patient Journey Map (PDF)
- IBH Model Overlaps Policies Fact Sheet (PDF)
- IBH Model Frequently Asked Questions
Past Events
- IBH Notice of Funding Opportunity Office Hours
- Jul 25, 2024
- Aug 7, 2024
- Aug 22, 2024
- Sep 4, 2024
- IBH Model Notice of Funding Opportunity Webinar (July 11, 2024)
- IBH Overview Webinar (February 29, 2024)
Outreach
If you are interested in receiving additional information, updates, or have questions about the Innovation in Behavioral Health Model, please see the resources below:
- Email: IBHModel@cms.hhs.gov
- Sign Up for email updates from the Innovation in Behavioral Health Model team