CMS looks to launch behavioral health pay model


The CMS is interested in launching a new pay model that will target behavioral health services and is seeking public comment on what the new effort should look like.

On Thursday, the CMS announced that its Innovation Center would like to design a payment or service delivery model to improve healthcare quality and access for Medicare, Medicaid or Children’s Health Insurance Program beneficiaries with behavioral health conditions.

The model may address the needs of beneficiaries battling substance use or mental disorders. It could also target Alzheimer’s disease and related dementias.

The Innovation Center will be soliciting ideas at a public meeting on Sept. 8 at CMS headquarters in Baltimore.

The announcement comes at a time when agency officials say they are still committed to value-based care. For months, there have been concerns the CMS would abandon its move toward value-based pay models after Dr. Tom Price became HHS secretary. Price had been critical of the Innovation Center and bundled-pay efforts when he was a member of Congress.

These concerns intensified when the CMS delayed the effective dates for four Obama-era bundled-payment initiatives covering cardiac and orthopedic care and announced it was seeking public comment on the overall future of the models. The agency also announced plans to allow up to 800,000 small and rural providers to be exempt from the new quality reporting system outlined in the Medicare Access and CHIP Reauthorization Act.

Since then, CMS officials have reiterated that clinicians who have invested millions in implementing pay models or the quality reporting system under MACRA don’t need to worry about the CMS changing course.

“The horse is out of the barn on this,” Dr. Kate Goodrich, chief medical officer at the CMS said at a bundled-pay summit in late June. “We will be continuing this progress towards value-based care under this new administration.”

However, the Trump administration’s value-based efforts may differ from the prior administration’s in terms of how much Medicare spending will be tied to new models of care.

The Obama administration wanted 30% of payments for traditional Medicare benefits to be tied to alternative payment models such as accountable care organizations or bundled-pay models by the end of 2016 and had set a goal of hitting 50% by the end of 2018.

The Obama administration hit the first goal last March, but it’s unclear if the Trump administration will shoot for the second one, according to Goodrich.

“We are currently thinking about what we want the next set of goals and targets to be,” Goodrich said.

Freezing implementation of various models was merely new leadership’s attempt to better understand them and their potential benefits, according to Christina Ritter, director of the patient care models group at the CMS.

“These kinds of delays a very typical for a new administration,” Ritter said at last month’s summit. “I want to make sure people understand that before there is a whole ton of reading tea leaves.”

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