Innovation in Behavioral Health (IBH) Model

Link

https://www.cms.gov/priorities/innovation/innovation-models/innovation-behavioral-health-ibh-model

Additional Links

Fact Sheet
Notice of Funding Opportunity (Grants.gov)

Deadline

Letter of Intent (Optional): Sep 9, 2024
Application Deadline: Sep 9, 2024

Sponsor

Centers for Medicare & Medicaid Services (CMS)

Purpose

Offers state Medicaid agencies the opportunity to participate in a value-based payment (VBP) model to promote integrated care delivery in specialty behavioral health organizations and settings for adult Medicaid, Medicare, and dually eligible beneficiaries with moderate to severe mental health conditions and/or substance use disorders (SUDs). Aims to increase access, improve behavioral healthcare quality and equity in outcomes, reduce emergency department and inpatient utilization, and strengthen health information technology (health IT) system capacity. The program consists of a 3-year pre-implementation period followed by a 5-year implementation period.

The IBH Model framework is designed to:

• Build and strengthen connections to physical healthcare for beneficiaries
• Promote screening and referral for health-related social needs (HRSN), such as food insecurity, housing instability, unemployment, and transportation needs
• Leverage care management and care coordination to increase access to and engagement with primary care and HRSN services
• Encourage investments in certified health IT products and infrastructure improvements

State Medicaid agencies will be responsible for recruiting and supporting local specialty behavioral health providers, including rural and tribal providers, in the program as practice participants. Practice participants are required to provide the following services:

• Care integration: screening and assessment, treatment, and referral for patients for both behavioral and physical health conditions, as needed and within the provider's scope of practice
• Care management: interprofessional care teams will address patient needs and provide ongoing care management across the patients' behavioral and physical health needs
• Health equity: activities that foster equitable care through health-related social needs (HRSN) screenings, a population needs assessment, and a health equity plan

Amount of Funding

Award ceiling: $7,500,000
Project period: Up to 8 years
Estimated number of awards: 8
Estimated total program funding: $60,000,000

Practice participants will receive direct funding from CMS during the pre-implementation period for infrastructure necessary to implement the model, including health IT, electronic health records (EHRs), practice transformation, new workflows, and staffing investments.

In the implementation period, practice participants will receive aligned payment through Medicaid and Medicare, if participating, as well as pay for reporting and performance incentives on a limited set of quality measures.

Who Can Apply

Eligible applicant are state Medicaid agencies from all 50 states, Washington D.C., and U.S. territories with the authority and capacity to accept the cooperative agreement award funding. Applicants may choose to participate at the state level or designate a sub-state region, subject to CMS approval.

Organizations must meet the following criteria to be eligible as a practice participant:

1. Have at least 1 behavioral health provider that is an employee, leased employee, or independent contractor of the practice that is licensed by the state to deliver behavioral health treatment services, meets state-specific Medicaid enrollment requirements, and is eligible for Medicaid reimbursement
2. Meet all state-specific requirements to deliver behavioral health services, if applicable
3. Serve adult Medicaid beneficiaries with moderate to severe behavioral health conditions (a practice must serve on average at least 25 Medicaid beneficiaries per month at the time of recruitment)
4. Provide mental health and/or SUD treatment services at the outpatient level of care, not including intensive outpatient care

Examples of eligible practice participants include, but are not limited to, the following organizations that provide specialty behavioral healthcare services:

• Community Mental Health Centers (CMHCs)
• Federally Qualified Health Centers (FQHCs) and FQHC look-alikes
• Rural Health Clinics (RHCs)
• Critical Access Hospital (CAH) outpatient behavioral health clinics
• Independent healthcare providers with and without clinic affiliations
• Certified Community Behavioral Health Clinics (CCBHCs)
• Opioid Treatment Programs (OTP)
• Private specialty clinics with and without medical center affiliations
• Specialty substance use disorder provider organizations
• Tribal health organizations and clinics
• Local and territorial health departments and governments
• Other entities that are part of a local government behavioral health authority where a locality, county, region, or state maintains authority to oversee behavioral health services at the local level and uses the entity to provide those services

Ineligible practice participants include inpatient and post-acute care settings, as well as practices that provide only case management or only recovery services and do not provide direct behavioral health diagnostic or treatment services.

Geographic Coverage

Nationwide

What This Program Funds

Capacity Building • Operating Costs and Staffing

Application Process

Application instructions, requirements, and other information can be found in the funding announcement.

Letter of intent (LOI) requested but not required. Applicants should email their LOI to IBHModel@cms.hhs.gov by September 9, 2024.

Applicant webinar recording, slides, and transcript
Applicant office hour #1 recording, slides, and transcript
Applicant office hour #2 recording, slides, and transcript
Applicant office hour #3 recording, slides, and transcript

Contact

IBHModel@cms.hhs.gov

Topics This Program Addresses

Mental Health • Social Services • Substance Use Disorder • Treatment