Email Updates
Financing by Payer
Medicare, Medicaid, the Children’s Health Insurance Program, and private payers have different coverage rules, reimbursement structures, and incentive models that directly shape how IBH services can be implemented and sustained.
Medicare
Navigate Original Medicare and Medicare Advantage requirements and payment models to support sustainable behavioral health integration.
Medicaid and the Children’s Health Insurance Program (CHIP)
Navigate federal and state-specific Medicaid/CHIP requirements and payment models to support sustainable behavioral health integration.
Private Payers
Navigate employer-sponsored and marketplace plan requirements and payment models to support sustainable behavioral health integration.
Financing by Setting
Primary care settings and care delivery models are influenced by several factors (e.g., contracting environment; federal and state provisions and requirements for coverage, reporting, and payment; and payer-specific policies) that shape which financing strategies are most viable.
Safety-Net Primary Care Settings
Navigate prospective payment and federal grant program eligibility and reporting requirements.
Accountable Care Organizations (ACOs)
Navigate federal, state, and private payer ACO program shared-savings and risk-based payment arrangements and reporting requirements.
Health Systems
Navigate complex governance structures and siloed departmental budgets.
Medical Homes & Health Homes
Navigate federal and state program eligibility, reporting requirements, and payment models.
Independent Primary Care Practices
Navigate limited negotiating power and limited capacity to assume risk.
Direct Primary Care Practices
Navigate membership-based revenue models and direct-to-patient or employer contracting.
Financing by Patient Population
Patient populations differ significantly in their health needs, benefit eligibility, and available coverage options, all of which affect the feasibility and design of financing strategies for IBH.
Patients with Substance Use Disorders (SUD)
Navigate payment for standardized SUD screening and brief interventions, referral pathways to specialty treatment, and the initiation of pharmacological or medication-assisted treatment.
Dual Eligible Patients (Medicare & Medicaid)
Navigate payment for behavioral health services from both Medicare and Medicaid or from Dual Eligible Special Needs Plans.
Pediatric Patients
Navigate payment for behavioral health services from Medicaid/CHIP for services provided in primary care settings or school-based health centers.
Older Adult Patients
Navigate payment for behavioral health services from Medicare/Medicare Advantage or from the Program of All-Inclusive Care for the Elderly.