Medicaid Payment Reform Initiatives to Support Integration



Several payment reform initiatives are shaping the world of behavioral health and primary care integration.  A recent blog post by the National Academy for State Health Policy (NASHP) provided an overview of state strategies being developed and implemented for integrating behavioral health and primary care.  Notably, a number of Medicaid programs now allow Federally Qualified Health Centers (FQHCs) to bill for behavioral health and primary care services that are provided on the same business day. The SAMHSA-HRSA Center for Integrated Health Solutions website provides information on policies, billing codes, and procedures regarding these changes in all 50 states. Universal changes to state-level Medicaid payment policies are encouraged to remove barriers related to the provision of integrated behavioral health and primary care.

The Medicare program has also examined payment reform initiatives as related to FQHCs. As of October 2014, Medicare’s new Prospective Payment System for FQHCs allows for reimbursement for same-day behavioral health and primary care services.

For information on NASHP and their work on policy and payment issues see NASHP.

More information about government-sponsored insurance and payment reform initiatives surrounding behavioral health and primary care can be found at SAMHSA.