Behavioral health services, including the psychiatric collaborative care model (CoCM), received rate increases from the Centers for Medicare & Medicaid Services (CMS) for 2027 in its fee schedule final rule, which was released last week.
While historically, collaborative care codes have received uneven adoption, the move from CMS was welcomed by industry groups like the American Psychiatric Association (APA). The final rule increases the value of collaborative care services from primary care physicians and the value of contributions from behavioral health care managers.
“Collaborative care extends the reach of psychiatrists’ expertise by making psychiatric consultation part of the primary care team’s ongoing work,” Dr. Mark Rapaport, president of the APA, stated in a news release. “Stronger payment helps sustain that partnership and the follow-up patients need to get better.”
Under the final rule, there is a higher value to the professional-work portion of CoCM services. A primary care clinician may often be the first door a patient enters into mental health or addiction treatment care through. As such, collaborative models ensure a behavioral health manager coordinates and follows up on those components and may consult a psychiatrist to review a case plan. The update will shift how payment calculations reimburse and recognize staffing resources needed for CoCM services, thereby increasing payment support for the care model.
Still, the Medicare changes are applicable to service reimbursement only, not mandatory pay increases for clinicians or care managers across the board.
Because Medicare beneficiaries do not receive coverage for residential treatment, increasing payment support for psychiatric and behavioral healthcare via other models is one way to shore up resources for this patient population.
The Primary Care Collaborative (PCC), a multistakeholder, nonpartisan group that advocates for improvements in primary care in the U.S. also supported the Medicare changes.
“We’re grateful that CMS appears to have doubled down on its commitment to strengthening whole-person primary care by establishing reimbursement for health coaching, shared medical appointments and more resources for behavioral health integration,” Ann Greiner, president and CEO of the PCC, said in a news release on the matter.
Other shifts worth noting for behavioral health, autism and addiction treatment providers from the final rule includes:
— Increased valuations for SUD and tobacco screening and cessation.
— A rule set in 2024 to gradually increase psychotherapy valuations reaches its final year of increases in the 2027 final rule.
— Ongoing alignment with legislation that relieves patients and providers from the in-person mental health requirements for services through December 31, 2027.
— Removal of the initiation and engagement of SUD treatment reporting.
— Changes to applied behavioral analysis (ABA) reimbursement with an expanded code family and billing system rules.
— Partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) both received updates to daily facility payment rates.
The Medicare changes are set to take effect on Jan. 1, 2027.
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