N.C. Medicaid Begins Using Collaborative Care Codes

State Medicaid programs are beginning to adopt reimbursement codes for collaborative care, including payment for psychiatrists who contract with primary care centers as consultants.

This month the state of North Carolina joined Washington State in allowing primary care practices to submit reimbursement codes to treat Medicaid patients using the collaborative care model (CoCM). The collaborative care codes were first developed by the Centers for Medicare and Medicaid Services (CMS), with strong backing from APA, in 2016 and were adopted for patients in the Medicare program in 2017.

Anna Ratzliff, M.D., associate director for education at the University of Washington’s AIMS (Advancing Integrated Mental Health Solutions) Center, told Psychiatric News that the movement by states to adopt collaborative care for their Medicaid populations will extend mental health care and psychiatric expertise to many who are not currently receiving it.

“The reimbursement codes offer payment for some core pieces of collaborative care that are not currently covered in traditional fee-for-service models—especially the work of psychiatric consultants,” she said. “The model allows psychiatrists to partner with primary care and spend a small amount of their time to have a large population impact.”

The state of Washington was the first to adopt the codes for use in the Medicaid program. Several other states are considering adoption of the codes.

“It’s an exciting opportunity, but it does require some time for primary care practices to build the systems necessary for delivering the core components of the collaborative care model that allow them to bill for these services,” Ratzliff said.

The North Carolina Medicaid program, which serves some 2 million people, began using three collaborative care codes on October 1. It is the result of vigorous advocacy by the North Carolina Psychiatric Association (NCPA) and APA. Also vital was the CoCM training that APA provided as a Support and Alignment Network in CMS’s Transforming Clinical Practice Initiative.

To date, APA has trained more than 150 physicians in North Carolina (127 psychiatrists and 29 primary care physicians) in collaborative care. APA is partnering with a number of North Carolina–based provider groups to continue to provide trainings and resources, such as Community Care of North Carolina, the North Carolina Academy of Family Physicians, and the North Carolina Pediatric Society.

“The Medicaid coverage of the collaborative care model in North Carolina will greatly expand access to mental health and substance use disorder treatment in the state,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “The collaborative care model has been proven to effectively provide mental health services to primary care patients. We encourage other states to follow North Carolina’s lead in adopting Medicaid codes for this method of health care delivery.”

NCPA President-elect Jennie Byrne, M.D., called the state’s adoption of the CoCM codes an important development for patients in North Carolina. “The collaborative care model is our best, evidence-based model for psychiatrists to deliver population-based mental health services. It has a demonstrated return on investment and is an opportunity to provide value when psychiatrists are in scarcity. The model allows psychiatrists to be ‘workforce multipliers,’ teaching our primary care colleagues and serving a larger population than we can see one on one.”

Byrne and NCPA Executive Director Robin Huffman emphasized that psychiatrists in the state do not have to be Medicaid provider participants to contract with a primary care center as a psychiatric consultant. The codes are submitted by the primary care practice, which receives a monthly lump-sum payment per patient. Psychiatric consultants are paid by the primary care center on a contractual basis.

“Our Medicaid system has been under reform for years,” Byrne told Psychiatric News. “Behavioral health has been carved out with a totally separate utilization review method that has caused a lot of psychiatrists to drop out. But we have psychiatrists in solo private practice who are interested in this model because it allows them to do more than one thing and engage a population of patients they would not otherwise be able to treat.”

Ratzliff said that the rules for submitting the codes and receiving payment under the Medicaid program differ from state to state. In Washington state, for instance, primary care practices must submit an “attestation form” stating that they will provide the core components of collaborative care—use of a care manager and psychiatric consultant, a registry to track patients over time, and “treatment-to-target.” (The latter refers to using validated instruments, such as the PHQ-9, to track patient progress in reaching designated target scores for recovery.)

Ratzliff said the movement toward adoption of the reimbursement codes by state Medicaid programs means that more and more pediatric practices—which have a high proportion of Medicaid patients—will begin to develop the components of collaborative care.

She urged psychiatrists in states that have not yet adopted collaborative care reimbursement codes for their Medicaid programs to convince their legislators to do so. Guidance on how to do so can be found on the APA webpage titled “Making the Case: Medicaid Payment for the Collaborative Care Model”.

“There is an important role for psychiatrists in advocating for collaborative care,” Ratzliff said. “Psychiatrists made a significant contribution to North Carolina Medicaid’s adopting the codes for collaborative care. That’s a really powerful message of the kind of impact psychiatrists can have.” ■

Information about APA’s CoCM training can be accessed here.