Sec. 113. Guidance to States on supporting mental health services or substance use disorder care integration with primary care in Medicaid and CHIP
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Not later than 18 months after the date of enactment of this Act, the Secretary shall conduct an analysis of Medicaid and CHIP regarding clinical outcomes among different models of integration of mental health services or substance use disorder care within the primary care setting. Such analysis shall— consider different models for how mental health services or substance use disorder care is delivered and integrated within the primary care setting, including when providers operating in an integrated model are physically located in the same practice or building, when at least 1 provider in an integrated care model is available via telehealth, and when primary care, mental health, or substance use disorder care providers seek education and consultation from other providers through electronic modalities; and evaluate— the use of different payment methodologies, such as bundled payments and value-based payment arrangements; and the use and quality of services to coordinate care, including but not limited to case management, care coordination, enhanced care coordination, and enhanced care management, for mental health services and for substance use disorder care.
Not later than 12 months after the Secretary completes the analysis required under subsection (a), the Secretary shall issue guidance to States on supporting integration of mental health services or substance use disorder care with primary care under Medicaid and CHIP. Such guidance shall be informed by the analysis required under subsection
(a)and, at minimum, shall do the following: Provide an overview of State options for adopting and expanding value-based payment arrangements and alternative payment models, including accountable care organizations and other shared savings programs, that integrate mental health services or substance use disorder care with primary care. Describe opportunities for States to use and align existing authorities and resources to finance integration of mental health services or substance use disorder care with primary care, including with respect to the use of electronic health records in mental health care settings and in substance use disorder care settings. Describe strategies to support integration of mental health services or substance use disorder care with primary care through the use of non-clinical professionals and paraprofessionals, including trained peer support specialists. Provide examples of specific strategies and models designed to support integration of mental health services or substance use disorder care with primary care for differing age groups, including children and youth, and individuals over the age of 65. Describe options for assessing the clinical outcomes of differing models and strategies for integration of mental health services or substance use disorder care with primary care. For purposes of subsections
(a)and (b), integration of mental health services or substance use disorder care with primary care may include (and shall not be limited to, including when furnished via telehealth, when appropriate)— adherence to the collaborative care model or primary care behavioral health model for behavioral health integration; use of behavioral health integration models primarily intended for pediatric populations with non-severe mental health needs that are focused on prevention and early detection and intervention methods through a multidisciplinary collaborative behavioral health team approach co-managed with primary care, to include same-day access to family-focused mental health treatment services; having mental health providers or substance use disorder providers physically co-located in a primary care setting with same-day visit availability; implementing or maintaining enhanced care coordination or targeted case management which includes regular interactions between and within care teams; providing mental health or substance use disorder screening and follow-up assessments, interventions, or services within the same practice or facility as a primary care or physical service setting; the use of assertive community treatment that is integrated with or facilitated by a primary care practice; and delivery of integrated primary care and mental health services or substance use disorder care in the home or in community-based settings for individuals who choose and are able to receive care in such settings, as authorized under subsections (b), (c), (i), (j), and
(k)of section 1915 of the Social Security Act ( 42 U.S.C. 1396n ), under a waiver under section 1115 of such Act ( 42 U.S.C. 1315 ), or under section 1937, 1945, or 1945A of such Act ( 42 U.S.C. 1396u–7 , 1396w–4, 1396w–4a). In this section: The term Secretary means the Secretary of Health and Human Services. The term State has the meaning given that term in section 1101(a)(1) of the Social Security Act ( 42 U.S.C. 1301(a)(1) ) for purposes of titles XIX and XXI of such Act.
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- 42 USC 1396u–7
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Sec. 113
Guidance to States on supporting mental health services or substance use disorder care integration with primary care in Medicaid and CHIP
Cite42 USC 1396u–7
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