Providing Care Management for Mental Illnesses
November 10, 2017
Written by Kristen Schuster, Practice Facilitator
The 10/27 blog outlined the care management model of behavioral health integration. This blog is going to establish steps for establishing a primary care behaviorist model. Remember, Track 1 practices, you are not off the hook. Program Year 2 changes were outlined in the 10/20 blog and now Track 1 practices need to choose a BHI model and begin implementation for 2018.
The Primary Care Behaviorist model integrates behavioral health into the PC workflow through warm handoffs to a co-located behavioral health professionals to address mental illness in the primary care setting and behavioral strategies for management of chronic general medical illnesses. It also facilitates specialty care engagement for those with serious mental illness. The PC behaviorist model integrates a licensed clinical social worker, someone with a master’s degree in behavioral health or a nurse practitioner with behavioral health training to provide brief therapy and evidence-based treatment for patients with behavioral health diagnosis. The PC behaviorist model is designed to take work off the primary care provider’s plate and provide immediate access to behavioral health care.
- Masters degree, PHD in relevant field, or an LCSW
- Same-day access to behavioral health services
- Provide brief therapy (limited to six 15-20 minute sessions)
- These sessions are brief because the PCP will do all pharmacological reviews and other evidence-based care for the patient
- Integration and communication between PC behaviorist and the care team
- Evidence-based behavioral health treatments are developed by the PC behaviorist
Remember: This model of behavioral health would have a full-time behaviorist seeing 80% of the mental health patients in a CPC+ practice.
Steps for implementation
- Assess your patient population
- A population with severe behavioral health needs may benefit more from this model
- Assess the availability of an onsite behaviorist
- Determine how much time a PC behaviorist is needed
- Ensure office space needs can be met
- Develop a contingency plan for care if the provider is part-time
- Care manager for warm handoff to fill the gap until the behaviorist can reach out to the patient
- Identify patients in need based on established evidence based screening tools (PHQ-9 score)
Remember: Communicate the job duties and establish a workflow before the behaviorist starts working in the CPC+ practice.
Challenges to Anticipate
- Provider and staff understanding of PC behaviorist’s job duties
- Identifying a target population (don’t start too big!)
- Adequate space for sessions
Billing for Behavioral Health
The following payment structure may be used for patients with any behavioral health condition that are being treated this includes substance use disorders.
- G0502 – first 70 minutes in the first calendar month for behavioral health care manager activities, in consultation with a psychiatric consultant and directed by the treating provider
- G0503 – first 60 minutes in a subsequent month of behavioral health care manager activities
- G0504 – each additional 30 minutes in a calendar month of behavioral health care manager activities listed above
- G0505– Assessment and care planning for patients with a cognitive impairment
Please review the cheat sheets below for billing requirements for these codes.
Remember: Practices still are not able to bill G0506 and G0507.
If your organization has not chosen a BHI model, the recordings for the BHI action groups are available on CPS+ Connect. Stay tuned for the Mountain-Pacific’s blog next week where we will outline the Primary Care Behaviorist Model. Don’t forget On the Plus Side is a weekly email newsletter, that lists upcoming educational events, CPC+ tasks and links to CMS resources. As always, complete CPC+ information from CMS can be found on the CPC+ Connect Portal. We encourage you to access the portal and check out all available CMS CPC+ resources.
If you have any questions, or run into issues with any of the CPC+ objectives and would like help please use the “Leave a Reply” section below, or email Kristen Schuster directly with your questions or comments.
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