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Provider Notice Issued 06/21/2022

Date:   June 21, 2022

To:       All Medical Assistance Program Providers

Re:      Coverage of Psychiatric Collaborative Care Model Services 

_______________________________________________________________________________________________________________________________________________________ 
This notice announces coverage of Psychiatric Collaborative Care Model (CoCM) services pursuant to Public Act 101-0574. CoCM services will be covered under both Medicaid fee-for-service and Medicaid managed care organizations effective for dates of service on or after July 1, 2022.

CoCM Overview
 
CoCM is an evidence-based model for integrating behavioral health into primary care settings using a person-centered, team-based approach. The goal of CoCM services is to extend the capabilities of primary care practices to identify and treat customers with low to moderate behavioral health needs. CoCM is intended for customers with common behavioral health conditions that require systematic follow-up due to their chronic nature, including but not limited to: mild to moderate depression, anxiety, post-traumatic stress disorder (PTSD), and substance use disorders (SUD).

The CoCM team is led by a primary care provider (PCP) and includes a behavioral health care manager (BHCM) and a psychiatric consultant. The team develops, implements, and regularly monitors a person-centered care plan, making referrals to specialized services when necessary. The model requires the use of validated screening tools and a patient registry. Five core principles define effective collaborative care and are necessary for an effective implementation of the model:

  • Person-centered care: the customer is part of the treatment team and makes the ultimate decision regarding their treatment.
  • Measurement based treatment-to-target strategy: validated tools are used for the measurement of customer symptoms and needs.
  • Population-based care: the use of a patient registry to allow the team to monitor the customer's outcomes over time.
  • Evidence-based treatment: treatments offered to customers are evidence-based (e.g., medications, brief interventions).
  • Accountable care: the team is accountable for the customer's care, including the quality of care and clinical outcomes.


Additional information on CoCM service delivery requirements, required team composition, and billing guidelines is outlined in the HFS Psychiatric Collaborative Care Model Guidelines


Provider Enrollment
 
CoCM services are reimbursable to physicians, advanced practice nurses, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Encounter Rate Clinics (ERCs), local health departments, and School-Based Health Clinics enrolled in the IMPACT system as one of the Provider Type/Specialty/Subspecialty combinations listed in the table below:

Enrollment
Type
Provider TypeSpecialtySubspecialty
Individual Sole ProprietorPhysicianBehavioral Health IntegrationCollaborative Care
Advanced Practice NurseAPN Behavioral Health IntegrationCollaborative Care
Rendering/
Servicing Provider
Physician AssistantPhysician AssistantsCollaborative Care
Facility, Agency, Organization (FAO)Public Health DepartmentCertified Health DepartmentsCollaborative Care
ClinicSchool Based/Linked Health ClinicCollaborative Care
Federally Qualified Health CenterCollaborative Care
Rural Health ClinicCollaborative Care
Encounter Rate ClinicCollaborative Care

 
Providers must attest to providing CoCM services consistent with the core principles and the specific service delivery requirements outlined in the HFS Psychiatric Collaborative Care Model Guidelines by completing and submitting the Attestation for Collaborative Care Model form. The attestation is required initially as part of the CoCM provider enrollment process and annually thereafter by October 1 of each calendar year. 
 
Questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 or the applicable managed care plan.

 

Kelly Cunningham, Administrator
Division of Medical Programs

 

 



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