CMS Behavioral Health Strategy

Mission:  To ensure that high-quality behavioral health services and supports are accessible to CMS beneficiaries and consumers.

Vision:  Beneficiaries and consumers with behavioral health needs have access to person-centered, timely, affordable care that enables optimal health and wellness.

The CMS Behavioral Health Strategy focuses on three key areas: 1) substance use disorders prevention, treatment and recovery services, 2) ensuring effective pain treatment and management, and 3) improving mental health care and services. These areas are aligned with CMS’s overall focus on four health outcomes-based domains: coverage and access to care, quality of care, equity and engagement, and data and analytics. Our vision is for all the people we serve to get access to person-centered, timely, and affordable care.

CMS’s behavioral health priorities advance the HHS Roadmap for Behavioral Health Integration, the HHS Overdose Prevention Strategy,  and the HHS Pain Management Task Force Report. 

Behavioral Health Cross Cutting Initiative 

CMS has 12 cross-cutting initiatives as part of the CMS Strategy (PDF), including behavioral health. The Behavioral Health Cross-Cutting Initiative investments and outcomes are described in this Fact Sheet. 

Behavioral Health Highlights

• CMS released the Dr. Todd Graham Pain Management Study (PDF) as required by section 6086 of the SUPPORT Act, which reviews coverage options for pain management under Medicare.  
• The Medicaid/CHIP Mental Health and Substance Use Disorder Action Plan outlines three strategies to improve treatment and support for Medicaid and CHIP beneficiaries with behavioral health needs by increasing access to prevention and treatment, engagement in care, and improving care quality.
• The Guiding an Improved Dementia Experience (GUIDE) Model aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, and caregiver education and support.
• In Medicare, several regulatory changes to improve access to behavioral health were finalized to begin in 2024 including a new benefit category for Marriage and Family Therapists and Mental Health Counselors, and for intensive outpatient services.
• The Multi-State Initiative to Strengthen Primary Care will enhance access and quality of primary care and improve the health system to address priorities specific to communities including care management for chronic conditions, behavioral health services, and health care access for rural residents.
• The 2023 CMS Quality Conference included several sessions on behavioral health topics including integrating physical and mental health, advancing chronic pain care, and best practices in mental health and substance disorder services.
• Re-entry demonstration opportunities for state Medicaid programs to help people receive behavioral health services in the period immediately prior to leaving incarceration.
• CMS’s Center for Consumer Information and Insurance Oversight engaged seven participating state Departments of Insurance with the goal of identifying and addressing state-based barriers to accessing tele-behavioral health services. (PDF)
  • The Story of Sam (PDF) describes a person’s perspective as they move through the substance use recovery process, helping to increase understanding of the recovery experience.
     

Customer Engagement Illustrations

• Pathways to Recovery (PDF) describes how support teams are critically important in a recovery journey in meeting people where they are.
• Beacon of Hope (PDF) focuses on the health care system to illustrate challenges during the recovery process and show how an effective system contributes to successful outcomes.
• The Chronic Pain Experience Visual (PDF) focuses on understanding access to care for chronic pain, services for people with pain, and the experiences of providers who furnish care.

We are focused on the needs of people of all ages who we serve at every stage of life - people with or at risk of developing substance use disorders, people with acute or chronic pain, and people with mental health challenges. 

Coverage and Access to Care

• Improve the Care Experience and increase strategic opportunities to enhance access to high quality, equitable, affordable whole-person care.
• Expand Workforce Capacity and Capability across provider types, including by exploringoptions for training primary care and specialty residents and current clinicians in the detection, diagnosis and management of behavioral health.
• Strengthen Access to Treatment and Recovery Services through innovative care and payment models and the dissemination of promising practices.
• Ensure Effective, Evidence-based Pain Treatment and Management by leveraging strategic opportunities for individualized care. 
• Increase Detection and Enhance Management through Coordination between and Integration of primary and specialty care.

Quality of Care

• Improve Quality Measurement by better understanding and improving measures in behavioral health, substance use disorders, and pain management.
• Increase Opportunities for enhanced access to high quality, affordable, whole-person behavioral health care.
• Improve Access to Crisis Care to effectively respond, stabilize, and follow up. 
• Expand Access to Community-based Mental Health Services and Resources that support care management, crisis prevention, and recovery.
• Strengthen Treatment and Recovery Services through innovative care and payment models, and dissemination of promising and best practices.

Equity and Engagement

• Reduce Disparities to improve access to high quality, affordable, person-centered care, including through technology and telehealth.
• Mitigate the Adverse Effects of Emergencies and Disasters on behavioral health.
• Provide Effective Outreach and Education to inform beneficiaries, consumers, and providers using materials that are culturally and linguistically appropriate.
• Identify and Address Barriers that impede access to evidence-based treatment and recovery services for detection, diagnosis and management across behavioral health.
• Embed Health Equity into care and payment models to optimize whole-person care. 

Data and Analytics for Action and Impact

• Optimize Alignment of CMS data sources to enable coordination across the populations CMS serves.
• Support Data Collaborations and Partnerships across government and the private sector that enhance transparency.
• Use the CMS Behavioral Health Strategy to drive program improvements.
• Create and Integrate Data Sources to improve knowledge about behavioral health in CMS programs.