Innovation in Behavioral Health (IBH) Model

On December 18, 2024, CMS announced that state Medicaid agencies in Michigan, New York, Oklahoma, and South Carolina were selected to participate in the Innovation in Behavioral Health (IBH) Model. Model implementation will begin on January 1, 2025.

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On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) announced the Innovation in Behavioral Health (IBH) Model.

The IBH Model is focused on improving the quality of care and behavioral and physical health outcomes for adults enrolled in Medicaid and Medicare with moderate to severe mental health conditions and substance use disorder (SUD).  

Medicaid and Medicare populations experience disproportionately high rates of mental health conditions or SUDs, or both. As a result, they are more likely to experience poor health outcomes such as frequent visits to the emergency department and hospitalizations, or premature death.

The IBH Model seeks to bridge the gap between behavioral and physical health. Specialty behavioral health practices under the IBH Model will screen and assess patients for priority health conditions, as well as mental health conditions or SUD, or both. The IBH Model is a state-based model, led by state Medicaid agencies, with a goal of aligning payment between Medicaid and Medicare for integrated services.

On December 18 CMS announced that state Medicaid agencies (SMAs) in Michigan, New York, Oklahoma, and South Carolina were selected to participate in the IBH Model. Oklahoma will implement the IBH model statewide, and Michigan, New York, and South Carolina will implement the model in designated sub-state geographic service areas.

The eight-year model period of performance will begin on January 1, 2025. 

Model Overview

The Innovation in Behavioral Health (IBH) Model is designed to deliver person-centered, integrated care to Medicaid and Medicare populations, including those who are dually eligible, with moderate to severe  mental health conditions or substance use disorder (SUD), or both.

Participants in the IBH Model (“Practice Participants”) will be specialty behavioral health practices, including community mental health centers, opioid treatment programs, and public or private practices, where individuals can receive outpatient mental health or SUD services, or both. Practice Participants may include safety net providers who ensure that the IBH Model’s priority population, who are at higher risk of poor health outcomes, has access to needed care.

Practice Participants will lead an interprofessional care team and will be responsible for coordinating with other members of the care team to comprehensively address a patient’s care to include behavioral and physical health, and health-related social needs (HRSN), such as housing, food, and transportation.

The Practice Participants will conduct an initial screening and assessment, offer treatment or referrals to other care specialists and community-based resources, and monitor ongoing behavioral and physical health conditions, and HRSNs. In this value-based care approach, the Practice Participants will be compensated based on the quality of care provided and improved patient outcomes. 

Highlights

  • A quarter of all people enrolled in Medicare experience mental illness, and 40 percent of all adults enrolled in Medicaid experience mental illness or SUD. Medicaid and Medicare populations also experience higher than average rates of SUD. People with behavioral health needs often have trouble accessing necessary health care, have unmet health-related social needs, experience poor health outcomes, and have premature mortality.
  • The Innovation in Behavioral Health (IBH) Model supports specialty behavioral health practices to coordinate care across different types of providers to address Medicaid and Medicare patients’ behavioral and physical health, and health-related social needs. States selected to participate in the voluntary model are responsible for ensuring delivery of integrated care, with comprehensive care coordination and care management, to fully support an individual’s care needs.
  • As a result, people served by this model can expect to receive more integrated care that may result in fewer visits to the emergency department and improved behavioral and physical health outcomes.

Model Purpose

Innovation in Behavioral Health (IBH) Model: Delivering Coordinated, Whole-Person Care showing Julia’s Outcomes under the IBH Model
(PDF)

Medicaid populations experience disproportionately high rates of mental health conditions or substance use disorders (SUD), or both, and account for nearly half of all Medicaid expenditures. Medicare populations also experience higher than average rates of mental illness or SUD, or both. Consequently, both populations are more likely to experience frequent visits to the emergency department and hospitalizations, have poor health outcomes, and premature death.

Limited access to care, stigma, and untreated or poorly managed priority health conditions like diabetes and heart disease can contribute to worsening health outcomes for these populations. Behavioral health providers face significant barriers to deliver care due to a lack of resources and a fragmented health care delivery system that does not systematically integrate behavioral and physical health care. The IBH Model aims to help participating practices improve access to and promote high-quality integrated care. By supporting specialty behavioral health practices to lead an interprofessional care team, the model will address patients’ behavioral and physical health, and HRSNs.

Model Design

The IBH Model is a state-based model focused on specialty behavioral health practices that treat people with Medicaid and Medicare and includes both Medicaid and Medicare-aligned Payment Approaches. On December 18, 2024, CMS issued awards to four (4) state Medicaid agencies (SMAs) to implement the IBH Model. The selected states will then recruit Practice Participants that will be eligible to participate in both the Medicaid and Medicare components of the IBH Model. The selected states will partner with their state’s mental health, SUD authorities, or both to ensure alignment in clinical policies. Selected states will also work with at least one partnering Medicaid managed care organization (MCO) or another intermediary partner, where applicable, to develop and implement the IBH Model in their state. States delivering Medicaid services through the fee-for-service system are also eligible to participate.

The IBH Model supports specialty behavioral health practices in delivering integrated care in outpatient settings. This person-centered approach to addressing whole-person health prioritizes close collaboration with primary care and other physical health providers to support all aspects of a patient’s care.

Specialty behavioral health practices will be responsible for conducting screenings and assessments of behavioral and physical health, and health-related social needs, offering treatment as appropriate within their scope of practice, providing closed-loop referrals to other primary care providers, specialists, and community-based resources, and monitoring ongoing conditions. Since people with moderate to severe behavioral health conditions frequently visit behavioral health settings, this approach uses the behavioral health setting as a point of entry to identify and secure further care and facilitate close collaboration with primary and specialty care providers.

The model works to improve care through four key program elements:

  • Care Integration: Behavioral health Practice Participants will screen, assess, refer, and treat patients, as needed, for the services they require.
  • Care Management: An interprofessional care team, led by the behavioral health practice participant, will identify, and as appropriate address, the multi-faceted needs of patients and provide ongoing care management.
  • Health Equity: Behavioral health Practice Participants will conduct screenings for HRSNs and refer patients to appropriate specialty-based services. Participating practices will be required to develop a health equity plan. The HEP should stipulate how disparities that impact their service populations will be addressed. 
  • Health Information Technology: Expansion of health information technology (health IT) capacity through targeted investments in interoperability and tools (including electronic health records) will allow participants to improve quality reporting and data sharing.

The IBH Model will have eight performance years, including a pre-implementation period (model years 1 – 3). During this period and throughout the implementation period, states and Practice Participants will receive funding to develop and implement model activities and capacity building. During model year 1, states will conduct outreach and recruit specialty behavioral health practices, to the model. Practice Participants will receive funding to support necessary upgrades to health IT and electronic health records, as well as practice transformation activities, and staffing to implement the model. Practice Participants who elect to participate in the Medicare Payment Approach will also be eligible for additional funding to support model activities.

By the start of model year 4 (the first implementation period) states will implement a Medicaid Payment Approach that supports Practice Participants in implementing the care delivery framework for people with Medicaid. Practice Participants in selected states who also serve people with Medicare and those who are dually eligible may participate in the additional Medicare Payment Approach. They will receive a per-person-per-month payment from CMS to support their implementation of the care delivery framework. These payments will be further supplemented with additional performance-based payments throughout the implementation period (model years 4 – 8). Additional information about eligibility to receive these payments is detailed in the NOFO.

The IBH Model is intended to prepare Practice Participants for advanced payment approaches and accountable care arrangements in the future.

Model Participation

CMS had the opportunity to award cooperative agreements to up to eight state Medicaid agencies (SMAs). On December 190, CMS announced the four state Medicaid agencies participating in IBH.

State Medicaid agencies (SMAs) from all U.S. states, territories, and the District of Columbia were eligible to apply to participate in the IBH Model. If selected, a participating state is required to select Practice Participants that are specialty behavioral health practices that, at the time of application, meet all the following criteria: 

  • Are licensed by the state Recipient to deliver behavioral services, either mental health and/or substance use disorders;
  • Meet all state-specific Medicaid provider enrollment requirements;
  • Are eligible for Medicaid reimbursement; 
  • Serve at the outpatient level of care, at least 25 people enrolled in Medicaid on average per month (age 18 or older) with moderate to severe behavioral health conditions; and
  • Provide mental health and/or substance use disorder services at the outpatient level of care.

People enrolled in Medicaid and Medicare, including those who are dually eligible, who receive behavioral health care from a Practice Participant are eligible to receive services as part of the IBH Model. All applications will be reviewed by a panel of technical experts.

Health Equity Strategy

The IBH Model supports CMS’ broader efforts to promote health equity and ensure all populations can achieve optimal health outcomes.

People with mental health conditions, substance use disorder, or both often experience health disparities. These health disparities are further exacerbated among historically marginalized racial and ethnic groups, low-income, and rural populations.

Practice Participants are required to create a health equity plan (HEP) using a needs assessment of the population they serve. The HEP should detail steps that Practice Participants will take to address the population needs and stipulate how the Practice Participant will address disparities that disproportionately impact their service populations.

Additionally, the IBH Model will require Practice Participants to annually screen and monitor patients for underlying and/or unmet health-related social needs and make necessary referrals to other health care providers or local safety-net services. The required care management component will help ensure that eligible individuals receive the services needed to address their health-related social needs.

Additional Information

Background Resources

Past Events

 

Outreach

If you are interested in receiving additional information, updates, or have questions about the Innovation in Behavioral Health Model, please see the resources below:


 

Where Health Care Innovation is Happening