Medicaid Psych Collaborative Care Model Final Policy Released, Effective Aug. 1

The Michigan Department of Health and Human Services (MDHHS) recently released a final policy to establish Medicaid program coverage conditions and requirements for the Psychiatric Collaborative Care Model (CoCM) effective for dates of service on and after Aug. 1, 2020. The goal of the model is to improve access to care for mild to moderate behavioral health disorders in the primary care setting for Medicaid fee-for-service and Medicaid health plan enrollees. Participation in the program is voluntary and not required prior to obtaining a referral to specialty behavioral health services. 

Eligible conditions for the CoCM include, but are not limited to:

  • Mild to moderate depression.
  • Anxiety.
  • Bipolar disorder.
  • Attention deficit disorder.
  • Substance use disorder.
  • Potential ineligibility for specialty services through the Community Mental Health Services Program.

CoCM services must include an initial assessment, continued monitoring and monthly monitoring. These services are covered for Medicaid beneficiaries diagnosed with a psychiatric disorder that requires a behavioral health care assessment; establishing, implementing, revising, or monitoring a care plan; and brief interventions.

For primary medical care practices that meet all CoCM team criteria, Medicaid will cover CoCM services provided by the care team and rendered by the primary care provider for six months. After the initial six months, prior authorization is required for six additional months if the beneficiary shows improvement and has a need for continued care. If no improvement occurs after the initial six months or the patient’s condition worsens, the beneficiary should be referred to specialty services.

CoCM services will be paid via a bundled monthly payment to the primary care provider, who is expected to have a contract with the psychiatric consultant and pay for the consultant’s services as part of the CoCM. Members with questions should contact Vickie Kunz at the MHA.