APA successful in advocating for CMS coverage of collaborative care reimbursement
The Centers for Medicare and Medicaid Services (CMS) recently released a final rule on the 2017 Medicare Fee Schedule including the 2017 fee for Psychiatric Collaborative Care Management Services, with improved payment amounts over those included in the proposed rule issued in August.
The coding for these services will support payments to psychiatrists for consultative services they provide to primary care physicians in the collaborative care model. The model was developed by the late Wayne Katon, M.D., and Jürgen Unützer, M.D., M.P.H., at the AIMS Center of the University of Washington. It is the only evidence-based model of its kind and has been proven effective in more than 80 randomized, controlled trials. The AIMS Center has been an invaluable ally to APA in advocating for reimbursement coding for collaborative care.
Under these services (and the CoCM), the primary health care provider employs a behavioral health care manager to provide ongoing care management for a caseload of patients with diagnosed mental health or substance use disorders. A consulting psychiatrist provides the primary care practice with the benefit of his or her specialized expertise in treating such conditions, through regular case review and recommendations for treatment, medication adjustments, the need for specialty care, etc.
The final rule heeded several points made in APA comments in response to the preliminary rule earlier this year — specifically the APA's concern regarding the value of the psychiatric consultant services that are bundled in the code, which resulted in increased payment for these services.