Providing Care Management for Mental Illnesses

October 27, 2017

Written by Kristen Schuster, Practice Facilitator

The first year of CPC+ is quickly coming to an end and it is a good time to take a pulse check! Track 2 practices are required to choose a behavioral health integration (BHI) option and need to start implementing this service in to its care. Remember Track 1 practices, you are not off the hook. Program Year 2 changes were outlined in the 10/20 blog and now Track 1 practices need to choose a BHI model and begin implementation for 2018.

There are two different tracks a practice can choose for BHI. This blog is going to outline the care management for mental illnesses model and will also include information on how to bill for behavioral health services. Don’t worry, next week will have the details on the primary care behaviorist model.

The care management approach to BHI identifies patients with a mental health condition that would benefit from proactive, relationship-based care management (CM), with specific attention to care management of the mental health condition (e.g., Major Depressive Disorder/Dysthymia, Generalized Anxiety Disorder, and Panic Disorder). The care management model will utilize a care team member that has had additional education in behavioral health but does not need to have behavioral health credentials (ex. licensed clinical social worker, psychologist, etc.)

Steps for Implementation

Identify a team member (RN, LPN, etc.)
Supply additional training as needed (education links are listed below)
Select a health condition(s) to prioritize patients in need
Choose a standardized screening tool and develop a workflow for communicating the results to other care team members
Identify or develop stepped care, evidence-based, treatment algorithms for mental health condition(s) identified for care management, incorporating principles of shared decision making and self-management support

Example: A patient that scores a 10-14 on the PHQ-9 will receive a basic assessment, self-management support, an action plan and a follow-up plan

Identify a behavioral health professional within the care community to aid the care manager in decision making for complex cases
Establish a plan for patients needing additional treatment and support

Example: A referral to a psychologist for a patient needing support with addiction

Remember: CMS does not require a specific training or license for the care manager. Choose a care team member that has an interest in behavioral health and is willing to get additional training.

Billing for Care Managers

The following payment structure may be used for patients with any behavioral health condition that is being treated by the treating provider, including substance use disorders.

G0502 – First 70 minutes in the first calendar month for behavioral health care manager activities, in consultation with a psychiatric consultant and directed by the treating provider.

$142.84

G0503 – First 60 minutes in a subsequent month of behavioral health care manager activities.

$126.33

G0504 – Each additional 30 minutes in a calendar month of behavioral health care manager activities listed above.

$66.04

G0505 – Assessment and care planning for patients with a cognitive impairment.

$238.30

Please review the cheat sheets below for billing requirements for these codes. Remember: Practices still are not able to bill G0506 and G0507.

If your organization has not chosen a BHI model the recordings for the BHI action groups are available on CPS+ Connect. Also, stay tuned for the Mountain-Pacific Blog next week to outline the Primary Care Behaviorist Model. Don’t forget about the On the Plus Side, a weekly newsletter, emailed to all subscribers that lists upcoming educational events, CPC+ tasks and links to CMS resources. As always, complete CPC+ information from CMS can be found on the CPC+ Connect Portal. We encourage you to access the portal and check out all available CMS CPC+ resources.

If you have any questions, or run into issues with any of the CPC+ objectives and would like help please use the “Leave a Reply” section below, or email Kristen Schuster directly with your questions or comments.

Other Resource Links

Other Resource Links
Aims Care Manager Training
Cheat Sheet for BHI Billing
G0505 Billing
BHI Care Management Worksheet
BHI Menu of Options
See all CPC+ Blog Posts

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