Financing to Support Coordination of Behavioral Health and Primary Care Services

In October 2003, the Health Resources and Servicespopulations now served by the public mental health
Administration issued Program Information Notice (PIN)system.
2004-05 regarding Medicaid Reimbursement forLearning from Pilot Sites:
Behavioral Health Services. The PIN requires Medicaid"Depression in Primary Care: Linking Clinical and
agencies to reimburse Federally Qualified HealthSystem Strategies" is a Robert Wood Johnson
Centers and Regional Health Centers for behavioralFoundation national program to increase the
health services provided by a physician, physicianeffectiveness of depression treatment in primary care
assistant, nurse practitioner, clinical psychologist, orsettings. The program charged its eight demonstration
clinical social worker, whether or not those servicessites with addressing financial and structural issues as
are included in the state Medicaid plan. The PIN clarifieswell as implementing clinical models. A special issue of
that "FQHC/RHC providers must be practicing withinAdministration and Policy in Mental Health and Mental
the scope of their practice under the state law."Health Services Research contains a series of
What might PIN 2004-05 mean for the Medicaidresulting papers, some of which speak directly to the
population? Categorically eligible Medicaid beneficiariesfinancial and policy barriers in the system.
(e.g., TANF, aged/blind/disabled) may or may not beThe pilots reveal the commitment of sites around the
able to easily gain access to public mental healthcountry that continue to patch together funding
services, depending on definitions of target populationsbecause they believe in the integration approach. For
and medical necessity, which vary from state to state.example, in Washington State there is a partnership
In states with public mental health systems that focusbetween the CMHC and the Federally Qualified Health
on populations with serious mental illness and seriousCenter, where the CMHC's clinicians in the FQHC sites
emotional disturbance, PIN 2004-05 creates anare financed by an annual golf tournament - hardly a
opportunity for other Medicaid populations, with highersustainable model. The IMPACT trials, Depression in
physical health and lower behavioral health risks, toPrimary Care project, state Medicaid pilot sites, and an
obtain behavioral health services through a CHC. ThisAetna project all identify similar components for
is consistent with the HRSA initiative to reduce healthfinancing:
disparities and create behavioral health capacity in- Screening
CHCs. PIN 2004-05 helps to assure that safety net- Care management
populations are served.- Psychiatric consultation
But what does PIN 2004-05 mean in terms ofThese are close to the components identified in the
financing and the behavioral health services nowreport of the President's New Freedom Commission
provided to populations with serious mental illness? Theon Mental Health, which emphasized that there must
answer varies from state to state because ofbe a relationship between mental health and general
differing Medicaid models. This variability requires everyhealth. However, these service components are
community partnership between a CHC and a CMHCcurrently missing from public and private sector billing
to assess their specific financing and policycodes and financing policy. The challenge - for federal,
environment in order to identify a business model thatstate and private payors - will be to align financial
will support integration activities. Such partnershipspolicy incentives to support clinical integration, which
must develop policy direction that addresses the needresearch demonstrates is effective in achieving
for greater access to behavioral health services forpositive outcomes.
the Medicaid population, without disadvantaging any