Innovation In Behavioral Health

The CMS Innovation Center is announcing a new NOFO focusing on improving the quality of care for people with behavioral health needs.

The Innovation in Behavioral Health Model (IBH) aims to improve quality and outcomes by establishing a standard of integrated care in mental health and substance use disorder health care settings. The model will increase access for people with Medicare and Medicaid by offering an aligned care delivery and payment model to community behavioral health providers to enhance existing services and achieve greater equity in outcomes for historically underserved populations by focusing on health-related social needs (HRSN). The Innovation Center will test the model in up to eight states in partnership with state Medicaid agencies and Medicaid Managed Care Organizations (MCOs) or intermediaries to recruit behavioral health provider organizations. In order to participate in the model for people with Medicare, behavioral health care providers must also participate in Medicaid.

Eligible applicants are all 50 states, Washington DC, and territories. Eligible U.S. territories include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the United States Virgin Islands.

The IBH Model will include adult Medicare and Medicaid beneficiaries (including dually eligible individuals) who receive care for moderate to severe mental health conditions and/or SUD in a community-based setting. The IBH Model will not include or exclude beneficiaries solely based on diagnosis. All adult beneficiaries receiving care from eligible Practice Participants identified using claims analysis will be eligible for the Model, regardless of their specific BH diagnoses. Recipients should encourage Practice Participants to educate beneficiaries regarding IBH services and develop standardized practices to determine their need for IBH care delivery framework services.

Cooperative Agreement funding is to be used for Recipient's costs in developing and operationalizing the IBH Model. Funding may be used for statewide infrastructure, health IT, staffing, interoperability projects, and convening. Cooperative Agreement funds may not be used to pay providers for services covered under Medicare, Medicaid, and/or CHIP, including services already covered under such programs or any newly covered services under this model. Recipients are encouraged to leverage other Medicaid funding sources, such as Medicaid 90/10 funding, to advance the Model aims. Recipients will be required to develop the Medicaid APM in accordance with CMS and state-based Medicaid policy. Cooperative agreement cannot be used to finance the care delivery services provided under the Model.

CMS will award eight-year cooperative agreements to a maximum of eight award Recipients ("Recipients"). The Model consists of a three-year Pre-Implementation Period along with a five-year Implementation Period. Method of awarding/releasing assistance: Recipients drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web-based payment system for HHS awards.

All qualified applications will be forwarded to a merit review committee. The results of the merit review of the applications by qualified experts will be used to advise the CMS approving official. In making these decisions, the CMS approving official will take into consideration: recommendations of the review panel; the readiness of the applicant to conduct the work required; the scope of overall projected impact on the aims; reviews for programmatic and grants management compliance; the reasonableness of the estimated cost to the government and anticipated results; and the likelihood that the proposed project will result in the benefits expected. Notification is made in writing by a Notice of Award (NoA).

Applications will be due 60 days after the NOFO is posted.

The application review period will take approximately 60 days.