The U.S. Centers for Medicare & Medicaid Services (CMS) is taking a significant step to improve access to behavioral health care by streamlining Medicaid behavioral health consultations. In a memo released Thursday, CMS informed state health officials that Medicaid programs may now directly pay consulting providers for interprofessional consultations—even when the patient is not present. This change aims to reduce administrative burdens for providers while improving patient access to specialized behavioral health care.
Previously, Medicaid and Children’s Health Insurance Program (CHIP) officials required providers to receive a larger-than-normal payment for a consultation and then pay the consulting specialist from that amount. CMS recognized that this process was cumbersome, time-consuming, and often created barriers to accessing specialists. The new policy allows for direct payment to consulting providers, simplifying Medicaid behavioral health consultations and making the process more efficient for both primary care providers and specialists.
“With today’s action, more families will be able to access the specialty care they need — including specialty care for children and adults with mental health needs,” said Department of Health and Human Services Secretary Xavier Becerra. “This is a key step forward in President Biden’s plan to address the nation’s mental health crisis by ensuring that mental health care is as accessible as physical health care.”
What Are Interprofessional Consultations?
Interprofessional consultations connect primary care providers with specialists to provide expert guidance on complex cases. This approach ensures that patients with behavioral health needs can receive timely and coordinated care. CMS highlights the importance of Medicaid behavioral health consultations for adults with mental illness, individuals with substance use disorders, and children with behavioral health challenges.
Provider shortages across the U.S. were a major factor in this policy change. CMS reports that roughly 158 million Americans live in areas lacking sufficient behavioral health practitioners. By allowing direct payment for consulting specialists, the agency hopes to encourage more providers to participate in Medicaid behavioral health consultations, improving access to care for underserved populations.
“Input from specialists with particular expertise in the beneficiary’s health conditions can be a critical component of care,” the CMS memo reads. “CMS encourages states to take advantage of this flexibility in their Medicaid and CHIP programs.”
Part of a Broader Mental Health Strategy
CMS’ efforts to streamline Medicaid behavioral health consultations align with the Biden administration’s broader mental health strategy, which aims to treat mental health care with the same priority and accessibility as physical health care. This initiative reduces administrative and financial barriers for providers, enabling faster and more effective specialist input for patients in need.
In addition to this policy, CMS has implemented several other initiatives to expand behavioral health access:
- National Provider Directory Proposal: In October, CMS proposed creating the first national directory of health care providers to help patients locate qualified specialists.
- Essential Community Providers: CMS recently suggested designating mental health and substance use disorder facilities as essential community providers under Affordable Care Act (ACA) plans.
- Network Adequacy for Medicare Advantage Plans: The agency proposed stronger standards requiring plans to include clinical psychologists, licensed clinical social workers, and prescribers of medication for opioid use disorder.
These efforts work together to address behavioral health provider shortages and improve access to specialty care. By making Medicaid behavioral health consultations easier to implement and reimburse, CMS is encouraging more specialists to participate, ultimately benefiting patients who need timely expert guidance.
Implications for Providers and Patients
For providers, the new policy reduces administrative hurdles and ensures consulting specialists are compensated fairly and promptly. For patients, it allows faster access to expert guidance on behavioral health concerns. Integrating interprofessional consultations into routine care ensures that mental health needs are addressed alongside physical health, making care more holistic and responsive.
By streamlining Medicaid behavioral health consultations, CMS is taking a meaningful step toward bridging gaps in behavioral health care access. As the nation continues to face a mental health crisis, these changes promise to make specialty care more reachable for both children and adults, particularly in underserved areas.
