North Carolina Medicaid Opens the Door for Collaborative Care

By Chad Stage, MA,
Emtiro Health

When the state of North Carolina set out to transform Medicaid over 3 years ago, many in the behavioral health world cringed.

The public behavioral health community has undergone some form of change about every five years for the last 20 years; from the days of community mental health centers, to the formation of the Local Management Entity (LME) system and the current LME/MCO structure.

Each of these major changes have required flexibility and resilience on the part of those working in the public mental health arena, particularly as they seek to help confused consumers navigate the continual system changes. However, as Medicaid Transformation has unfolded, a little ray of sunshine has emerged, symbolizing that we just might be moving toward an era of better care for patients with behavioral health needs.    

Some of the first official documents produced by the Division of Medical Assistance (DMA) – North Carolina’s Medicaid department – contained language that not only behavioral health providers, but also many medical providers, had been hoping for.  Words like “integration” and “innovative” were littered throughout these documents. Additionally, there was mention of the notion of funding that would support the delivery of behavioral health treatment in a physical health setting. Through Medicaid Transformation, the state has showed its first signs of moving away from a completely bifurcated system, where funding for physical health flows one direction and funding for behavioral health flows another. This change opens the door for primary care providers (PCPs) to adopt practices that incorporate behavioral health integration on a scale that has previously been too costly and ultimately unsustainable for most PCPs.

Up to this point, most practices that have adopted integration models (e.g. Co-location, Primary Care Behavioral Health, and Collaborative Care) have been clinic-based. These decisions to base the integration models within clinics have often resulted in high financial costs to the practice or were grant-funded decisions where the integration ultimately ends with the grant term. For the past two years under the support of a grant, Emtiro Health has worked with three different clinics to implement the evidence-based Collaborative Care Model. We’ve worked diligently with these practice sites to train their staff on the Collaborative Care Model, train the care manager, and provide ongoing technical assistance to work out the kinks in the program. We’ve spent countless hours working to get the clinics operating at maximum capacity, all the while wondering what might happen when the grant term ends.

That was until our little ray of sunshine appeared on the horizon.

In January of 2017, the Centers for Medicare and Medicaid Services (CMS) announced the Medicare G-Codes that were designed specifically to support the collaborative care model of integration. Our team began frantically working to understand all the components and requirements needed to effectively and ethically bill these codes. We quickly learned that these G-codes did not easily fit into a primary care billing structure. There are several reasons that the billing of these codes are challenging for a primary care clinic:

  1. They are based on monthly accrued time per patient and can only be billed once the team reaches a certain amount of time spent on any given patient. (Initial month = 70 minutes or billable at 36 minutes, subsequent month= 60 minutes or billable at 31 minutes.)  This type of time-based billing is foreign to PCPs who operate in a fee for service environment.

  2. Primary care electronic medical records do not have these types of time accrual registries built into them. Therefore, all time tracking must be done manually by the care manager. Although this is doable, it proves to be quite a time consuming and archaic way of tracking time spent per patient.

  3. Having such a limited payer base (only Medicare) means that only a small portion of a practice’s empaneled patients are able to participate. This limitation made it questionable whether it would be financially sustainable for PCPs, especially because they want to provide these services to all patients, not just a small subset.

Then, just a few days ago, North Carolina Medicaid announced that the collaborative care codes will take effect in Medicaid effective October 1, 2018. With this announcement, and North Carolina’s commitment to integrated care through Medicaid Transformation, the collaborative care model becomes a much more financially stable and executable reality for primary care practices.

Emtiro Health has extensive experience implementing the collaborative care model in conjunction with PCPs. We stand ready to assist practices in implementation of this evidence-based model. We can help practices navigate the billing complexity, develop appropriate workflows to effectively implement the model, and address other practice-specific needs to be successful with this model of care.

Not ready to hire the staff to carry this out? That’s okay. Emtiro Health can help practices with that too. We have experienced and capable care managers, consulting psychiatrists, and the necessary information technology resources to carry out the collaborative care model for PCPs.

Whether you're a patient, provider, or community-based organization, Emtiro Health's products and services can provide the inspired, bold support you need to achieve that brighter future. Contact Emtiro Health today to discuss how we can work together to chart a course for a brighter future for you and your interests.

Brea Neri