Financing IMPACT care varies depending on your setting.

References Bachman J, Pincus H, Houtsinger JK, Unützer J. Funding mechanisms for depression care management: opportunities and challenges. General Hospital Psychiatry. 2006; 28: 278-288. There is overwhelming evidence that depression care management works well for patients and is a cost effective treatment. However, inconsistent third-party reimbursement for depression care management is a significant economic barrier to utilization and sustainability in primary care settings. Seven funding mechanisms, mostly under-utilized and not widely publicized, are described. While substantial obstacles remain in the way of fully implementing these depression care management funding mechanisms, several recent policy advancements provide some optimism for the potential adoption of financial mechanisms to support and disseminate these evidence-based practices. Goldberg RJ, Oxman TE. Billing for the evaluation and treatment of adult depression by the primary care physician. Prim Care Companion J Clin Psychiatry. 2004;6(1):21-26. Depression is a common problem encountered in primary care practice. There are many barriers that the primary care clinician faces in managing patients with depression. Financial reimbursement is one infrequently addressed barrier that influences how care is provided. This article addresses the coding, documentation, and reimbursement issues that pertain to the treatment of depression in the primary care setting. Coding options are reviewed with specific documentation guidelines. Reimbursement and fee schedule issues are also addressed, including clarification of certain limitations on payment by some payers.

Cost of IMPACT

The costs of providing IMPACT care outside of the research study is estimated to be $300-$500 based on:

1. Length of program (which can be less than 12 months)
2. Number and type of visits (e.g. in-person vs. telephone)
3. Type of care management personnel used

For managed care organizations, the cost of offering IMPACT as a member benefit is estimated to be less than $1.00 per member per month (PMPM). In Medicare Advantage plans, a program like IMPACT can significantly increase capitated payments by documenting diagnoses of and treatment for depression under the new HCC payment system.

Billing & Reimbursement

Billing and reimbursement for the kind of care management services provided in IMPACT can be complex. However, there is movement on many fronts to reduce or eliminate this barrier to collaborative care for depression. In nearly all cases, at least some services are reimbursable.

We have pulled together some resources on this issue to help you design a plan that will work for your organization. Please contact us if you would us to send you a copy of any of the references or if you would like to speak with someone at an organization similar to yours that has established a financing plan for IMPACT.

Resources

Financing IMPACT Care
The free Online IMPACT Training includes a module on Financing IMPACT Care. To view the module, click here. Navigate to the Table of Contents (top right) and select Module 13.

Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health
In February 2008, SAMHSA published a report entitled Reimbursement of Mental Health Services in Primary Care Settings that seeks "solutions to the barriers to the reimbursement of mental health services in primary care settings, specifically reimbursement by Medicare and Medicaid." In December of 2007, SAMHSA published a report entitled Examples of States' Billing Codes for Mental Health Services, Publicly Funded, which is a "collection of examples of successful codes that states use to bill for mental health services."

National Association of State Medicaid Directors (NASMD)
In April 2008, the NASMD published an Issue Brief with support from the Health Resources and Services Administration (HRSA), UW Dept. of Health and Human Services. The publication, Serving the Needs of Medicaid Enrollees with Integrated Behavioral Health Services in Safety Net Primary Care Settings, offers examples of how integrated care can work for Medicaid recipients.

HRSA Provider Reimbursement Technical Assistance Materials
HRSA (Health Resources and Services Administration, US Department Health and Human Services) offers a range of technical assistance materials on their website related to provider reimbursement, including Medicare/Medicaid funded, private sector and behavioral health care projects. Click here to go to the HRSA website.