Medicare incentives for behavioral health integration with primary care

(a)

Incentives

(1)

In general

Section 1848(b) of the Social Security Act (42 U.S.C. 1395w–4(b)) is amended by adding at the end the following new paragraph:

(13)

Incentives for behavioral health integration

(A)

In general

For services described in subparagraph (B) that are furnished during 2027, 2028, or 2029, instead of the payment amount that would otherwise be determined under this section for such year, the payment amount shall be equal to the applicable percent (as defined in subparagraph (C)) of such payment amount for such year.(B)

Services described

The services described in this subparagraph are services identified, as of January 1, 2024, by HCPCS codes 99484, 99492, 99493, 99494, G2214, and G0323 (and any successor or similar codes as determined appropriate by the Secretary).(C)

Applicable percent

In this paragraph, the term applicable percent means, with respect to a service described in subparagraph (A), the following:(i)For services furnished during 2027 , 175 percent.(ii)For services furnished during 2028, 150 percent.(iii)For services furnished during 2029, 125 percent.

(2)

Waiver of budget neutrality

Section 1848(c)(2)(B)(iv) of such Act (42 U.S.C. 1395w–4(c)(2)(B)(iv)) is amended—(A)in subclause (V), by striking and at the end;(B)in subclause (VI), by striking the period at the end and inserting ; and and(C)by adding at the end the following new subclause:

(VII)the increase in payment amounts as a result of the application of subsection (b)(13) shall not be taken into account in applying clause (ii)(II) for 2027, 2028, or 2029.

(b)

Technical assistance for the adoption of behavioral health integration

(1)

In general

Not later than January 1, 2026, the Secretary of Health and Human Services (in this subsection referred to as the Secretary) shall enter into contracts or agreements with appropriate entities to offer technical assistance to primary care practices that are seeking to adopt behavioral health integration models in such practices.(2)

Behavioral health integration models

For purposes of paragraph (1), behavioral health integration models include the Collaborative Care Model (with services identified as of January 1, 2024, by HCPCS codes 99492, 99493, 99494, and G2214 (and any successor codes)), the Primary Care Behavioral Health model (with services identified as of January 1, 2024, by HCPCS codes 99484 and G0323 (and any successor code)), and other models identified by the Secretary.(3)

Implementation

Notwithstanding any other provision of law, the Secretary may implement the provisions of this subsection by program instruction or otherwise. (4)

Funding

In addition to amounts otherwise available, there is appropriated to the Secretary for each of fiscal years 2025 through 2029, out of any money in the Treasury not otherwise appropriated, such sums as are necessary, to remain available until expended, for purposes of carrying out this subsection.