Massachusetts Expands Tiered Payment Model for Behavioral Health Integration in Primary Care
MassHealth implemented a sub-capitation program that uses tiered payments to primary care practices based on their level of behavioral health integration. The program creates financial incentives for practices to advance from basic screening and referral capabilities to full on-site behavioral health services. Primary care practices receive higher per-member-per-month payments as they achieve higher tiers of integration, measured by staffing, workflows, and service capacity. The model aims to expand behavioral health access by embedding services in primary care settings where Medicaid members routinely receive care.
This tiered sub-capitation approach provides a replicable model for MCOs to expand behavioral health network capacity and meet integration requirements through differential primary care payments tied to practice capabilities.
Behavioral Health · Managed Care · Finance
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