HHS Roadmap for Behavioral Health Integration Fact Sheet of Accomplishments

In his first State of the Union, President Biden laid out the Administration’s vision to transform behavioral health by strengthening system capacity, connecting more Americans to care, and supporting the wellbeing of Americans by creating healthy environments.  

Last year, Secretary Becerra, Deputy Secretary Palm and Department of Health and Human Services (HHS) Agency Leaders introduced the HHS Roadmap for Behavioral Health Integration. The HHS Roadmap articulated HHS’ commitment to engaging our entire Department in service of the following goal to further advance the President’s vision: 

The full spectrum of behavioral health care will be integrated into health care, social service, and early childhood systems to ensure all people have equitable access to evidence-based, culturally appropriate, person-centered care. 

Since launching the HHS Roadmap, HHS has advanced a number of critical policy actions to expand access to and the quality of behavioral health care. A subset of these actions are highlighted below. Please note this list is not exhaustive of our efforts. HHS is committed to continuing this important work, and to providing bold leadership that transforms our nation’s behavioral health system to meet the needs of every American.

HHS has taken the following steps over the last year to expand access to behavioral health by integrating behavioral health with primary care and other physical health and community settings:

• The Centers for Medicare & Medicaid Services (CMS) released new policy guidance to encourage direct reimbursement for interprofessional consultations in Medicaid and the Children’s Health Insurance Program (CHIP) if the consultation is for the benefit of the patient, even if the specialist does not see the patient. This policy supports improved integration of mental health (MH) and substance use disorder (SUD) treatment into additional settings, including pediatric primary care offices, emergency departments, and school-based health centers.
• Medicare recently started paying for behavioral health integration services performed by clinical psychologists, licensed clinical social workers, marriage and family therapists, and mental health counselors in primary care settings. Medicare is also now covering Intensive Outpatient Program (IOP) services, closing one of the biggest gaps in Medicare behavioral health coverage. These services can also be provided in hospital outpatient departments, community mental health clinics, Federally Qualified Health Centers, Rural Health Clinics, and Community Mental Health Centers as well as by Opioid Treatment Programs, expanding access in primary care settings for  underserved populations.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) implemented a new track within its Promoting the Integration of Primary and Behavioral Health Care program to support the development of Collaborative Care programs in primary care settings for states receiving these grants.

• The Health Resources and Services Administration (HRSA), through the Bipartisan Safer Communities Act, awarded nearly $60 million in funding to support integration of mental health training into the training of primary care clinicians with a specific focus on preparing primary care providers to treat the mental health needs of children and adolescents.    
• The Administration for Children and Families (ACF) and SAMHSA provided trainings about children’s mental health to parents, caregivers and community members. The trainings were developed in partnership with parent and youth leaders and featured their expertise.
• The Indian Health Service (IHS) awarded 14 grants to Tribes, Tribal Organizations and Urban Indian Organizations totaling $5.5M in 2022 through the Behavioral Health Integration Initiative (BH2I).
• CMS partnered with SAMHSA to implement the Medicaid Certified Community Behavioral Health Clinics (CCBHC) Demonstration across a growing list of states. The CCBHC model promotes complex comprehensive mental health (MH) and SUD services and improved care coordination for individuals with mental illness and/or SUDs.) As part of this demonstration program, CMS issued prospective payment system guidance on reimbursement for clinics that supports wider adoption of the CCBHC model. HHS also most recently awarded $15 million towards this endeavor.
• The National Institutes of Health (NIH) is funding several studies on strategies for incorporating SUD screening and management into primary care settings.

HHS has taken the following steps over the last year to help recruit, train, and support a diverse behavioral health workforce:

• CMS announced policy changes for Medicare payments under the Physician Fee Schedule, effective January 1, 2024. This included provisions to broaden the behavioral health workforce – such as Medicare Part B coverage and payment for marriage and family therapist and mental health counselor (MHC) and Marriage and Family Therapist (MFT) services billed by these professionals, as well as provisions to allow for better integration of physical and behavioral health care. 
• HRSA, through the National Health Service Corps, supports more than 18,000 primary care medical, dental, and behavioral health providers through scholarships and loan repayment programs. The NHSC has increased access to much-needed mental health and opioid use disorder (OUD) treatment in hard-hit areas of the country by supporting more than 8,700 behavioral health providers in 2023.
• HRSA, through the Behavioral Health Workforce Education and Training Program- Children, Adolescents and Young Adults Program, awarded over $11 million to 23 organizations to train more behavioral health providers focused on serving children, adolescents, and young adults in underserved and rural areas.
• SAMHSA funded new Providers Clinical Support System grant awards to provide training and mentoring for practitioners in primary care to assist them in managing SUD in their practices
• CMS, in consultation with HRSA, is advancing opportunities to authorize loan repayment for qualified health care providers through Medicaid 1115 demonstrations. Recently, CMS approved section 1115 demonstration activities for New York and Massachusetts that specifically allocate loan repayment to support behavioral health and the primary care workforce, including for family nurse practitioner residency programs at community health centers.
• SAMHSA, in partnership with the Office of National Drug Control Policy (ONDCP), developed Core Curriculum Elements for integration of SUD content into the early academic training of healthcare professionals; incorporating SUD education into training will prepare the future workforce of tomorrow to address SUD in healthcare. 
• To address provider stigma, NIH launched a study aimed at documenting the impact of substance use stigma in mental health care settings. Lessons from this study will be incorporated into new training curricula designed to enhance the quality and effectiveness of the behavioral health workforce by reducing the professional stigma toward people who use drugs.
• The Centers for Disease and Prevention (CDC) is partnering with the American Academy of Pediatrics to design and launch the first ever National Center for Relational Health and Trauma-Informed Care. This effort will ensure that pediatric providers have the training and resources they need to understand the impact of trauma on all aspects of health and to provide trauma-informed care to children and their families.
• CMS has worked with SAMHSA to create the Center for Excellence for Behavioral Health in Nursing Facilities, a centralized resource hub with easy access to staff trainings, technical assistance, and additional resources, at no cost. The Center’s work is aimed at improving the quality of life for residents living with behavioral health conditions.

HHS has taken the following steps to help strengthen the implementation and enforcement of behavioral health parity:

• HHS, the Department of Labor, and the Department of Treasury proposed critical rules to better ensure that people seeking coverage for mental health and substance use disorder care can access treatment as easily as people seeking coverage for other medical care. Specifically, these proposed rules would amend the existing standard to require health plans to evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental health and substance use disorder benefits and their medical benefits. Importantly, these proposed rules would require health plans to make changes if these analyses show inadequate access to mental health care. SAMHSA has developed publications to support public understanding of parity health conditions.
• HHS, the Department of Labor and the Department of Treasury released the second Mental Health Parity and Addiction Equity Act’s Comparative Analysis Report to Congress. As summarized in the report, CMS requested 21 comparative analyses from 6 non-federal governmental group health plan sponsors and 5 issuers in direct enforcement states between March 25, 2022 and June 6, 2022. After CMS reviewed the comparative analysis from each of the plan sponsors and issuers, CMS identified areas of noncompliance and issued an initial determination of non-compliance to each plan sponsor and issuer.
• CMS works with state agencies to ensure compliance with federal parity requirements in Medicaid managed care and CHIP and issued a request for public comment seeking suggestions for updates to the processes used for implementing parity. 

HHS has taken the following steps over the last year to help engage several of the highest-risk populations—including youth, people who are experiencing homelessness, people who are justice-involved, people with co-occurring disabilities, older adults, people involved with the child welfare system, pregnant people, and victims of domestic violence, trafficking, and other forms of trauma—in integrated behavioral health care through targeted outreach tailored to their needs: 

• ACF, IHS, and SAMHSA, with the Center for Faith-based and Neighborhood Partnerships, held a Tribal Behavioral Health Convening on May 11-12, 2023, to highlight promising practices and outcomes of behavioral health prevention and services developed and implemented by and for children, youth, and families in tribal communities
• ACF has approved 47 Title IV-E prevention plans, including 42 states, 4 tribes, and DC, which allow child welfare agencies to access behavioral health services to prevent unnecessary involvement in the child welfare system. ACF has provided technical assistance to states, territories, and tribes to support the implementation of Title IV-E prevention plans.
• ACF launched the first-ever National Center for Child Welfare Competent Mental Health Services. This Center will provide technical assistance and evidence-informed training to strengthen coordination and capacity among child welfare and mental health professionals and systems to improve the quality of mental health services they provide to children, young adults, and their families and caregivers who are involved in the child welfare system and who have experienced adoption. 
• SAMHSA and ACF developed a critical online training course available in both English and Spanish for mental health consultants and anyone who currently uses or wants to learn more about Infant and Early Childhood Mental Health Consultation (IECMHC). 
• SAMHSA developed and disseminated the National Guidelines for Child and Youth Behavioral Health Crisis Care as well as additional technical guidance in a companion report, “A Safe Place to Be: Crisis Stabilization Services and Other Supports for Children and Youth.” 
• SAMHSA awarded $185.7 million in funding for 299 child and family-serving grants through the Bipartisan Safer Communities Act, including for Mental Health Awareness Training, Resiliency in Communities After Stress and Trauma, Trauma-Informed Services in Schools, National Child Traumatic Stress Initiative, and Project Advancing Wellness and Resiliency in Education. These grantees are supporting health efforts across 231 cities in 47 states, DC, and three territories.
• HRSA’s National Maternal Mental Health Hotline celebrated its one-year anniversary on Mother’s Day 2023. Since its launch in 2022, the 24/7, free, confidential hotline has offered support from professional counselors to nearly 20,000 pregnant and postpartum individuals who struggled with mental health concerns, and their loved ones. Support is available by phone or text, and in English and Spanish. With additional resources received in 2023, HRSA launched and expanded partnerships and increased staffing and promotion efforts to increase the number of people served.
• SAMHSA created the LGBTQI+ Family Support grant program and awarded four grants to prevent health and behavioral health risks (e.g., suicide, depression, homelessness, drug use, HIV) and to promote well-being for LGBTQI+ youth in the context of their families/caregivers, cultures, and communities by establishing LGBTQI+ family counseling and support programs and training providers on effective provision of these evidence-based services.
• The Administration for Community Living (ACL) has funded the Link Center, a national technical assistance and resource center to improve services to people with intellectual and developmental disabilities (I/DD), brain injury (BI) and other cognitive or communication disorders who have co-occurring mental health conditions. This year ACL partnered with SAMHSA to launch a collaboration between the Link Center and the 988 Suicide and Crisis Lifeline to improve crisis support services to this population, including through a Policy Academy to assist states in creating inclusive, accessible 988/Lifeline and crisis response systems that can effectively support this population.
• CMS announced a new Medicaid Reentry Section 1115 Demonstration Opportunity that allows state Medicaid programs to help increase care for individuals who are incarcerated in the period immediately prior to their release to help them succeed and thrive during reentry. To-date, CMS has approved demonstrations in California and Washington with several other state proposals currently under consideration.
• Medicare has increased payment rates for crisis psychotherapy outside of clinical settings such as in the home of the beneficiary, and for Opioid Treatment Programs to furnish treatment via mobile units. These services are expected to increase treatment to hard-to-reach populations such as people in rural areas and persons experiencing homelessness.
• HHS is leveraging strong, interdisciplinary research-practice partnerships to better diagnose and treat opioid use disorder and mental illness. For example, through the Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, NIH has funded four cooperative agreements, one research project grant, and nine supplemental awards to improve the treatment and management of services for people with opioid use disorder and co-occurring mental health conditions and/or suicide risk.

To address the persistent youth behavioral health crisis, HHS has taken the following steps over the last year to help align structural supports and financing to integrate promotion and prevention programs in community-based settings from early childhood to young adulthood, inclusive of schools: 

• The Office of the Assistant Secretary for Health (OASH) established a Children & Youth Resilience Challenge, a $1 million prize competition to encourage community-led, innovative solutions to support resilience in children and youth in the wake of the pandemic. OASH received 500 submissions and in August 2023 awarded 14 finalists to pilot and test community-led solutions to promote resilience in children and adolescents. In May 2024, finalists will participate in an innovators summit in Washington DC and compete for the grand prize.
• CMS released Delivering Services in School-Based Settings: A Comprehensive Guide to Medicaid Services and Administrative Claiming.Developed in consultation with the U.S. Department of Education, this guide offers new flexibilities and consolidates existing guidance, making it easier for all schools, no matter their size or the resources available to them, to receive payment for delivering Medicaid- and CHIP-covered services. 
• CMS, together with the Department of Education, launched a new technical assistance center to assist and expand the capacity of State Medicaid agencies, local education agencies (LEAs), and school-based entities to provide greater assistance through the Medicaid program in schools.
• CDC released a new school mental health action guide, Promoting Mental Health and Well-Being in Schools: An Action Guide for School and District Leaders, that provides school and district leaders with prevention strategies, approaches, and practices that can help promote students’ mental health and well-being. By providing prevention and early intervention strategies designed to reach large numbers of students, schools can promote positive behavioral and mental health and help reduce the need for services. The guide describes six proven in-school strategies to promote and support mental health and well-being, specific approaches to put each strategy into action, and examples of evidence-based policies, programs, and practices.
• CMS is also reviewing all states’ compliance with the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit and providing technical assistance to states while preparing guidance on best practices, and yearly Reports to Congress on the findings.
• Since 2021, HRSA has awarded a total of $55 million in funding to 229 HRSA-funded health centers to expand school-based service sites to increase behavioral health screening and treatment for children. This expansion has led to over 4,000 school-based sites providing services to nearly 1 million children. With the expansion of funds in fiscal year 2023, for the first time ever, all school-based service sites are required to provide mental health services.
• HRSA, through Bipartisan Safer Communities Act funding, expanded the Pediatric Mental Health Care Access grant program, which funds pediatric mental health care teams to provide tele-consultation for providers in settings such as primary care practices, emergency departments, and schools. With this expansion, 36 states have expanded into schools.
• CDC funded 12 recipients as part of the Essentials for Childhood: Preventing Adverse Childhood Experiences through Data to Action program. Recipients will use data to inform the implementation of evidence-based prevention strategies and approaches to ensure safe, stable, nurturing relationships and environments for all children.
• SAMHSA awarded $2 million in funding to establish a National Center of Excellence on Social Media and Mental Wellness, which is developing and disseminating information, guidance, and providing training on the impact, including risks and benefits, that social media use has on children and young people, especially in regard to their mental health.

HHS has taken the following steps over the last year to help test models of care integration facilitated through value-based payment arrangements and emerging technologies as well as an opportunities to reduce technology gaps between behavioral health care providers and physical health care providers:

• CMS’s Center for Medicare & Medicaid Innovation (Innovation Center) announced a new state-based Medicaid and Medicare aligned payment model for integrated services – Innovation in Behavioral Health (IBH) – focused on improving the quality of care for people with behavioral health needs.
• CMS continues to use Medicaid section 1115 demonstrations as an opportunity to encourage state Medicaid agencies to increase use of Health Information Technology (HIT), which is a key tool for supporting increased integration, to improve care for people living with MH conditions and SUDs. Specifically, 1115 demonstrations focused on serious mental illness and for children, serious emotional disturbance, as well as section 1115 demonstrations focused on community reentry, and improved care transitions for people who were incarcerated.

• SAMHSA and the Office of the National Coordinator for Health Information Technology (ONC) will invest more than $20 million of SAMHSA funds to advance health information technology (IT) in behavioral health care and practice settings. The Behavioral Health Information Technology (BHIT) Initiative will identify and pilot a set of behavioral health data elements among SAMHSA’s Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG) and Community Mental Health Services Block Grant (MHBG) grantees. The data elements will become a United States Core Data for Interoperability extension, or “domain,” for behavioral health called “USCDI+BH” and will improve data integration and reduce the costs of data capture, use, and exchange for behavioral health providers.
• The Office of the National Coordinator for Health Information Technology (ONC) released United States Core Data for Interoperability (USCDI) Version 4 which includes Patient Demographics, Health Insurance Information, Mental/Cognitive Status Health Assessment, Alcohol Use Health Assessment, Substance Use Health Assessment, and Medications, among other data elements that facilitate behavioral health integration with primary care and other physical care.

HHS continues to work towards achieving other opportunities to drive resources into integrated care through pay-for-reporting and pay-for-performance mechanisms based on integration related quality measures.

For more information regarding the HHS Roadmap for Behavioral Health Integration, please visit: https://www.aspe.hhs.gov/reports/hhs-roadmap-behavioral-health-integration