Coordinated Specialty Care (CSC) Billing Strategy Guide for Massachusetts

Iqra Imam, MPH, Elaine Marshal, JD, MPH, Kelsey A. Johnson, MPH, Monica Luke, Michelle Freidman-Yakoobian, PhD, Matcheri Keshavan MD, Raquelle Mesholam-Gately, PhD

Abstract

Background: Coordinated Specialty Care (CSC) is an evidence-based treatment model that addresses psychotic disorders early in order to reduce psychiatric hospitalizations for people with first-episode psychosis (FEP). With CSC, a multi-disciplinary team with licensed and non-licensed mental health specialists work with a person with a psychotic disorder to create and deliver an individualized treatment plan. However, there is no established payment model for necessary elements of CSC, which results in key services unable to be billed to insurance. The leads to economic burden placed on patients and their families, and clinics that struggle to provide CSC.

Methods: In order to address these issues, the Massachusetts Psychosis Network for Early Treatment (MAPNET) developed a guidebook of strategies to fund CSC using a team-based payment model, which would allow for teams to receive a flat rate for all the encompassing services.

Results: There are five critical questions to consider in order to advocate for a more comprehensive CSC billing system include: (1) Why pay for CSC? (2) What services are included in CSC? (3) How much does CSC cost? (4) How is CSC paid for? (5) How can we implement a new CSC billing model? The biggest hurdle to cross is how to implement the standardized billing for CSC. Strategies to promote implementation include employer advocacy, private insurance adoption, enforcing mental health parity laws, and developing legislation and regulation.

Conclusion: This guide identifies key resources and strategies to implement a sustainable payment model for CSC in MA and beyond. We outline next steps for MA towards this model, including a thorough assessment of CSC program costs.