​The Collaborative Care Model (CoCM) is an established evidence-based, patient-centered care model used to improve behavioral health in primary care settings. CoCM uses a team-based approach to integrate and increase the effectiveness of mental health and substance use disorder (SUD) treatment while reducing stigma around these conditions. Primary care provider (PCP)-led teams of qualified professionals are eligible to provide and receive reimbursement for CoCM services. 

Core CoCM services include: 

• Care coordination and management.
• Regular, systematic monitoring and treatment using a validated clinical rating scale.
• Regular, systematic psychiatric and/or SUD caseload reviews and consultation for patients who do not show clinical improvement.

CoCM care teams include a PCP, a behavioral health care manager, and a psychiatric consultant. Reimbursement for CoCM services will be billed under the PCP’s name and provider number. 

CoCM services do not require prior authorization. This applies to both HealthChoice and Fee-For-Service programs. 

​Resources

• For guidance on reimbursement, coding, provider participation, and coordination with the Behavioral Health Administrative Services Organization: Superseding Guidance - Medicaid Coverage of Collaborative Care Model Services: HealthChoice and Fee-for-Service, PT 71-24 (April 19, 2024)
• Senate Bill 101 – Maryland Medical Assistance Program – Collaborative Care Model Services – Implementation and Reimbursement Expansion

Contact

For help, call the Provider Enrollment Helpline at 1-844-4MD.PROV (1-844-463-7768) or email MDProviderRelations@automated-health.com.