The passage of the Affordable Care Act has ensured many opportunities to improve health care quality. One such opportunity is the integration of primary and behavioral health care. SAMHSA has taken a primary role in the promotion and adoption of primary and behavioral health care integration nationwide through a number of different initiatives, including Section 2703 of the Affordable Care Act, which allows States to establish health homes through their Medicaid program, the establishment and awarding of primary and behavioral health care integration grants nationwide, and the establishment of the SAMHSA - HRSA Center for Integrated Health Solutions. Below is information on each of these initiatives along with tools that can be used when adopting an integrated model.
Health Homes - Section 2703 of the Affordable Care Act
SAMHSA, in collaboration with the Centers for Medicare and Medicaid (CMS), have been working together to encourage States to take advantage of an opportunity, authorized by the Affordable Care Act, (Sec. 2703 & Sec. 19459(e)) for States to build a person-centered health home that results in improved outcomes for beneficiaries and better services and value for State Medicaid and other programs, including mental health and substance abuse agencies.
States interested in adopting the health home model through a Medicaid State Plan Amendment must seek consultation from SAMHSA prior to submission to CMS. The consultation process can be found here and to schedule a consultation please send an e-mail to firstname.lastname@example.org.
Based on SAMHSA's initial consultations with States regarding Section 2703, it is clear that States are at different stages of preparing and planning their State Plan Amendments. To that end, SAMHSA developed a Guidance Document
for States as they consider taking advantage of the Section 2703 provision for people with behavioral health (i.e., mental health and substance abuse, MH/SA) disorders. The document serves as a checklist of key behavioral health questions organized according to the Health Home Service components involved in Section 2703. By providing States this structured background regarding the core elements of the Section 2703 health home, SAMHSA aims to ensure that key behavioral health topics are considered as States develop health home proposals. This document serves solely as guidance for entities thinking about health homes, and is not meant to be prescriptive or regulatory. The intended audiences for this document are those involved in developing the State Plan Amendment to establish a health home under the Section 2703 provision. Although, SAMHSA believes this document to be useful to health home providers and others interested in health homes.
For more information on the process of implementing health homes, please see the State Medicaid Director letter CMS (PDF | 327k) sent out to States regarding background on the provision and guidance for consultation. Please send questions or comments to email@example.com.
Primary and Behavioral Health Integration Grants
Funded primarily by the Affordable Care Act's Prevention and Public Health Fund, SAMHSA has awarded grants to 64 community-based health agencies to build partnerships and infrastructure needed to initiate or expand the integration of primary care services for people in treatment for serious mental illnesses and co-occurring substance use disorders.Â The objectives of the grant program are to better coordinate and integrate primary and behavioral health care resulting in:
- Improved access to primary care services;
- Improved prevention, early identification and intervention to reduce the incidence of serious; physical illness, including chronic disease;
- Increased availability of integrated, holistic care for physical and behavioral disorders; and
- Better overall health status of clients.
Services provided at the various sites include:
- Facilitation of screening and referral for primary care prevention and treatment needs;
- Providing and/or ensuring that primary care screening, assessment, treatment and referral be provided in a community-based behavioral health agency;
- Developing and implementing a registry/tracking system to follow primary health care needs and outcomes;
- Offering prevention and wellness support services;
- Establishing referral and follow-up processes for physical health care requiring specialized services beyond the primary care setting.
SAMHSA, along with others nationwide are working to improve the quality of health care through integrated care opportunities. Above, the 64 behavioral health sites are mapped. Explore the different places integration is happening, from Wrangell, Alaska to Miami, Florida.
SAMHSA - HRSA Center for Integrated Health Solutions
The SAMHSA-HRSA Center for Integrated Health Solutions, run by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by SAMHSA and HRSA. The Center promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings. For more information about the Center for Integrated Health Solutions click here. Additionally, below are a number of tools and documents that can be used when planning and implementing an integrated model.
Screening Tools for Behavioral Health Disorders
SAMHSA recommends the following screening instruments to identify individuals with alcohol abuse or dependence, depression, and/or tobacco use/dependence in primary care or behavioral health care settings:
Alcohol - The Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) is a 3-item alcohol screening instrument that can help identify individuals who engage in unhealthy alcohol use or have active alcohol use disorders (including alcohol abuse or dependence).
Depression - The Patient Health Questionnaire (PHQ-9) is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.
Tobacco - The “5 A's” Model for Tobacco Use and Dependence is a 5-item screening instrument for tobacco use and dependence that offers medical assistance for appropriate intervention with smoking and tobacco use cessation.
Additionally, below are examples of tools available to screen for behavioral health needs in primary care or behavioral health care settings.
Screening tools for Children
Screening tool for Adolescents
Screening tool for Adults
- CAGE Questionnaire is a brief assessment instrument for screening for unhealthy alcohol use or people who have active alcohol use disorders. The acronym comes from key words in each of the four yes-no questions. Two or more affirmative responses are indicative of alcohol dependence.
Below are resources that detail State-level experiences with different health home models.
Below are examples of behavioral health outcome and quality measures to consider when establishing a health home.
Below are research resources detailing health home demonstration projects, behavioral health and primary care integration, and financing and payment methods.
Health Home Demonstration Projects
Behavioral Health in Primary Care Settings
Financing and Payment Methods
Resources for Providers and Consumers when discussing health homes
Additional Resources on Section 2703 of the Affordable Care Act
Last updated: 07/16/2012