The Center for Medicare and Medicaid Innovation (Innovation Center) is announcing a new model as part of a multi-pronged strategy to combat the nation’s opioid crisis. The Integrated Care for Kids (InCK) Model is a child-centered local service delivery and state payment model that aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs. The model will empower states and local providers to better address these needs and the imact of opioid addiction through care integration across all types of healthcare providers.
Behavioral health conditions in children and youth, including use of opiates and other substances, drive significant morbidity, health care utilization, and premature death. The current child health care system has challenges in identifying and addressing risk factors for behavioral health conditions, because the earliest signs of a problem may present outside of clinical care—such as behavioral problems in schools, or chaotic family situations known to child welfare and foster care programs. Although a variety of federal, state, and local services exist to support children’s health, limited information sharing and differing eligibility and enrollment processes may create barriers to putting children and families at the center of their care.
The goals of the InCK Model are to improve child health, reduce avoidable inpatient stays and out of home placement, and create sustainable Alternative Payment Models (APMs). The InCK Model will support states and local providers to conduct early identification and treatment of children with health-related needs across settings. Participants will be required to integrate care coordination and case management across physical and behavioral health and other local service providers to provide child-and family-centered care. Finally, through the APM that is developed through this model, states and local providers will share accountability for cost and outcomes. These interventions are designed to increase behavioral health access, respond to the opioid epidemic and positively impact the health of the next generation.
The InCk Model aims to achieve these goals through:
Early identification and treatment of children with multiple physical, behavioral, or other health-related needs and risk factors through population-level engagement in assessment and risk stratification.
Integrated care coordination and case management across physical health, behavioral health, and other local service providers for children with health needs impacting their functioning in their schools, communities, and homes.
Development of state-specific APMs to align payment with care quality and supporting accountability for improved child health outcomes and long-term health system sustainability.
The key participants of the InCK Model will be the state Medicaid agency and a local entity called a “Lead Organization.” Additional details on participant roles are described below:
- Lead Organizations will convene community partners to integrate coordination and management of the InCK Model’s core child services for the attributed population. The Lead Organization will be accountable for improving population-level care quality and outcomes and developing service integration protocols and processes. HIPAA-covered entities, including state Medicaid agencies, will be eligible to serve as Lead Organizations.
- State Medicaid Agencies will support local implementation by providing population-level data for the geographic service area, supporting the development of information sharing arrangements and infrastructure, working to align support for the model across child-focused state agencies, and developing the pediatric APM. State Medicaid agencies will participate in the model regardless of whether they also serve as the Lead Organization.
The state Medicaid agency and Lead Organization will partner together to write the application, but only one of these entities will be considered the applicant and the model awardee of a cooperative agreement.
How to Apply
The CMS Innovation Center anticipates releasing a detailed Notice of Funding Opportunity in Fall 2018 with additional details on how state Medicaid agencies and local health and community-based organizations can apply to participate in the model. CMS intends to award funding for up to 8 cooperative agreements at a maximum of $16 million each as early as Spring of 2019 to implement the seven-year model.
- Fact Sheet
- Press Release
- Pediatric APM Request for Information (RFI) comments (PDF)
- Webinar: InCK Model Overview