Collaborative Care For Perinatal Mental Health In Obstetrics and Gynecology and Family Medicine Practices

The New York State (NYS) Office of Mental Health (OMH) announces the availability of funds to support the expanded implementation of the Psychiatric Collaborative Care Model (CoCM) in obstetrics and gynecology (OBGYN) and family medicine practices across New York State. CoCM is the most evidence-based model for integrating behavioral health into physical health care with over 100 randomized control trials from the last two (2) decades of implementation. 1 CoCM builds behavioral health capacity in primary care by enhancing the team with support from a Psychiatric Consultant and a Behavioral Health Care Manager (BHCM). With specialized behavioral health training, the BHCM provides brief evidence-based behavioral health treatment and supports medication management. The BHCM is the lead contact for the patient and provides treatment-to-target care with regular use of symptom monitoring tools. Patient status is communicated to the physical health provider and reviewed with the psychiatric consultant regularly to inform changes to treatment. CoCM leads to significantly better clinical outcomes, greater patient and provider satisfaction and improved functioning for patients with behavioral health needs. In the perinatal population, implementation of CoCM is associated with increased perinatal depression screening and treatment from obstetric clinicians, and reduced depression in this population. 2 Implementation of CoCM is also associated with reduction in racial disparities in perinatal depression care, with significant differences by race in antenatal depression screen and treatment recommendations after CoCM. 3 NYS OMH currently provides comprehensive training and technical assistance to practices implementing CoCM. In 2015, NYS became the first state to provide Medicaid reimbursement for CoCM. In 2018, CMS began paying for the service and Commercial plans followed, making it reimbursable across payers in NYS. To date, comprehensive behavioral health services have been provided to tens of thousands of NYS Medicaid patients. There are now more than 430 physical health practices providing CoCM, eligible for Medicaid reimbursement. Data from these practices is congruent with the RCT outcomes, with a consistent programmatic average of about 50 percent of patients achieving clinical improvement in PHQ/GAD score after 70 days in treatment. Real-time data from OBGYN practices in NYS that provide CoCM report an average of 78 percent of patients received an annual depression screen with a standardized tool. This is significantly more consistent than the usual care data. The Medicaid Perinatal Care study that showed while 63 percent of birthing persons were assessed for depression at an initial visit, just seven (7) percent of those were documented using a standardized screening tool. Mental health conditions are attributed to 23 percent of maternal deaths nationally, and there is a growing body of evidence that demonstrates increased risk for developing psychiatric disorders during the peripartum period. 5 This demands that OBGYN and family practices supporting perinatal birthing persons prioritize behavioral health screening and treatment. CoCM provides the infrastructure needed to provide this care in the physical healthcare space. This Request for Applications (RFA) will provide the opportunity to expand CoCM reach to perinatal birthing persons in NYS as the state continues to prioritize access for birthing persons and infants in at-risk communities. Applicants must identify a primary care or OBGYN practice providing services to perinatal patients that will commit to implement CoCM and participate in the comprehensive training and technical assistance OMH provides, designed to support implementation and sustainability of the model. This model must be implemented in an outpatient setting serving the perinatal population. Inpatient hospital and emergency room locations are not eligible. It is anticipated that OMH will make up to 17 awards across the state, contingent upon funding availability. This funding is specifically designated for sites that are not yet providing CoCM, with the goal to expand the capacity of OBGYN and family medicine practices to support perinatal birthing persons with behavioral health needs. Priority will be given to applicants in counties with no current CoCM presence, as well as at-risk areas, determined by counties with higher-than-average maternal mortality rates and higher percentage of births covered by Medicaid or self-pay. Applicants should not be receiving duplicative financial support for the initial COCM implementation and start up from other sources, including public or private funding. Applicants are expected to support the ongoing program with revenue received from claims. The combined total of these awards will be up to $850,000 distributed to awardees in three payments. (See Section 1.F Operating Funds). The Local Governmental Unit (LGU), Director of Community Service (DCS)/Mental Health Commissioner has a statutory authority and responsibility for oversight and cross-system management of the local mental hygiene system to meet the needs of individuals and families affected by mental illness, substance use disorder and/or intellectual/ developmental disability in their communities. The full RFP can be found at: https://omh.ny.gov/omhweb/rfp/ All applicants must be Prequalified by the due date/time of the RFP. All applications/proposals must be submitted through the Statewide Financial System. Business enterprises awarded an identical or substantially similar procurement contract within the past five years: Samaritan Medical Center Neighborhood Health Center of WNY, Inc. The Jamaica Hospital Montefiore Medical Center William F Ryan Community Health Center Niagara Falls Memorial Medical Center WMC - New York Inc. Jericho Road Ministries Inc. Service-Disabled Veteran-Owned Business (SDVOB) SDVOB Goal: 0.00% Minority / Women Business Enterprise contracting goals (MWBE) MBE Goal: 0.00% WBE Goal: 0.00% Disadvantaged Business Enterprise contracting goals (DBE) DBE Goal: 0.00%