This bill amends Medicare (Title XVIII) to create a time‑limited financial incentive for primary care–based behavioral health integration (BHI). It directs the Centers for Medicare & Medicaid Services to apply enhanced fee‑for‑service payment multipliers for a set of BHI HCPCS codes for calendar years 2027–2029 and directs HHS to provide technical‑assistance contracts to help primary care practices implement integration models.
Why it matters: the measure aims to accelerate uptake of integrated behavioral health in primary care by raising the near‑term revenue for BHI visits and care management, while also investing in practice support. That combination changes revenue calculus for clinicians and could materially affect staffing, referral patterns, and Medicare spending trajectories during and after the incentive period.
At a Glance
What It Does
Adds a new payment provision to the Medicare physician fee schedule that temporarily increases the payment amount for a defined set of behavioral‑health integration services, and authorizes HHS to award technical‑assistance contracts to primary care practices seeking to adopt BHI models.
Who It Affects
Primary care clinicians who bill Medicare for integrated behavioral‑health services, behavioral health clinicians embedded in primary care, CMS (for fee‑schedule adjustments and oversight), and Medicare beneficiaries who receive behavioral‑health care in primary‑care settings.
Why It Matters
By pairing payment incentives with implementation support, the bill pushes practices toward integrated models faster than reliance on quality reporting or long‑term payment reform alone — with implications for provider mix, billing behavior, and near‑term Medicare outlays.
More articles like this one.
A weekly email with all the latest developments on this topic.
What This Bill Actually Does
The bill creates a temporary financial incentive inside the Medicare physician fee schedule by inserting a new provision that adjusts payment amounts for specific HCPCS codes tied to behavioral health services in primary care. Rather than changing the codes themselves, it instructs CMS to multiply the otherwise applicable payment by an above‑100% factor for a three‑year window.
The change applies to services furnished in calendar years 2027, 2028, and 2029 and is structured to be time‑limited rather than permanent.
To prevent automatic offsets that would otherwise be required under the fee‑schedule budget‑neutrality rules, the legislation explicitly excludes the increased spending from the usual budget‑neutrality calculation for the years covered. Practically, that means CMS will not be required to reduce other fee‑schedule payments to pay for these increases during the incentive period; instead, the increment is treated as an added cost to Medicare for those years.Separately, the bill directs the Secretary of HHS to contract with suitable entities to deliver technical assistance to primary care practices seeking to adopt behavioral‑health integration models.
It specifies the Collaborative Care Model and the Primary Care Behavioral Health model as examples and authorizes the Secretary to identify additional models. The statute permits implementation by program instruction and provides an open appropriation — “such sums as are necessary” — for fiscal years 2025 through 2029 to fund the assistance, with the expectation that contracts will be in place by January 1, 2026.Operationally, practices that currently bill Medicare for care‑management and collaborative psychiatric services will see higher allowed amounts during the covered years, which can change hiring choices (for example, embedded behavioral health staff or consulting psychiatric time) and billing patterns.
CMS will need to issue guidance on successor or similar codes, adjust fee‑schedule files, and set up the contracting and monitoring framework for the technical‑assistance program. The provision to implement by program instruction speeds rollout but reduces the time for formal rulemaking and public notice.
The Five Things You Need to Know
The bill targets the set of HCPCS codes that, as of January 1, 2024, include 99484, 99492, 99493, 99494, G2214, and G0323 (and allows CMS to identify successor or similar codes).
It directs CMS to apply an above‑100% multiplier to the usual payment amount for the targeted services: 175% for 2027, 150% for 2028, and 125% for 2029.
The legislation adds a provision that prevents those increased payments from being counted in Medicare’s usual fee‑schedule budget‑neutrality offset for 2027–2029.
HHS must enter into contracts to provide technical assistance to primary care practices (including for the Collaborative Care and Primary Care Behavioral Health models) with contracts in place by January 1, 2026.
The bill includes an appropriation mechanism that makes available “such sums as are necessary” to HHS for fiscal years 2025–2029 to carry out the technical‑assistance program.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short title
Designates the act as the "COMPLETE Care Act" (Connecting Our Medical Providers with Links to Expand Tailored and Effective Care). This is purely identificatory but signals the bill’s dual focus on payment incentives and implementation support.
Temporary payment multipliers for specified behavioral‑health integration services
Adds a new paragraph to 42 U.S.C. 1395w–4(b) that instructs CMS to calculate the payment amount for specified HCPCS codes by applying an “applicable percent” to the otherwise applicable payment amount for calendar years 2027–2029. The provision lists the codes that qualify (as of Jan 1, 2024) and delegates to the Secretary the authority to treat successor or similar codes as eligible. The key operational implication: CMS must update the physician fee‑schedule computation engine to apply these multipliers for claims with applicable dates of service, and practices must track whether services they provide map to the named codes or any successor codes identified by CMS.
Waiver of fee‑schedule budget‑neutrality for the incentive years
Amends the statutory language governing budget neutrality to exclude the increased payments resulting from the new paragraph from the normal offset calculations for 2027–2029. That has two practical effects: it removes the statutory requirement that CMS lower other relative value unit conversion factors to finance the increase, and it treats the incentive as an incremental Medicare outlay for those years. CMS must therefore account for the additional budget impact in its actuarial and budget planning processes.
Technical assistance contracts and funding
Directs HHS to enter into contracts or agreements with appropriate entities to provide technical assistance to primary care practices seeking to adopt behavioral‑health integration models, naming Collaborative Care and Primary Care Behavioral Health as examples. The Secretary may implement by program instruction and has authority to identify additional models. Funding is authorized as "such sums as are necessary" for FY2025–FY2029 and to remain available until expended. Practically, HHS will design procurement, performance measures for assistance, and a monitoring plan; the open appropriation accelerates start‑up but leaves the ultimate funding amount subject to executive and congressional budget processes.
This bill is one of many.
Codify tracks hundreds of bills on Healthcare across all five countries.
Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries with behavioral‑health needs who receive care in primary‑care settings — greater access to integrated services as practices have a stronger financial incentive to provide BHI.
- Primary care practices that adopt BHI models — they receive higher Medicare payments for specified services during 2027–2029, improving the near‑term business case for hiring or contracting behavioral‑health staff.
- Behavioral health clinicians who work in or with primary care — increased demand for embedded behavioral‑health providers and consultants as practices expand integrated offerings.
- Organizations that provide practice transformation support (community health centers, quality improvement organizations, technical‑assistance vendors) — potential contracting opportunities under the HHS technical‑assistance program.
Who Bears the Cost
- The Medicare program/US Treasury — the budget‑neutrality waiver makes the payment increases an explicit net cost to Medicare during the covered years.
- CMS and HHS administrative operations — CMS must implement fee‑schedule changes and successor‑code guidance, and HHS must stand up contracting and monitoring for technical assistance, adding administrative workload.
- Small or resource‑constrained primary care practices that lack capital — while the incentive improves revenue for billed services, these practices may still face upfront costs to integrate behavioral health (hiring, EHR changes, training) that the bill’s technical assistance may not fully cover.
- Behavioral‑health specialty providers outside primary care — faster integration in primary care could change referral flows and potentially reduce some demand for standalone specialty visits, altering market dynamics.
Key Issues
The Core Tension
The central dilemma is between speed and scale versus fiscal and operational stability: the bill uses a temporary, off‑budget payment boost to quickly incentivize behavioral‑health integration, which can drive rapid adoption, but that same approach risks creating short‑lived financial dependencies, uneven implementation, and administrative discretion over eligible services and use of technical‑assistance funds.
The statute uses a temporary, multiplicative payment approach rather than creating a permanent new code or ongoing care‑management benefit. That design accelerates uptake by improving immediate revenue for billed services, but it also raises questions about sustainability once the multipliers expire.
Practices that reorganize staffing based on enhanced payments could face abrupt financial adjustments in 2030 unless follow‑on policy stabilizes reimbursement.
The bill identifies specific HCPCS codes as of a fixed date and allows the Secretary to designate successors or similar codes, but it does not set objective criteria for those determinations. That leaves room for administrative discretion that will matter to clinicians billing evolving care models.
The open appropriation language speeds implementation of technical assistance but provides no cap or statutory guidance on how HHS should prioritize recipients or measure success, which could lead to uneven distribution of support across rural, safety‑net, and private practices.
Finally, excluding the incentive from budget‑neutrality calculations removes an important automatic constraint on fee‑schedule changes; while useful for rapid incentives, it creates a precedent for off‑budget adjustments and forces CMS and Congress to absorb the fiscal impact. The bill also relies on program instruction for implementation, which shortens the public comment window but could complicate legal challenges or auditing of how the incentive and TA programs are executed.
Try it yourself.
Ask a question in plain English, or pick a topic below. Results in seconds.