The Kennedy Forum is working with clinics across 12 health systems and 8 states to implement and test how Coordinated Specialty Care can be reliably covered and paid for by commercial insurance using new CMS billing codes. If successful, this model could be replicated to other codes for other complex mental health and addiction issues.

Coordinated Specialty Care (CSC) is the evidence-based model for treating first-episode psychosis, making it a model for early intervention efforts, especially for young people. CSC brings together psychiatry, therapy, supported education and employment, family support, and peer services. 

CSC has been shown to:

• Reduce hospitalizations
• Improve long-term outcomes
• Help young people stay connected to school, work, and community

Unfortunately, CSC treatment remains limited because payment pathways are inconsistent, most commercial plans have not clearly defined how these services are reimbursed, and providers often rely on fragmented billing approaches or avoid commercial billing altogether.

Participating organizations receive direct support to:

• Apply CSC billing codes within commercial insurance workflows
• Prepare internal systems and teams for CSC billing implementation
• Reduce administrative burden associated with fragmented billing
• Engage commercial payers in contracting and coverage discussions
• Navigate reimbursement challenges, including denials and appeals

Why The Coordinated Specialty Pilot Matters Now

1. Many Coordinated Specialty Care programs rely on grants or public funding that are becoming increasingly unstable, particularly with recent federal grant disruptions. Without a sustainable reimbursement pathway, access remains limited and difficult to scale. The end result? The public sector then ends up subsidizing the private sector. 
2. This pilot focuses on building a durable approach to commercial payment for the suite of CSC services. The work is informed by data from the Mental Health Parity Index using Transparency in Coverage data, helping providers better understand payer behavior and strengthen contracting and billing strategies.
3. If successful, this model can extend beyond CSC, supporting sustainable financing for other evidence-based behavioral health services that face similar barriers, like bipolar disorder or eating disorders.

To get more information on the pilot’s successes or to inquire about participating, please contact info@thekennedyforum.org.