CMS Proposes Major Behavioral Health Medicare Changes to Improve Access to Care

The Centers for Medicare & Medicaid Services (CMS) might be making major behavioral health Medicare changes to improve access to services. These come as new proposed policies that are wrapped into the Physician Fee Schedule and Hospital Outpatient Prospective Payment System rules.

These behavioral health Medicare changes would expand the behavioral health workforce, cover gaps in access to behavioral health services, pay more accurately for behavioral health services, and promote access to behavioral health for underserved communities. Here’s how:

More Behavioral Health Providers Could Enroll in Medicare

CMS is proposing to allow marriage and family therapists and mental health counselors to enroll as Medicare providers. This would allow more than 400,000 additional behavioral health practitioners to provide care to people with Medicare.

CMS is also proposing to pay for community health integration and principal illness navigation services that can be provided by community health workers and peer support specialists. These workers can help individuals who have behavioral health conditions navigate unmet social needs and access support.

Intensive Outpatient Programs Could be Covered Under Medicare

CMS is proposing to pay for intensive outpatient programs (IOPs), which are an intermediate level of care between outpatient therapy and inpatient hospitalization. IOPs can be offered by many different types of behavioral health organizations, such as:

  • Outpatient providers
  • Community mental health clinics
  • Federally Qualified Health Centers (FQHCs)
  • Rural health clinics (RHCs)

CMS is also proposing to provide payments for intensive outpatient services provided by behavioral health organizations that offer opioid treatment programs.

“The ability to use Medicare funding for IOP for both mental health and substance use disorders is a great expansion,” said Kathy Dettling, Vice President of Clinical Strategies at SimiTree Behavioral Health.

“The IOP level of care has shown great promise in diverting psychiatric hospitalization and supporting a person’s recovery and sobriety goals while they remain in the community,” Dettling continued. “Especially when inpatient and substance use disorder residential programs are not provided within someone's immediate community. It also supports shorter stays in higher levels of care.”

Some Behavioral Health Providers Might See Rate Bumps

As a part of the proposed Medicare changes, some behavioral health providers might see some rate bumps. These include:

  • Crisis intervention services – CMS is proposing to increase the Physician Fee Schedule rate to 150% for crisis intervention services that are provided outside of the healthcare setting. This change is aimed at better reflecting the actual cost of providing these crucial behavioral health services.
  • Addiction treatment providers – And to better reflect the true cost of providing addiction treatment, CMS is also proposing to increase the payment rate for substance use disorder treatment and psychotherapy services. This rate bump would be a serious benefit to those who provide detox, medication-assisted treatment, and other addiction treatment services.

“Behavioral health organizations do not look away when a client is in need. Meeting a client's needs is always the highest priority, regardless of reimbursement,” said Cynthia Sikina, Vice President of Financial Strategy at SimiTree Behavioral Health.

“An increase in the payment rates for substance use disorder and psychotherapy services is long overdue,” Sikina explained. “Fees for medical and surgical services reflect the cost differential of providing those services, so it is only fitting to see proposed increases in reimbursement for these services. Most behavioral health organizations struggle to break even, so any increase in reimbursement rates will help ensure the organization can provide services to the clients it serves.”

Underserved Communities May See Expanded Access to Behavioral Health Services

Currently, FQHCs and RHCs require direction supervision for behavioral health services furnished “incident to” a physician or NPP. CMS is proposing to change this requirement to allow general supervision. This could expand access to counseling and cognitive behavioral therapy, particularly in rural or underserved communities where care can be hard to find.

Certain Opioid Addiction Treatment Might Continue to Be Available Via Telehealth

Under these proposed policies, opioid treatment providers can continue to offer certain services via telephone or audio-only technology. For those who live in rural or underserved areas, this can be a crucial way to improve access to much-needed support for people who are struggling with substance use disorders.

“The expansion of telehealth intervention in opioid treatment shows great promise,” added Dettling. “Especially in areas where access to treatment is impacted by lack of reliable transportation or distance to travel to more intensive programs.”

Need Help Working with Payers?

The experts at SimiTree Behavioral Health know the ins and outs of working with private, commercial, and government payers. Our team can help your behavioral health organization decrease claim denials and get paid appropriately for the services you provide your patients.

Take the next step today! Don't miss this opportunity to elevate your behavioral health organization to new heights. Contact us now for a personalized consultation and see how SimiTree Behavioral Health can help your business thrive and make a lasting impact in the communities you serve.