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HHS Finalizes Payment Rule That Expands Access to Behavioral Health Services
The US Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced this week that it has finalized its Physician Fee Schedule for 2023, a move that the department says will increase access to behavioral healthcare services and opioid use disorder (OUD) treatment, particularly in rural and underserved areas.
The new payment rule is in line with the strategy to address the nation’s mental health crisis that was introduced by President Joe Biden as part of his administration’s Unity Agenda unveiled during the State of the Union address in March.
The PFS will create easier access to behavioral health services for Medicare beneficiaries by allowing clinicians, including licensed professional counselors and marriage and family therapists, to offer their services under general (rather than direct) supervision of the Medicare practitioner.
“Practically speaking, this means that these behavioral health practitioners will be able to provide services without a doctor or nurse practitioner physically on site, expanding access to behavioral health services like counseling and cognitive behavioral therapy in additional communities, particularly rural or underserved communities where care can be hard to find,” Meena Seshamani, MD, PhD, deputy administrator and director for the Center for Medicare, and Douglas Jacobs, MD, MPH, chief transformation officer for the Center for Medicare, wrote in a blog post accompanying the HHS announcement.
“We will also pay psychologists and social workers to help manage behavioral health needs as part of the primary care team, in addition to on their own, because it can be easier for a person to get behavioral health care like psychotherapy when the care is coordinated through their primary care provider.”
Medicare will also pay opioid treatment providers (OTPs) that use telehealth platforms to initiate treatment with buprenorphine. Further, OTPs will be able to bill for OUD treatment services provided through mobile units, in accordance with Substance Abuse and Mental Health Services (SAMHSA) and Drug Enforcement Administration (DEA) guidance.
Another priority of the PFS is integrating behavioral health with other aspects of healthcare. This includes “paying psychologists and social workers to help manage behavioral health needs as part of the primary care team,” Dr Seshamani and Dr Jacobs wrote.
The department is also addressing the treatment of chronic pain. Medicare will now provide payments for team-based, comprehensive management and treatment of chronic pain.
>> READ: CMS fact sheet on the calendar year 2023 Physician Fee Schedule Final Rule
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