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CMS Addressing Behavioral Health Shortfalls With Medicare Physician Fee Schedule Changes
This summer, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to how Medicare addresses behavioral health in the 2024 Medicare Physician Fee Schedule (Fee Schedule). The proposed changes will improve beneficiary access to behavioral health services, while increasing payment rates prescribed by the Fee Schedule for certain services. The proposed changes suggest that CMS is attempting to address behavioral health shortfalls within the Medicare program, and on a larger scale, address growing behavioral health issues in the United States.
Proposed Changes to the Fee Schedule
In response to a dramatic increase of Americans reporting mental health issues over the past few years, CMS has identified the need for increased beneficiary access to behavioral health services. Historically, coverage of behavioral health issues was restricted to specific inpatient and outpatient programs and certain types of providers, resulting in significant gaps in behavioral healthcare coverage. These restrictions contributed to a lack of eligible behavioral health providers under Medicare, limited to no beneficiary access to intensive outpatient programs, as well as inadequate access to behavioral healthcare options in rural areas. At the same time, CMS’s valuation of behavioral health services failed to accurately reflect the costs of providing such services, potentially deterring providers from entering the behavioral health space altogether.
The proposed changes to the Fee Schedule address these issues in a variety of ways. Proposed expansion of provider coverage would allow clinical social workers and other mental health counselors to be reimbursed by CMS for certain behavioral health services. This expansion would also allow licensed professional counselors, addiction counselors, and marriage and family therapists to enroll in the Medicare program. There is also continued coverage for the provision of certain telehealth behavioral health services provided by rural health clinics or federally qualified health centers, effectively delaying the reintroduction of in-person visit requirements for at least another year.
Additionally, program coverage will be expanded to cover intensive outpatient programs. These programs add more benefits for people seeking behavioral health treatments that do not require inpatient services, but need a higher level of care than a traditional outpatient program. Last, the proposed changes would increase reimbursement rates for crisis care, substance use disorder treatments, and psychotherapy.
Implications
The proposed Fee Schedule changes relating to behavioral health received positive feedback from the behavioral health and greater medical communities, as the changes should result in providers being more accurately compensated for the costs of their services, a factor that should lead to an increase in behavioral health providers overall. Providers frequently highlight financial burdens and low payment rates as major factors in not including behavioral health services in their organization. By increasing reimbursement rates and updating certain behavioral health billing codes to more accurately reflect the resource and time‑intensive nature of the services provided, more providers may be encouraged to integrate these services.
While the long-term benefits for beneficiaries and providers are substantial, there will undoubtedly be growing pains during implementation. As some groups suggested during the Fee Schedule’s comment period, CMS will need to work to ensure providers and beneficiaries alike are aware of the expanded coverage and that regulatory text addressing this expanded coverage clearly outlines the requirements providers must meet to be eligible for reimbursement under Medicare. Similarly, groups have suggested that the telehealth options, particularly in the behavioral health space, must be extended beyond just the 2024 Fee Schedule, as such flexibilities help ensure behavioral health resources are available to those who may be unable to access typical in‑person resources. One should expect the telehealth question to extend beyond just the 2024 Fee Schedule.
Assuming no drastic revisions to the Fee Schedule come out of the public comment period, which ended in September, providers and beneficiaries alike can expect the new Fee Schedule to be effective as of January 1, 2024. Once implemented, it will be interesting to see what, if any, impact the changes have on access to behavioral healthcare in the United States.
Venable LLP Partner Ari Markenson practices at the intersection of healthcare, law, and business. Venable LLP Associate Patrick Dunbar focuses his practice on complex matters related to corporate law.
The views expressed in Perspectives are solely those of the authors and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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