CMS has released their proposed 2023 Physician Fee Schedule rule, and it includes many important (and positive) updates for mental and behavioral health providers. Medicare is continuing to push forward towards their goal of a cohesive, integrated continuum of care that requires collaboration and coordination across many different provider types. Let’s take a look at the most important changes:
Relaxed Supervisory Requirements
The proposed rule changes supervision requirements for marriage and family therapists, licensed professional counselors, addiction counselors and certified peer recovery specialists from “direct” supervision to “general” supervision. In practical terms, this means that supervising clinicians (such as a physician) are not required to be present/on-site for services from those specialists to be reimbursed by Medicare.
However, it is very important to note that these practitioners can not bill Medicare for mental health services and/or behavioral health services under their own name. They will still need to be submitted under the name of their supervising provider. Also, “general supervision” does not mean “no supervision.” Coordination of care and regular communication will still be important to serve clients and comply with Medicare Conditions of Participation (CoPs).
Reimbursement for Team-Based Chronic Pain Management
CMS is proposing new HCPCS codes and valuation for chronic pain management and treatment services (CPM) for 2023. The proposed codes include “diagnosis; assessment and monitoring; administration of a validated pain rating scale or tool; the development, implementation, revision, and maintenance of a person-centered care plan that includes strengths, goals, clinical needs and desired outcomes; overall treatment management; facilitation and coordination of any necessary behavioral health treatment; medication management; pain and health literacy counseling; any necessary chronic pain related crisis care; and ongoing communication and coordination between relevant practitioners furnishing care, such as physical and occupational therapy and community-based care, as appropriate.”
More Funding and Changes for Addiction Treatment Providers
Opioid Treatment Programs are getting help from CMS in several key areas. Reimbursement for Medication-Assisted Treatment (MAT) that is started with telehealth is getting a significant bump. In addition, the COVID-19 Public Health Emergency telehealth rules will be extended 151 days after the end of the public health emergency declaration. When the PHE will end is anyone’s guess, but this gives regulators more time to make the rules permanent (or come up with new ones). Nearly all providers have seen an explosion in telehealth usage and it is difficult to believe that CMS could put the genie back in the bottle.
Under the proposed rule, opioid treatment programs can also bill Medicare for services provided via “mobile units” such as vans and busses without creating a separate registration with CMS. Medicare has prioritized healthcare equity in recent years, and removing barriers to access such as transportation is a great way to achieve that goal.
Reimbursement for “Integrated Care”
The proposed fee schedule also includes a provision that would pay for clinical psychologists and licensed clinical social workers to provide behavioral health services as part of a patient’s primary care team. If finalized as written, the rule will offer much greater flexibility for initiating a client’s/patient’s behavioral health integration (BHI) service. Either a psychologist, social worker or the treating provider will be able to commence the BHI service.
How these changes will impact your practice depends on the services you provide and your market. Many behavioral and mental health providers will face operational challenges before being able to take advantage of these new opportunities, such as using a compatible EHR/EMR for care coordination and figuring out if these programs make financial sense in the first place. If you would like to discuss these issues or any other matter, please give us a call today!