On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues, effective on or after January 1, 2023. The PFS Fact Sheet offers a detailed summary of the proposed changes for calendar year 2023 and a July 7 CMS blog post details the specific changes for behavioral health care.

Telehealth Services

As a reminder, the CY22 PFS focused on increased access to behavioral health services through the continued extension of telehealth services for BH services with no geographic restrictions, allowing services in the patient’s home, and allowing audio only services (when it is the patient’s choice). However, a requirement for in-person visits six months prior to initial telehealth service and every 12 months thereafter after the end of the PHE was included in these changes. CMS changed the requirement to every 12 months unless the clinician and patient agree (and document in the medical record) that the burden of an in-person visit outweighs the benefit. Additionally, CMS allows the patient to see other practitioners in the same practice in person if their practitioner is unavailable.

In the CY23 PFS, CMS is proposing to implement the telehealth provisions in the CAA, 2022 that delays the in-person visit requirements for mental health services furnished via telehealth until 152 days after the end of the PHE. Additionally, they are proposing that telehealth claims will require the appropriate place of service (POS) indicator to be included on the claim, rather than modifier “95,” after a period of 151 days following the end of the PHE and that modifier “93” will be available to indicate that a Medicare telehealth service was furnished via audio-only technology, where appropriate.

Behavioral Healthcare Workforce

CMS is proposing to create an exception to supervision requirements that would allow marriage and family therapists, licensed professional counselors, addiction counselors, certified peer recovery specialists, and others to provide behavioral health services while being under general supervision rather than “direct” supervision. Practically speaking, this means that these behavioral health practitioners would be able to provide services without a doctor or nurse practitioner physically on site, expanding access to behavioral health services such as counseling and cognitive behavioral therapy in additional communities and particularly rural or underserved communities where care can be hard to find. CMS is also proposing to 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 such as psychotherapy when the care is coordinated through their primary care provider.

Additionally, CMS is looking to mobilize the behavioral health workforce by giving practitioners the ability to connect with people in different ways. For example, the agency acknowledged that sometimes people need significant care for their behavioral health condition, but—rather than resorting to hospitalization—many people can benefit from intensive management in community settings. So, CMS is asking the public for feedback on how Medicare should consider covering these services.

Opioid Treatment Programs

CMS is providing clarification in line with requirements of the Drug Enforcement Administration (DEA) that Opioid Treatment Programs may bill Medicare for services performed by mobile units such as vans without obtaining a separate registration. This can improve treatment access for hard-to-reach populations, such as people who are homeless or who live in rural areas. CMS is also proposing to increase payment rates to Opioid Treatment Programs in order to better reflect the costs of the counseling services while also proposing to pay for the initiation of buprenorphine over telehealth, rather than just in person, to further improve access.

These proposed rules are open for public comment until September 6, 2022. The Ohio Council will submit comments. If you have ideas or suggestions, please feel free to share them with us. Your organization is welcome to submit comments individually as well. We will share information on the final rule when it is available later this year.