CMS Expands Entry to Behavioral Well being Companies; Doctor Charge Schedule Expands Billing Suppliers and Flexibilities

On November 2, 2023, the Facilities for Medicare and Medicaid Companies (CMS) issued its 2024 Doctor Charge Schedule ultimate rule (Closing Rule) for calendar yr 2024 that can, partially, implement a few of the most essential modifications to enhance entry to behavioral well being care in Medicare’s historical past. These modifications additional the objectives of CMS’s Behavioral Well being Technique as follows:

• For the primary time, CMS permits Marriage and Household Therapists (MFTs) and Psychological Well being Counselors (MHCs) to enroll in Medicare Half B and invoice for his or her providers.
• CMS expands billing flexibilities by the creation of latest codes, modifying some Circumstances of Participation and Circumstances for Protection, and permits current behavioral well being codes to be billed by extra varieties of suppliers.

In an on-going try to fulfill its objectives of enhancing entry to and the standard of psychological well being providers, the Closing Rule contains quite a lot of modifications that modernize and broaden Medicare protection. Consequently, supplier organizations and traders within the behavioral well being sector can plan for extra Medicare income alternatives. 

New Supplier Sorts Established; Medicare Enrollment

In our 2023 Doctor Charge Schedule rule abstract, we famous that CMS acknowledged it didn’t have the regulatory authority to create new reimbursable practitioner varieties. Nonetheless, this modified with the 2023 Consolidated Appropriations Act (CAA), wherein Congress established a brand new profit class for MFTs and MHCs. The Closing Rule implements rules permitting these suppliers to invoice for the analysis and therapy of psychological diseases (aside from providers furnished to an inpatient of a hospital).

Medicare defines an MFT as a person who:

• Possesses a grasp’s or doctorate diploma which qualifies for licensure or certification as a MFT below State legislation of the State wherein such particular person furnishes marriage and household therapist providers,
• Is licensed or licensed as an MFT by the State wherein they furnish providers,
• Has carried out not less than two years of medical supervised expertise in marriage and household remedy or psychological well being counseling after acquiring the diploma referenced above, and
• Meets different necessities because the Secretary of Well being and Human Companies (HHS) determines applicable.

An MHC as a person who:

• Possesses a grasp’s or doctorate diploma which qualifies for licensure or certification as a MHC, medical skilled counselor, or skilled counselor below State legislation of the State wherein such particular person furnishes MHC service,
• Is licensed or licensed as an MHC, medical skilled counselor, or skilled counselor by the State wherein they furnish providers,
• Has carried out not less than two years of medical supervised expertise in marriage and household remedy or psychological well being counseling after acquiring the diploma referenced above, and
• Meets different necessities because the Secretary of HHS determines applicable.

Moreover, CMS acknowledged that states use various phrases to outline MFTs and MHCs and, importantly, different clinician classes/designations below state legislation. For instance, licensed or licensed skilled counselors together with habit counselors or drug and alcohol counselors, could enroll in Medicare as MHCs supplied they meet relevant necessities for MHCs.

MFTs and MHCs will have the ability to enroll in Medicare beginning November 2, 2023, and start to invoice for his or her providers on January 1, 2024. Observe that though suppliers can enroll in Medicare as of November 2, 2023, MFTs/MHCs is not going to be granted an efficient date for his or her enrollment sooner than January 1, 2024, so claims with dates of service previous to January 1, 2024, is not going to be payable. MFT and MHC providers might be billed at 80% of the lesser of both (1) the precise cost for the providers or (2) 75% of the quantity decided for fee of a psychologist.

CMS printed a Supplier Enrollment FAQ doc for MFTs and MHCs who can enroll with Medicare utilizing the CMS-855I enrollment software. Observe that the paper CMS-855I software doesn’t listing MFT and MHC specialties (candidates are suggested to pick the “Undefined Non-Doctor Practitioner Specialty” possibility in part 2H and specify MFT or MHC within the area supplied), nonetheless, the Medicare Supplier Enrollment, Chain, and Possession System’s on-line software will embrace these specialties as of November 2023.

Increasing Billing Flexibilities

Along with establishing new supplier profit classes, CMS elevated varied billing flexibilities to extend entry to behavioral well being providers by the creation of latest codes, modifying Circumstances of Participation and Circumstances for Protection, and permitting current behavioral well being codes to be billed by extra varieties of suppliers.

First, CMS is implementing varied different sections of the CAA to determine new Healthcare Widespread Process Coding System codes for psychotherapy for disaster providers furnished at relevant websites of service. An relevant web site of service is taken into account anyplace of service at which the non-facility fee for psychotherapy for disaster providers applies, aside from the workplace setting. These providers will also be furnished at residence, a cell unit and even through telehealth so long as necessities are met. Particularly, fee for these disaster providers shall be equal to 150% of the payment schedule quantity for non-facility websites. This variation is designed to extend the variety of suppliers keen to supply these providers and handle problems with entry and availability of disaster providers. Usually, for providers furnished in an workplace setting, Medicare reimburses physicians and practitioners at a fee based mostly on a full vary of assets utilized to ship the service. Alternatively, providers delivered to physicians and different practitioners in a facility setting (e.g., hospital or an ambulatory surgical middle) are reimbursed just for these assets usually incurred by the practitioner whereas furnishing the service, i.e., the clinician receives a decrease fee quantity to mirror their decrease prices.

Subsequent, CMS is finalizing its proposal to switch hospice Circumstances of Participation to permit MFTs and MHCs to function members of the hospice interdisciplinary group. Relatedly, CMS is finalizing the necessities for the Rural Well being Clinics and Federally Certified Well being Facilities Circumstances for Certification and Circumstances for Protection to permit MFTs and MHCs to supply further behavioral well being providers at these areas.

Moreover, CMS has finalized its proposal that Well being Conduct Evaluation and Intervention (HBAI) providers could now be billed by extra supplier varieties. Beforehand solely open to medical psychologists, medical social employees, MFTs and MHCs could now invoice these codes used to determine potential psychological, behavioral, emotional, cognitive, and social components which can affect the therapy of bodily well being issues. CMS hopes increasing the vary of practitioner varieties who can furnish these providers (and be paid for them) will permit for a greater integration of bodily and behavioral well being care.

Key Takeaways

These modifications promise to extend entry to high quality behavioral well being to Medicare beneficiaries throughout the nation. Suppliers and behavioral well being corporations ought to rejoice these investments in enhancing entry to behavioral well being providers. On a sensible stage, these modifications will permit behavioral well being suppliers to leverage a big sector of certified clinicians (MFTs and MHCs). Steps might be taken now to enroll and credential these clinicians in Medicare and implement medical protocols and insurance policies to appropriately combine these clinicians into the outpatient plan of look after Medicare beneficiaries, in addition to hospice interdisciplinary groups, disaster response applications, and HBAI providers.

Foley is right here that can assist you handle the short- and long-term impacts within the wake of regulatory modifications. Now we have the assets that can assist you navigate these and different essential authorized concerns associated to enterprise operations and industry-specific points. Please attain out to the authors, your Foley relationship companion, or to our Well being Care Observe Group with any questions.