There are many barriers that can keep people from getting the mental health care they need. One of these key barriers is access. Thankfully, organizations like the Centers for Medicare and Medicaid Services (CMS) continue to drive new initiatives to mitigate this barrier and help more people get the care they need. In November 2022, CMS finalized new rules to expand access to behavioral health.
Key initiatives include flexibility in billing and supervision as well as permanently covering certain telehealth services. These new flexibilities improve access to substance use and mental health services for patients all across the country.
These new telehealth rules are an optimistic next step in expanding behavioral health care to those who need it most. That’s why we’ve condensed everything you and your providers need to know about the newly expanded rules.
Overview of new CMS rules
At a high level, these new changes by CMS include flexibility in supervision denoting that a supervising clinician does not need to be on-site for certain behavioral health services. In addition, Medicare will pay opioid treatment programs to start MAT (medication assisted treatment) with buprenorphine for care delivered via telehealth or by a mobile unit.
Let’s take a closer look at these two final rules:
1. Physician fee schedule final rule: This new rule helps ensure patients needing behavioral health care can access the care they need. By no longer requiring clinicians to be on-site for billable behavioral health services, it opens up greater opportunity for those enrolled in Medicare to see their providers.
This rule states that certain behavioral health clinicians can provide care without their supervisor on-site. CMS permits clinicians like licensed professional counselors (LPCs) and licensed marriage and family therapists (LMFTs) to bill under the general supervision of a physician or non-physician practitioner rather than direct supervision for any mental health or substance use disorder (SUD) treatment.
Additionally, the final physician fee schedule rule also clarifies that any mental health or substance use disorder (SUD) treatment service is billed under general supervision.
2. Hospital outpatient prospective payment system final rule: The hospital outpatient prospective payment system final rule allows hospital outpatient departments to bill for certain in-home telebehavioral health services when patients cannot go in person for a visit but need to be seen. This expanded access is crucial for reaching those in rural communities who need care.
This final rule requires patients to have an in-person visit within 6 months before and every 12 months after the telehealth visit. However, if the patient and provider agree that the risk and burden of an in-person visit outweighs the benefits, they can forgo the in-person visit.
Additionally, the final rule allows audio-only visits when video technology isn’t available.
Core benefits of the new CMS rules
These new rules provide benefits for providers, patients, and organizations overall. Here are a few core benefits for each person in the healthcare ecosystem:
- For patients: Access is everything in mental health care and these new rules from CMS help patients secure continuity of care. Additionally, as this access improves, there are more opportunities for patients to find the right care.
- For providers: Making the public health emergency telehealth flexibilities permanent means there is no longer a worry about a disruption of workflow and care – should this line of service no longer be a billable option. The new rules create flexibility in delivery of care; via telehealth and a more flexible supervision model allowing clinicians to reach more patients.Additionally, the CMS rules provide new codes for psychologists and LCSWs for behavioral integration, allowing services to be delivered in a primary care setting which ultimately improves patient access to substance use and mental health services.If you’re a provider looking to learn more about navigating these new changes, check out this article by CMS.
- For organizations: As the new rules permanently cover certain telehealth services, organizations who are delivering care via telehealth are able to maintain this model that has ensured continuity of care during the pandemic and improved the number of patients served.
How Iris Can Help
At Iris, we’re always here to clarify and help your organization understand new rules and regulations in the evolving telehealth landscape. If you have any questions about the new CMS rules, we can help guide you and your team through these new changes. To talk to one of our team members, contact us today.