On November 2, 2023, the Facilities for Medicare and Medicaid Companies (CMS) issued its 2024 Doctor Price Schedule ultimate rule (Remaining Rule) for calendar yr 2024 that can, partly, implement among the most necessary 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 companies.
• CMS expands billing flexibilities by means of 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 satisfy its objectives of bettering entry to and the standard of psychological well being companies, the Remaining Rule consists of quite a few modifications that modernize and broaden Medicare protection. Because of this, supplier organizations and buyers within the behavioral well being sector can plan for added Medicare income alternatives. 

New Supplier Sorts Established; Medicare Enrollment

In our 2023 Doctor Price 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), through which Congress established a brand new profit class for MFTs and MHCs. The Remaining Rule implements rules permitting these suppliers to invoice for the prognosis and therapy of psychological sicknesses (apart from companies 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 regulation of the State through which such particular person furnishes marriage and household therapist companies,
• Is licensed or licensed as an MFT by the State through which they furnish companies,
• Has carried out a minimum of 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 regulation of the State through which such particular person furnishes MHC service,
• Is licensed or licensed as an MHC, medical skilled counselor, or skilled counselor by the State through which they furnish companies,
• Has carried out a minimum of 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 regulation. For instance, licensed or licensed skilled counselors together with habit counselors or drug and alcohol counselors, might enroll in Medicare as MHCs offered 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 companies on January 1, 2024. Observe that though suppliers can enroll in Medicare as of November 2, 2023, MFTs/MHCs won’t 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, won’t be payable. MFT and MHC companies could be billed at 80% of the lesser of both (1) the precise cost for the companies or (2) 75% of the quantity decided for cost 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 checklist MFT and MHC specialties (candidates are suggested to pick the “Undefined Non-Doctor Practitioner Specialty” choice in part 2H and specify MFT or MHC within the house offered), 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 numerous billing flexibilities to extend entry to behavioral well being companies by means of 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 numerous different sections of the CAA to determine new Healthcare Frequent Process Coding System codes for psychotherapy for disaster companies furnished at relevant websites of service. An relevant website of service is taken into account anyplace of service at which the non-facility charge for psychotherapy for disaster companies applies, apart from the workplace setting. These companies can be furnished at dwelling, a cellular unit and even by way of telehealth so long as necessities are met. Particularly, cost for these disaster companies shall be equal to 150% of the payment schedule quantity for non-facility websites. This variation is designed to extend the variety of suppliers prepared to supply these companies and tackle problems with entry and availability of disaster companies. Usually, for companies furnished in an workplace setting, Medicare reimburses physicians and practitioners at a charge based mostly on a full vary of assets utilized to ship the service. Alternatively, companies delivered to physicians and different practitioners in a facility setting (e.g., hospital or an ambulatory surgical heart) are reimbursed just for these assets sometimes incurred by the practitioner whereas furnishing the service, i.e., the clinician receives a decrease cost quantity to replicate 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 companies at these areas.

Moreover, CMS has finalized its proposal that Well being Habits Evaluation and Intervention (HBAI) companies might now be billed by extra supplier varieties. Beforehand solely open to medical psychologists, medical social staff, MFTs and MHCs might now invoice these codes used to determine potential psychological, behavioral, emotional, cognitive, and social components which can influence the therapy of bodily well being issues. CMS hopes increasing the vary of practitioner varieties who can furnish these companies (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 bettering entry to behavioral well being companies. On a sensible stage, these modifications will permit behavioral well being suppliers to leverage a big sector of certified clinicians (MFTs and MHCs). Steps could 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 companies.

Foley is right here that will help you tackle the short- and long-term impacts within the wake of regulatory modifications. Now we have the assets that will help you navigate these and different necessary 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 Apply Group with any questions.