On November 2, 2023, the Facilities for Medicare and Medicaid Providers (CMS) issued its 2024 Doctor Charge Schedule last rule (Closing Rule) for calendar yr 2024 that can, partially, implement a few of the most vital 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 via the creation of recent codes, modifying some Situations of Participation and Situations for Protection, and permits present behavioral well being codes to be billed by extra kinds of suppliers.

In an on-going try to satisfy its objectives of bettering entry to and the standard of psychological well being providers, the Closing Rule consists of plenty of modifications that modernize and increase Medicare protection. Because of this, supplier organizations and traders within the behavioral well being sector can plan for added Medicare income alternatives. 

New Supplier Varieties 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 sorts. Nonetheless, this modified with the 2023 Consolidated Appropriations Act (CAA), by which 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 remedy of psychological diseases (apart 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 by which such particular person furnishes marriage and household therapist providers,
• Is licensed or licensed as an MFT by the State by which 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 Providers (HHS) determines acceptable.

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 by which such particular person furnishes MHC service,
• Is licensed or licensed as an MHC, medical skilled counselor, or skilled counselor by the State by which 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 acceptable.

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, might enroll in Medicare as MHCs supplied they meet relevant necessities for MHCs.

MFTs and MHCs will be capable of enroll in Medicare beginning November 2, 2023, and start to invoice for his or her providers on January 1, 2024. Word 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 cost of a psychologist.

CMS revealed a Supplier Enrollment FAQ doc for MFTs and MHCs who can enroll with Medicare utilizing the CMS-855I enrollment utility. Word that the paper CMS-855I utility doesn’t checklist MFT and MHC specialties (candidates are suggested to pick out the “Undefined Non-Doctor Practitioner Specialty” choice in part 2H and specify MFT or MHC within the area supplied), nevertheless, the Medicare Supplier Enrollment, Chain, and Possession System’s on-line utility will embody 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 providers via the creation of recent codes, modifying Situations of Participation and Situations for Protection, and permitting present behavioral well being codes to be billed by extra kinds of suppliers.

First, CMS is implementing numerous different sections of the CAA to ascertain 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, apart from the workplace setting. These providers may also be furnished at dwelling, a cellular unit and even through telehealth so long as necessities are met. Particularly, cost for these disaster providers shall be equal to 150% of the payment schedule quantity for non-facility websites. This transformation is designed to extend the variety of suppliers keen to supply these providers and tackle 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 sources utilized to ship the service. Then again, providers delivered to physicians and different practitioners in a facility setting (e.g., hospital or an ambulatory surgical heart) are reimbursed just for these sources 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 Situations 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 Situations for Certification and Situations for Protection to permit MFTs and MHCs to supply further behavioral well being providers at these places.

Moreover, CMS has finalized its proposal that Well being Habits Evaluation and Intervention (HBAI) providers might now be billed by extra supplier sorts. Beforehand solely open to medical psychologists, medical social employees, MFTs and MHCs might now invoice these codes used to establish potential psychological, behavioral, emotional, cognitive, and social elements which can affect the remedy of bodily well being issues. CMS hopes increasing the vary of practitioner sorts who can furnish these providers (and be paid for them) will enable 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 have fun these investments in bettering entry to behavioral well being providers. On a sensible degree, these modifications will enable 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 packages, and HBAI providers.

Foley is right here that will help you tackle the short- and long-term impacts within the wake of regulatory modifications. We’ve the sources that will help you navigate these and different vital 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 Follow Group with any questions.