CMS Rule to Help Behavioral Health Providers Coordinate Patient Care Post-Hospitalization

The Centers for Medicare & Medicaid Services (CMS) has released a new final rule that will help behavioral health providers coordinate care by requiring hospitals to notify them when their patients have been admitted.

The Interoperability and Patient Access rule applies to acute care, psychiatric and critical access hospitals that participate in Medicare and Medicaid. It says those hospitals must send electronic notifications to other health care providers when one of their patients has been admitted, discharged or transferred (ADT).

“This will improve care coordination by allowing a receiving provider, facility or practitioner to reach out to the patient and deliver appropriate follow-up care in a timely manner,” CMS wrote in a fact sheet accompanying the rule.

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Of all behavioral health providers, the rule will likely impact psychiatric hospitals the most, as it adds another administrative requirement on the back end. But the new provision shouldn’t be very burdensome, according to Jay Desai, CEO of Boston-based care coordination platform PatientPing.

“If you have an EHR that’s certified, it tends to be that you’re able to produce an ADT message,” Desai told Behavioral Health Business. “[Getting] that data out to the provider community … does require some routing capabilities, which intermediaries like PatientPing [and other] are able to make very easy.”

Previously, the federal government has not required hospitals to share ADT data, though many hospitals do so anyway because of state rules or participation in certain networks.

For behavioral health providers who are not psychiatric hospitals, the rule provides greater transparency into patients’ lives, indicating when they might be struggling, Desai said.

“We know that patients with behavioral health disorders, particularly serious mental illness or substance use disorder (SUD), tend to have higher healthcare needs, so they may end up in the emergency room or be hospitalized more frequently,” Desai said. “It’s really important for their full care team, including their primary care provider or their psych provider, to be aware of those particular encounters because that’s when a patient is really fragile. … It’s a really big opportunity for their full provider care team to come together and support the patient.”

The new policy will go into effect in September, six months after the rule’s publication, according to a CMS fact sheet.

The new rule also requires health plans in public programs to share claims data electronically with patients.

For this story, BHB also reached out to the National Association for Behavioral Healthcare (NABH), who said they did not have a comment on the new rule, and the National Council for Behavioral Health, who had not yet provided a comment at the time of publication.

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