The Centers for Medicare & Medicaid Services (CMS) wants to make it easier for Medicare beneficiaries to receive behavioral health treatment via telehealth, according to the proposed 2022 Medicare physician fee schedule released Tuesday.
Specifically, CMS has proposed lifting certain statutory restrictions to allow Medicare beneficiaries to receive tele-mental health services in their homes — and any other geographic location — for the purposes of diagnosis, evaluation and treatment. Plus, the agency wants to let Medicare pay for tele-mental health visits provided by rural health clinics and federally qualified health centers.
Additionally, the proposed rule aims to make it possible for providers to offer audio-only behavioral treatment to Medicare beneficiaries, when certain conditions are met. That includes for opioid use disorder (OUD) treatment, as well as mental health care.
“The COVID-19 pandemic has put enormous strain on families and individuals, making access to behavioral health services more crucial than ever,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “The changes we are proposing will enhance the availability of telehealth and similar options for behavioral health care to those in need, especially in traditionally underserved communities.”
Historically, Medicare has left a lot to be desired in terms of behavioral health coverage. One reason for that is that the federal program is exempt from Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which says that insurers must make behavioral health coverage no more restrictive than medical coverage.
As a result, many behavioral treatment options have long been unavailable to beneficiaries with traditional Medicare coverage.
For example, Medicare has a 190-day lifetime limitation on inpatient psychiatric care and most community-based services delivered by SUD treatment facilities are not reimbursed by Medicare. Plus, many clinician types — such as licensed counselors, certified addiction counselors and peer counselors — are not authorised Medicare providers.
As such, the coverage updates outlined in the proposed 2022 Medicare physician fee schedule would likely come as a welcome change to providers in the behavioral health industry.
You can read the full proposed rule here.