Hospital outpatient departments may soon be able to bill Medicare for tele-behavioral health services offered to patients in their homes on a permanent basis.
The U.S. Centers for Medicare & Medicaid Services (CMS) on Friday included this provision in the 2023 Hospital Outpatient Prospective Payment System proposed rule.
The move is meant to ensure rural and other underserved communities maintain access to behavioral health, according to a news release.
If implemented, the rule would mean that remote behavioral health visits to CMS beneficiaries could be covered as outpatient service. During the public health emergency (PHE), CMS created flexibility to allow virtual behavioral health reimbursement through the Hospitals Without Walls (HWW) policy.
However, once the PHE comes to an end, this will cease.
Friday’s proposal specifies that telecommunications will be covered, as well as “audio-only interactive telecommunication systems” when a beneficiary isn’t able to use two-way audio and video technology.
“CMS is taking action to ensure that people with Medicare in rural and underserved areas have improved access to high-quality health care and to prepare for the next pandemic,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “The proposals in this rule, if finalized, will expand access to care options in rural communities and permanently allow behavioral health services to be provided to people in their homes.”
Currently, beneficiaires can only receive the remote care if they have had an in-person service within 6 months of their first virtual care visit. Additionally, beneficiaries must have an in-person service without the use of communications technology every 12 months.
“We are proposing to permit exceptions to the in-person visit requirement when the hospital clinical staff member and beneficiary agree that the risks and burdens of an in-person service outweigh the benefits of it, among other requirements,” CMS wrote in its FAQs about the changes.
The federal government instituted and has continuously extended the PHE. The PHE loosened health care regulatory frameworks to allow for a better response to the pandemic.
This loosened regulatory framework allowed telehealth to flourish in behavioral health.
“With this proposed rule, we are taking important steps forward to ensure that CMS is doing our part to make sure we have a competitive American health care system that works for all people with Medicare,” Dr. Meena Seshamani, deputy administrator and director of CMS’ Center for Medicare, said.
Telehealth and behavioral health have fused in a unique way among health care specialties. Starting in March 2020, COVID-19 mitigation efforts shut down or severely limited in-person health care services. This forced health care to embrace telehealth unlike at any other time.
In recent months, the utilization of telehealth has dropped across several specialties. But behavioral health has seen the largest increase in its utilization and a more enduring presence.
The number of telebehavioral health visits provided to Medicare beneficiaries increased by 32x — or by 3,090% — in 2020 compared to 2019, according to a report from the Office of the Assistant Secretary for Planning and Evaluation.
Earlier in the month, CMS revealed it would change the supervision requirements for several types of behavioral health care providers in the proposed 2023 Medicare Physician Fee Schedule.
That proposed rule makes it easier for more types of behavioral health practitioners to participate in the care of Medicare providers. CMS cited the critical shortage of behavioral health providers as the impetus of the proposed rule change.
The proposed physician fee schedule also allows for more reimbursement to start virtual medication-assisted treatment for virtual opioid-use disorder treatment.
Additional reporting by Laura Lovett
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