The U.S. Centers for Medicare & Medicaid Services (CMS) included multiple behavioral health updates in two proposed payment rules released on Wednesday.

Intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) will likely see rate changes as part of the CMS proposed payment rates for hospital outpatient and Ambulatory Surgical Center services.

IOPs and PHPs offer an intermediate level of care to patients and can be used as a step-down from inpatient services or a step-up from traditional outpatient services.

In the proposal, CMS notes that to be considered an IOP, programs require a minimum of 9 hours of service a week. IOPs can be used by individuals with acute mental health needs or for those with substance use disorders (SUD).

As with previous years, Medicare can cover IOP programs offered by hospital outpatient departments, Federally Qualified Health Centers (FQHCs) , Rural Health Clinics (RHCs), Opioid Treatment Programs (OTPs) and Community Mental Health Facilities.

In the proposal, CMS plans to keep the rate structure in place for IOPs, which lumps the programs into two categories: one for days with three services and one for days with four or more services.

The agency plans to use claims data from 2023 and data from the previous three years to determine the cost-per-day rate.

CMS also plans to update the payment rates for PHPs. For a program to be categorized as a PHP, it must offer a minimum of 20 hours of service per week. Similar to IOPs, programs are categorized into two rate structures: ones with three services a day and ones with four or more services a day.

CMS will pay for the service per diem under the Outpatient Prospective Payment System. The agency plans to update rates based on recent data from 2023 and prior fiscal years.

Later that day, CMS released the Physician Payment Rule, which proposes new payment for clinicians who care for people at high risk of suicide or overdoes. The proposal includes a separate fee for safety planning interventions and post-discharge follow-up contracts.

The new proposal also pitches a new payment and coding for digital tools that provide behavioral health treatments.

On the SUD side, the proposal would create new codes for FDA-approved medications for opioid use disorder (OUD). It would also develop codes to boost telecommunication flexibilities for periodic assessments and methadone treatment initiation. The rule would also increase payment for intake activities to provide more wrap-around services to individuals with OUD.