The Facilities for Medicare & Medicaid Providers (CMS) recently issued the calendar 12 months (CY) 2024 Medicare Doctor Charge Schedule (PFS), a proposed rule to announce charge updates, advance well being fairness, and increase entry to vital medical companies — together with behavioral well being care.
The proposed rule, when finalized, will create a number of the most vital adjustments to advertise entry to behavioral well being within the historical past of the Medicare program. These adjustments assist shut the entry hole by increasing the behavioral well being workforce and paying extra precisely for behavioral well being companies. These new insurance policies are proposed as a part of the Doctor Charge Schedule and embody:
- Corresponding adjustments to Behavioral Well being Integration codes to permit MHCs to offer built-in behavioral well being care as a part of major care settings.
- A proposal to permit the Well being Conduct Evaluation and Intervention (HBAI) companies described by CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168, and any successor codes, to be billed by medical social staff, marriage and household therapists (MFTs), and psychological well being counselors (MHCs), along with medical psychologists. Well being Conduct Evaluation and Intervention codes are used to determine the psychological, behavioral, emotional, cognitive and social elements included within the remedy of bodily well being issues.
- A proposed enhance within the valuation for timed behavioral well being companies underneath the progression-free survival (PFS). Particularly, CMS is proposing to use an adjustment to the work relative worth items (RVUs) for psychotherapy codes payable underneath the PFS, which CMS is proposing to implement over a four-year transition.
- A proposal to change the necessities for the hospice Circumstances of Participation (CoPs) to permit MHCs to function members of the interdisciplinary group interdisciplinary group.
The rule strives to help an individual’s emotional and psychological well-being by way of their behavioral well being care. The rule additionally proposes to permit licensed skilled counselor, together with dependancy counselors, and marriage and household therapists to enroll in Medicare and invoice for his or her companies for the primary time, and proposes elevated cost for disaster care, substance use dysfunction remedy and psychotherapy.
Individually, every of the proposed adjustments described would assist to make an important contribution in the direction of strengthening behavioral well being take care of individuals with Medicare, and brought as an entire, they will make a profound and sustained distinction within the behavioral well being remedy of tens of millions of Individuals.
To make sure that the proposed rule turns into closing, we want your assist! CMS wants to listen to straight from you! The remark interval opens August 7, 2023, and ends on September 11, 2023, for the Doctor Charge Schedule. ACA will give you the hyperlink and steerage as soon as the remark interval begins. Please submit your feedback, in order that collectively we are able to finest strengthen behavioral well being care for everybody.
For extra info relating to the proposed rule, please check out this fact sheet. If you want to turn out to be concerned in ACA’s advocacy efforts, you may contact the ACA Authorities Affairs and Public Coverage staff at firstname.lastname@example.org.