CMS Releases Medicare Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) recently issued the calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS), a proposed rule to announce rate updates, advance health equity, and expand access to critical medical services — including behavioral health care.

The proposed rule, when finalized, will create some of the most significant changes to promote access to behavioral health in the history of the Medicare program. These changes help close the access gap by expanding the behavioral health workforce and paying more accurately for behavioral health services.  These new policies are proposed as part of the Physician Fee Schedule and include:

• Corresponding changes to Behavioral Health Integration codes to allow MHCs to provide integrated behavioral health care as part of primary care settings.
• A proposal to allow the Health Behavior Assessment and Intervention (HBAI) services described by CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168, and any successor codes, to be billed by clinical social workers, marriage and family therapists (MFTs), and mental health counselors (MHCs), in addition to clinical psychologists. Health Behavior Assessment and Intervention codes are used to identify the psychological, behavioral, emotional, cognitive and social factors included in the treatment of physical health problems.
• A proposed increase in the valuation for timed behavioral health services under the progression-free survival (PFS). Specifically, CMS is proposing to apply an adjustment to the work relative value units (RVUs) for psychotherapy codes payable under the PFS, which CMS is proposing to implement over a four-year transition.
• A proposal to modify the requirements for the hospice Conditions of Participation (CoPs) to allow MHCs to serve as members of the interdisciplinary group interdisciplinary group.

The rule strives to support a person’s emotional and mental well-being through their behavioral health care. The rule also proposes to allow licensed professional counselor, including addiction counselors, and marriage and family therapists to enroll in Medicare and bill for their services for the first time, and proposes increased payment for crisis care, substance use disorder treatment and psychotherapy.

Individually, each of the proposed changes described would help to make an essential contribution towards strengthening behavioral health care for people with Medicare, and taken as a whole, they can make a profound and sustained difference in the behavioral health treatment of millions of Americans.

To ensure that the proposed rule becomes final, we need your help! CMS needs to hear directly from you! The comment period opens August 7, 2023, and ends on September 11, 2023, for the Physician Fee Schedule. ACA will provide you with the link and guidance once the comment period begins. Please submit your comments, so that together we can best strengthen behavioral health care for everyone.

For more information regarding the proposed rule, please take a look at this fact sheet. If you would like to become involved in ACA’s advocacy efforts, you can contact the ACA Government Affairs and Public Policy team at advocacy@counseling.org.