August 6, 2024

As Congress continues to negotiate to get a new federal budget in place by October 1 here’s a brief summary of FY25 highlights in the two proposed Labor-Health and Human Service-Education appropriations bills from both the House and Senate.

• In the Senate, the Labor-H bill passed committee 25-3.
  • Senate proposal highlights include (bill text; bill report): 
    • $400M (+$15M) for CCBHCs
    • Includes report language on CCBCH accreditation
    • Includes $2.5M for our CCBHC data infrastructure request
    • $27.96M (level) for Mental Health Awareness Training (MHAT)
    • Includes report language clarifying BSCA funding, as well as support for first responder grantees
    • $55.877M (level) for Primary and Behavioral Health Care Integration (PBHCI) Grants
    • $2.991M (level) for PBHCI TA
    • $2.048B (+$40M) for Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS BG)
    • $1.042B (+$35M) for Community Mental Health Service Block Grant (MHBG)
• In the House, the Labor-H bill passed the full committee by a party-line vote.
  • House proposal highlights include (bill text; report language): 
    • $385M (level) for CCBHCs
    • $0 (no funding provided, report language noted BSCA funding) for MHAT
    • $55.877M (level) for PBHCI Grants
    • $2.991M (level) for PBHCI TA
    • $2.508B (+$500M) for SUPTRS BG
    • $1.022B (+$15M) for MHBG
• When Congress reconvenes in September, a continuing resolution (CR) will likely be needed to provide stopgap funding past the Oct 1 funding deadline. A potential CR would likely go through the November elections. 

With regard to federal regulatory action, below is a summary of proposed provisions in the annual Medicare Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) proposed rules for CY 2025. Comments on both proposals are due September 9th, and the National Council intends to create template comments to share with us ahead of the deadline if you would like to review, customize, and submit comments on these proposals. If you have feedback, input, or experiences that you would like to share with Katherine (KatherineS@thenationalcouncil.org) at the National Council, please reach out to her at your convenience regarding any of the provisions included in the proposals:   on any of the provisions included in the proposals, please let her know by next week.

• CY25 PFS proposed highlights include:
  • Conversion Factor: The proposed conversion factor is $32.36, a 2.8% decrease over CY24. Table 128 (on p. 1561 of this pdf) shows the estimated impact of the PFS on services by specialty. 
  • Telehealth: Several PHE telehealth flexibilities are proposed to be extended through CY25. Per CAA, 2023, in-person visit requirements are currently set to take effect for services furnished on or after January 1, 2025; CMS is delaying in-person visit requirements for RHCs and FQHCs until Jan 1, 2026.
  • OTPs: CMS is proposing to: establish payment for SDOH risk assessment for OTP intake activities, provide that all claims submitted to Medicare under the OTP benefit must include an OUD diagnosis, and align OTP provisions with recent Part 8 final rule. CMS is also proposing new payment for injectable buprenorphine and nalmefene hydrochloride products furnished by OTPs. 
    • Notably, there is also an OTP specific RFI.
  • Behavioral Health: CMS is proposing to: establish separate coding and payment for safety planning interventions and furnishing post-discharge follow-up, establish payments for digital mental health treatment devices, and create new G-codes for payment for interprofessional consultations for clinical psychologists, clinical social workers, marriage and family therapists, and mental health counselors.
    • Here too, there are RFIs specific to CCBHCs and crisis stabilization services.

• CY25 OPPS proposed highlights include:
  • PHP/IOP: CMS is proposing to maintain this rate structure and update payment rates using the latest available cost information from the three latest fiscal year cost reports, as well as OPPS claims from CY 2023. There is no proposal to add any new services to the list of PHP and IOP services. And CMS proposes to maintain the calculations for the CMHC outlier percentage, cutoff point and percentage payment amount, outlier reconciliation, outlier payment cap, and fixed dollar threshold according to previously established policies to include PHP and IOP services.
  • Four Walls Exception: CMS is proposing to add three exceptions to the four walls requirement for IHS/Tribal clinic services, clinic services furnished by a clinic primarily organized for the care and treatment of outpatient behavioral health care, and clinic services furnished by a clinic in a rural area. Under this section, CMS has an explicit footnote about CCBHCs codified in the CAA, 2024 and that there is no four walls requirement for CCBHCs.
  • Remote Services: CMS is proposing to clarify that it anticipates aligning its payment policies and requirements for remote services with those associated in the Fee Schedule.
  • Continuous Eligibility: CMS is proposing to amend existing regulations to conform to the continuous eligibility (CE) requirements imposed by the CAA, 2023, is also proposing to remove the option to limit CE to an age younger than 19, and is proposing to remove the state option to disenroll children from CHIP coverage during the 12-month continuous coverage period for failure to pay required premiums or enrollment fees during the coverage period.
  • Legal Obligation to Pay for Individuals in Custody: CMS is proposing to narrow its definition of “custody” to no longer include individuals who are under supervised, released or required to live under home detention – removing the presumption that Medicare is prohibited to pay for services for this population. Under this section, CMS is seeking comments on what types of medically necessary health care items or services are typically provided at no cost to individuals on parole, probation, or home detention.  (Source:  National Council)