November 7, 2023
Yesterday we shared a ‘heads up’ alerting NYS Council members to a live radio interview with the state’s (relatively) new Budget Director Blake Washington. See below for a link to the interview with David Lombardo, host of the Capitol Pressroom on 11/6, fyi:
State budget director discusses New York’s finances
November 6, 2023 – State Budget Director Blake Washington visits the studio to discuss the mid-year financial plan update, including what it says about future budget deficits, spending on Medicaid costs, and future decreases in federal aid.
Here’s a link to the recorded broadcast:
The Centers for Medicare & Medicaid Services (CMS) recently issued final rules for its Calendar Year (CY) 2024 Physician Fee Schedule (PFS) and its CY 2024 Hospital Outpatient Prospective Payment System (OPPS).
Below is a summary of the Rules soon to be published in the Federal Register, from the National Council, and below that is an article from Becker’s describing some of the coming changes.
On Nov. 2, 2023, CMS issued its final rule for the CY 2024 Physician Fee Schedule (PFS), which establishes policy changes for Medicare payments and related policies effective on or after Jan. 1, 2024.
- Overall, payment rates under the CY 2024 PFS will be reduced by 1.25% compared to CY 2023. The final CY 2024 PFS conversion factor is $32.74, a decrease of 3.4% from CY 2023, which reflects statutory budget neutrality requirements. (For more information, see Table 118: CY 2024 PFS Estimated Impact on Total Allowed Charges by Specialty, which demonstrates the estimated payment impact of policies in the final rule by specialty.)
Medicare Mental Health and Substance Use Disorder-specific Provisions Include:
- Ability for marriage and family therapists (MFTs) and mental health counselors (MHCs), as well as addiction counselors who meet MHC requirements, to now enroll in Medicare and bill for services furnished starting January 1, 2024. MFTs and MHCs are also added as distant site practitioners for purposes of furnishing telehealth services and included as eligible for payment for services furnished at rural health clinics (RHCs) and federally qualified health centers (FQHCs).
- Individuals who meet the MFT or MHC eligibility requirements established in the Final Rule are able to enroll in Medicare via the Form CMS-855I application (Medicare Enrollment Application – Physicians and Non-Physician Practitioners; OMB No. 0938-1355) and can begin submitting their enrollment applications now, for services furnished beginning Jan. 1, 2024. Visit the Medicare enrollment for providers & suppliers page for basic information on the provider enrollment process.
- Ability for MFTs, MHCs, Clinical Social Workers (CSWs), and Clinical Psychologists to conduct and bill for health behavior assessment and intervention services (HBAI);
- New Healthcare Common Procedure Coding System (HCPCS) codes for psychotherapy for crisis services that are furnished in applicable site of service at which the non-facility rate applies, other than the office setting. The payment amount for these psychotherapy for crisis services is 150% the fee schedule amount for non-facility sites of service;
- A 19.1% increase to the work Relative Value Units (RVUs) for both standalone psychotherapy codes, psychotherapy codes billed as an add-on to an E/M (evaluating/managing) visit, and HBAI codes over the course of four years;
- Extended current flexibilities for periodic assessments that are furnished through audio-only telecommunications through the end of CY 2024 for Opioid Treatment Programs (OTPs) when video is not available to the beneficiary to the extent to which doing so is permissible under Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) regulations; and
- Requirement to allow social workers, MHCs or MFTs to serve as members of the interdisciplinary group under hospice conditions of participation.
Medicare Telehealth-specific Provisions Include:
- Continued delay of the in-person requirement for tele-behavioral health visits, continued temporary expansion of telehealth originating sites for telehealth services, continued coverage for audio-only communication systems, and direct supervision defined to permit the immediate availability of the supervising practitioner through real-time audio and visual communications through December 2024; and
- Beginning in CY 2024, claims billed with POS 10 (Telehealth Provided in Patient’s Home) will be paid at the non-facility PFS rate, and claims billed with POS 02 (Telehealth Provided Other than in Patient’s Home) will continue to be paid at the PFS facility rate.
Additionally, CMS is finalizing new coding and payment changes for social determinants of health risk assessment, community health integration, and principal illness navigator services.
CMS expands Medicare payments for behavioral care: 5 things to know
CMS will allow more types of behavioral health providers to bill Medicare in 2024, and establish payment for intensive outpatient behavioral healthcare.
The agency published its final payment rules for 2024 on Nov. 2. CMS is adding several updates to how Medicare will reimburse for behavioral health services, intended to improve access to more types of care.
“HHS is committed to expanding access to behavioral healthcare for people with Medicare. This rule will fill longstanding gaps in behavioral health treatment for Medicare beneficiaries and advance health equity for Tribal communities, rural communities and others who are underserved,” HHS Secretary Xavier Becerra said in a news release.
Here are five key behavioral health changes to note:
- CMS will establish Medicare payments for intensive outpatient care for acute mental illness and substance use disorder. These services can be provided by hospital outpatient departments, Community Mental Health Centers, Federally Qualified Health Centers and Rural Health Clinics.
- The intensive outpatient treatment services payments will also apply to Opioid Treatment Programs.
- Beginning in 2024, marriage and family therapists and mental health counselors will be able to bill Medicare for their services. Drug and alcohol counselors who meet the requirements to be mental health counselors will also be able to bill Medicare.
- CMS will establish payment for crisis psychotherapy services provided outside of an office setting, including at patients’ homes or through mobile outreach units.
- CMS will increase Medicare payments for timed-behavioral health services over a four-year phase in period.
2) Read more about the final payment rules here:
Attached, please find a letter we recently endorsed urging leaders in Washington to (finally) make the Child Health Insurance Program (CHIP) permanent by passing the Children’s Health Insurance Program Permanency Act (CHIPP Act – HR4771). The Act would guarantee the Program is in federal statute rather than it being subjected to repeated threats of expiration or political game playing.
New Toolkit Demonstrates Business Case for Partnering with Community-Based Organizations
The Institute for Medicaid Innovation has released a social determinants of health (SDOH) toolkit to help advance investments in community based organizations The toolkit helps Medicaid manage care organizations make the business case for deepening these relationships with community members. Phase 1, which is funded by the Episcopal Health Foundation, offers tools to support authentic partnerships with community-based organizations. Future phases will provide tools to address implementation strategies and mitigate barriers.