CMS addresses behavioral health workforce shortage with proposed regulatory changes

A nationwide shortage of all types of behavioral health staff – therapists, nurses, psychologists, substance use disorder treatment counselors and psychiatrists –   is exacting a harsh toll on the behavioral health field.

Long wait times for new assessments, longer times between visits, missed medication refills, and accelerating crisis situations head the list of patient and provider concerns in a behavioral health workforce shortage crisis fueled by the pandemic and showing no signs of abating.

Providers say they’re often faced with the choice to overload available staff, refer behavioral health patients out of county for services, or eliminate needed services. Increased caseloads lead to more staff burnout and turnover, exacerbating the problem.

Medicare is looking to ease some of the burden with a rewrite of at least some of the rules, recognizing the role of behavioral health in whole person health care and making it easier for patients to access behavioral healthcare services.

Specifically, the Centers for Medicare and Medicaid Services (CMS) wants to change requirements for how some behavioral health care services are supervised, allow additional providers to be reimbursed for coordinating behavioral health services, and in some cases of opioid treatment, allow a new method of delivery for services to rural patients.

Proposed rule for CY 2023

Earlier this summer, CMS introduced a proposed rule setting the Medicare Physician Fee Schedule (PFS) for CY 2023. The rule includes numerous regulatory changes specifically designed to make behavioral health care more accessible.

“CMS is recognizing that the staffing shortage is negatively impacting the availability of behavioral health care and is proposing some regulatory revisions to improve access to and the quality of behavioral health services,” said Eloy Paez, Executive Vice President Behavioral Health, INFINITY.

“Among other changes, the proposed regulations would enable behavioral health practitioners to practice to the full scope of their license under general rather than direct supervision of a physician,” Paez said.

“It also puts in place a mechanism for psychologists and social workers to become an integral part of a patient’s primary care team, allowing reimbursement to them for managing the patient’s behavioral health care needs,” he added.

Whole person health care

The CY 2023 PFS proposed rule is one of several proposed this year reflecting new CMS strategy to create a more equitable health care system and advance whole person health care initiatives.

Whole person health care is a concept which recognizes and addresses underlying factors likely to impact patient outcomes and well-being. For example, financial concerns may prevent a patient’s ability to buy nutritious foods, or depression may interfere with a patient’s self-care regimen for diabetes.

“CMS wants to address the relationship between a person’s whole emotional and mental well-being and promote person-centered behavioral health care,” Paez said.

“To accomplish that, it has implemented a new set of initiatives this year known as the Behavioral Health Strategy.”

The new Behavioral Health Strategy aims to strengthen patient access to prevention and treatment services for substance use disorders, mental health services, crisis intervention and pain care.

Proposed regulations changes

The CY 2023 PFS proposed rule attempts to align Medicare regulations with many of the goals CMS identified in its new Behavioral Health Strategy. Among regulatory changes set out in the proposed rule are:

• A change in supervision and coordination requirements. The proposed rule would allow more behavioral health services to be provided to Medicare patients under the general supervision of a physician or nurse practitioner rather than under direct supervision. This means a physician may not have to be directly on site for services to be provided by addiction counselors, certified peer recovery specialists or certain other therapists. However, to be covered under Medicare, services would have to be provided by auxiliary personnel incident to the services of a physician or non-physician practitioner. Examples of behavioral health professionals allowed to provide services under general rather than direct supervision include licensed professional counselors (LPCs) and Licensed Marriage and Family Therapists (LMFTs). The change would enable practitioners to provide behavioral health services to the full scope of their license. Licensure laws vary state by state, so the regulatory change would have more impact in some states than others.
• A path to behavioral health integration. The rule proposes to pay psychologists and social workers to help manage behavioral health needs as part of a patient’s primary care team. The proposed change is designed to make it easier for a patient to get behavioral health care services such as psychotherapy because the care would be coordinated through their primary care provider.
• A new team-based approach to pain treatment. For the first time, CMS is proposing new payments for a comprehensive, holistic, and team-based approach for the treatment of chronic pain. A CPM code would include diagnosis, assessment and monitoring, administration of a validated pain rating scale, and the development and implementation of a person-centered care plan. Coordination of any necessary behavioral health treatment would be required for the care plan, along with goals, clinical needs, overall treatment management, and other care planning components.
• Advanced shared savings payments for behavioral health. To assist Accountable Care Organizations (ACOs) in providing whole person services to patients, CMS proposes making advanced shared savings payments to new and smaller AOCs. They would be able to use the funds upfront to hire behavioral health practitioners and address social needs such as food or housing.
• Billing for opioid treatment by mobile units. Under the proposed rule, CMS would allow opioid treatment programs to bill for services performed by mobile units such as vans without obtaining a separate registration. The change is designed to increase availability of services to homeless or rural populations. CMS also wants to pay for the telehealth initiation of a drug used to treat opioid use disorder. Currently use of the treatment drug must be initiated in person.

Want to learn more about the proposed rule? View the CMS Fact Sheet here.

How INFINITY can help

A shifting regulatory landscape accelerates the need for a deeper understanding of requirements at every stage of the revenue cycle to ensure compliance and profitability.

INFINITY delivers precision billing and claims management, including payor source management, benefits verification, utilization review and other components of an effective revenue cycle.  Our knowledgeable team ensures compliance with payor requirements. We identify the problems leading to denials, accelerate cash flow, and remedy obstacles to profitability.

Use the form below to reach out to us today to see how we can make your revenue cycle stronger and healthier overall.