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President Biden Sends National Drug Control Policy to Congress

Written by Emily Wilkins (NABH) on . Posted in Alerts.

[vc_row][vc_column][vc_column_text]President Biden on Thursday sent his administration’s inaugural National Drug Control Policy to Congress with the goal of using a whole-of-government approach to combat the nation’s overdose crisis. The comprehensive strategy focuses on the main drivers of the crisis—untreated addiction and drug trafficking—as it directs federal agencies to take actions that will expand access to evidence-based prevention, harm reduction, treatment, and recovery services, while also reducing the supply of drugs. The plan comes as the nation continues to produce grim statistics: for the first time in America’s history, the country has passed the milestone of 100,000 deaths resulting from drug overdoses in a 12-month period. Meanwhile, since 1999, drug overdoses have killed approximately 1 million Americans. A message from President Bident to Congress at the beginning of the strategy explains the Office of National Drug Control Policy led the effort to produce the strategy in close collaboration with the 18 national drug control agencies. In addition, the Biden administration involved more than 2,000 leaders and stakeholders, including Congress, all 50 Governors, and advocates representing public safety, public health, community groups, local governments, and Tribal communities. An important component of the strategy is its emphasis on harm reduction, an approach that works with people who use drugs to prevent overdose and infectious disease transmission; improve the physical, mental, and social wellbeing of those served; and offer flexible options for accessing substance use disorder treatment and other health care services. “We are changing how we help people when it comes to drug use, by meeting them where they are with high-impact harm reduction services and removing barriers to effective treatment for addiction,” Rahul Gupta, M.D., M.P.H., M.B.A., director of National Drug Control Policy, said in the document, “while addressing the underlying factors that lead to substance use disorder head on.”[/vc_column_text][/vc_column][/vc_row]
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President Biden’s 2023 Budget Seeks to Transform U.S. Behavioral Healthcare Delivery

Written by Emily Wilkins (NABH) on . Posted in Analysis.

[vc_row][vc_column][vc_column_text]President Biden is proposing new, mandatory investments totaling $51.7 billion over 10 years to enhance behavioral healthcare in America in the fiscal year (FY) 2023 budget proposal he released Monday. Among the budget blueprint’s most notable behavioral health provisions is the president’s request of $697 million for the Substance Abuse and Mental Health Services Administration (SAMHSA) to ensure that 100% of contacts are answered for the new 988 behavioral health crisis hotline that will begin to operate in July. This is an increase of $590 million from what was enacted for fiscal year 2022. Another significant provision is the president’s proposal for a new, $7.5 billion Mental Health System Transformation Fund through Medicaid to increase access to mental health services through workforce development and service expansion, including the development of non-traditional health delivery sites, the integration of quality mental health and substance use care into primary care settings, and the dissemination of evidence-based practices. President Biden’s budget also provides an investment of $397 million for the Health Resources and Services Administration’s (HRSA) Behavioral Health Workforce Development Programs, which is $235 million above FY 2022 enacted level. This funding is intended to increase training of new behavioral healthcare providers, including a track for health support workers such as peers and community health workers. The program also places an emphasis on team-based care. This investment is meant to promote inclusive and equitable behavioral healthcare for youth and focus on the knowledge and understanding of children, adolescents, and youth at risk for a mental health disorder, serious emotional disturbance, or substance use disorder (SUD). The budget also includes increases in primary care training and enhancement and nurse education, practice, and retention to expand behavioral health services into primary care. The FY 2023 budget provides $4.6 billion for SAMHSA’s mental health activities, an increase of $2.5 billion above the FY 2022 enacted level. These investments would provide a historic investment in the Behavior Health Crisis Services; expand access to crisis services; ensure access to early intervention and prevention services to the nation’s vulnerable populations; and invest in children’s mental health. NABH is pleased to see President Biden’s budget calls for improving compliance with behavioral health parity standards by requiring plans and issuers to use medical necessity criteria for behavioral health services that are consistent with the criteria developed by not-for-profit medical specialty associations. The proposal would also place limits on the consideration of profit in determinations of medical necessity. The budget would authorize the secretaries of the U.S. Health and Human Services, Labor, and Treasury Departments to regulate behavioral health network adequacy, and to issue regulations on a standard for parity in reimbursement rates based on the results of comparative analyses submitted by plans and issuers at a cost of $720 million over 10 years. The budget proposes requiring all plans and issuers to cover three behavioral health visits and three primary care visits each year without charging a copayment, co-insurance or deductible-related fee.  And it would provide $125 million in mandatory funding over five years for grants to states to enforce mental health and SUD parity requirements.  Any funds not expended by states at the end of five fiscal years would remain available to the HHS secretary to make additional mental health parity grants. It also proposes to eliminate the ability of self-insured non-federal governmental plans to opt out of parity, affording state and municipal employees the same consumer protections that apply to other employees with private health insurance. In Medicare, the president’s budget would eliminate the 190-day lifetime limit and would require Medicare to cover up to three behavioral health visits per year without cost-sharing. Also related to the Medicare program, current law requires the Centers for Medicare & Medicaid Services (CMS) to terminate psychiatric hospital participation in Medicare after six months of non-compliance with conditions of participation, even if the deficiency does not jeopardize patient health and wellbeing.  This provision does not apply to any other provider category. The president’s proposal would give CMS flexibility to allow a psychiatric hospital to continue receiving Medicare payments when deficiencies are not considered to immediately jeopardize the health and safety of its patients and where the facility is actively working to correct the deficiencies identified in an approved Plan of Correction.  This provision is considered budget-neutral and would not have cost implications. Among other provisions, the White House budget proposal would also establish a Medicare benefit category for licensed professional counselors and marriage and family therapists that authorizes direct billing and payment under Medicare for these practitioners; remove limits on the scope of services for which Medicare can pay clinical social workers, licensed professional counselors, and marriage and family therapists; and allow these practitioners to bill Medicare directly for their mental health services for covered Part A qualifying Skilled Nursing Facility stays. And the proposal would ensure that mental health and SUD benefits under Medicare do not face greater limitations on reimbursement or access to care relative to medical and surgical benefits.  The Medicare Payment Advisory Commission (MedPAC) would be required to issue a report to identify existing gaps in mental health and substance use disorder benefits to be addressed in the Medicare statute. Specifically for SUD, President Biden has proposed $519 million, more than double the 2022 enacted level, for the Family Violence Prevention and Services program. This is the primary federal funding stream dedicated to the support of emergency shelter and related assistance for victims of domestic violence and their children. The funding represents an increase of $292 million over FY 2022 enacted for the base program’s shelters and supportive services. This funding provides services to an estimated 1.3 million children and families to prevent family violence, domestic violence, and dating violence. This includes $250 million in cash assistance for domestic violence survivors and $30 million for the Safe Recovery Together demonstration grants. The demonstration grants will support families affected by domestic violence at the intersection of substance-use coercion, housing instability, and child welfare involvement. President Biden’s FY 2023 budget also proposes:
  • $413 million to SAMHSA in FY 2023, and $4.1 billion over 10 years, for community health centers
  • A $238 million increase above the FY 2022 enacted level in funding for Certified Community Behavioral Health Center Expansion Grants
  • An increase in the amount of Mental Health Block Grant funds reserved for crisis intervention services to 10% from 5%
  • An investment of $11.4 billion, including $10.8 billion in discretionary funding, in programs addressing opioids and overdose-related activities across HHS.
After President Biden kicked off the federal budget process on Monday with his budget proposal, Office of Management and Budget Director Shalanda Young testified Tuesday before the House Budget Committee. Director Young will take more questions from the Senate Budget Committee on Wednesday. Meanwhile, congressional appropriators will begin their work soon, starting with a House Appropriations Committee hearing this Thursday that will feature U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra.[/vc_column_text][/vc_column][/vc_row]
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NABH Issue Brief: Details About 9th U.S. Circuit Court of Appeals Ruling to Overturn Wit v. United Behavioral Health Decision

Written by Emily Wilkins (NABH) on . Posted in Issue Brief.

[vc_row][vc_column][vc_column_text]In a blow to parity this week, a three-judge panel of the 9th U.S. Circuit Court of Appeals overturned a trial court’s Wit v. United Behavioral Health (UBH) decision, asserting that UBH’s interpretation that health insurance plans do not require consistency with generally accepted standards of care (GASC) “was not unreasonable.” This NABH Issue Brief highlights brief background on the earlier decision from the trial court, as well as the main points of the three-judge panel’s reversal of that decision this week in its seven-page ruling:
  • The original Wit decision determined that patients’ health and safety are protected when clinicians provide services consistent with GASC that are established by not-for-profit, professional associations, rather than insurance companies whose financial incentives often conflict with what is best for patients.
  • The three-judge panel said it is “not unreasonable” for health insurers’ coverage determinations to be inconsistent with GASC; however, the trial court’s decision, including two 100-page decisions, described how UBH made medical coverage decisions based on financial interests.
  • In its ruling, the appellate court’s three-judge panel did not cite one holding or one fact that the trial court concluded, despite the trial court’s exhaustive trial findings.
  • The trial court’s decision explained UBH’s misrepresentation to regulators that UBH used American Society of Addiction Medicine (ASAM) criteria when, in fact, the company modified and ultimately undercut the actual ASAM criteria.
  • The appellate court’s three-judge panel ruled that UBH is not obligated to cover treatment consistent with GASC if the treatment is not a covered benefit; however, the plaintiffs did not argue that UBH was obligated to cover all services consistent with GASC. Instead, the plaintiffs argued that if services—such as outpatient, intensive outpatient, and residential treatment—are covered benefits, UBH must make medical necessity determinations that are consistent with GASC.
The deeply flawed ruling from the three-judge panel of the 9th U.S. Circuit Court of Appeals has the potential for worsening America’s mental health and addiction crises as the critical need for mental health and addiction treatment services continues to rise during the ongoing Covid-19 pandemic. NABH will continue to fight for true mental health addiction treatment parity and expanded access to care for all who need it.[/vc_column_text][/vc_column][/vc_row]
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President Biden’s First State of the Union to Include Strategy to Address U.S. Mental Health Crisis

Written by Emily Wilkins (NABH) on . Posted in Alerts.

[vc_row][vc_column][vc_column_text]President Biden is expected to announce his administration’s strategy to address the nation’s mental health crisis in the president’s first State of the Union tonight, according to a White House announcement. The strategy is part of what the White House has called a “unity agenda” that consists of policy in which there has historically been support from both Democrats and Republicans—and for which the president will call on Congress to send bills to his desk that deliver progress for all Americans. According to the administration, the mental health strategy aims to strengthen system capacity, connect more Americans to care, and create healthy environments where the country’s health and social services infrastructure addresses mental health holistically and equitably. A White House fact sheet provides detailed action steps for each of these three goals, such as launching the 988 behavioral health crisis hotline that will go live in July; expanding and strengthening parity; and establishing stronger online protections for young people, including prioritizing safety-by-design standards and practices for online platforms, products, and services. President Biden will deliver the State of the Union at 9 p.m. ET. The address will air on all major broadcast networks and cable news channels.[/vc_column_text][/vc_column][/vc_row]
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CMS Issues Guidance on Covid-19 Vaccination Requirements for Most Medicare- and Medicaid-Certified Providers

Written by Emily Wilkins (NABH) on . Posted in Issue Brief.

[vc_row][vc_column][vc_column_text]The Centers for Medicare & Medicaid Services (CMS) on Dec. 29 issued guidance regarding the Interim Final Rule (IFR) regarding Covid-19 vaccination requirements for healthcare staff that the agency published in early November. In the Dec, 29 memo, CMS specified that this guidance does not apply to the following states that are still subject to preliminary injunctions that federal courts issued to block implementation of the IFR in those states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia, and Wyoming. The new CMS guidance delineates the following deadlines and clarifications for requirements that most Medicare- and Medicaid-certified providers must meet in all other states: Within 30 days after issuance of the guidance, healthcare facilities must:
  • Have policies and procedures developed and implemented to ensure all facility staff are vaccinated; and
  • 100% of staff have received at least one dose of Covid-19 vaccine, or have requested an exemption due to a disability or sincerely held religious beliefs, or must wait to receive the vaccine as the Centers for Disease Control and Prevention (CDC) recommends.
  • Facilities that fail to meet this requirement will receive notice of non-compliance, but those that are above 80% and have a plan to achieve 100% staff vaccination within 60 days will not be subject to additional enforcement action.
Within 60 days after the guidance has been issued, healthcare facilities must:
  • Have policies and procedures developed and implemented to ensure all facility staff are vaccinated; and
  • 100% of staff have received completed vaccine series or been granted an exemption due to a disability, or sincerely held religious beliefs, or must wait to receive the vaccine as the CDC recommends.
  • Facilities that fail to meet this requirement will receive notice of their non-compliance, but those that are above 90% and have a plan to achieve 100% staff vaccination within 30 days will not be subject to additional enforcement action.
Within 90 days of issuance of the guidance, facilities failing to maintain compliance with the 100% standard may be subject to enforcement action. CMS also issued specific guidance for each healthcare facility type subject to the IFR, including hospitals and psychiatric residential treatment facilities (PRTFs). The guidance for hospitals and PRTFs appears to be the same. These more specific guidance documents note that “the requirements described above do not include the 14-day waiting period as identified by CDC for full vaccination. Rather, these requirements are considered met with the completed vaccine series (i.e., one dose of a single dose vaccine, or final dose of a multi-dose vaccine series).” This guidance specifies that hospitals and PRTFs “must have a process for ensuring all staff have received at least a single-dose, or the first dose of a multi-dose Covid-19 vaccine series prior to providing any care, treatment, or other services for the facility and/or its patients.” Hospitals and PRTFs “must also ensure those staff who are not yet fully vaccinated . . . adhere to additional precautions that are intended to mitigate the spread of Covid-19.” The guidance suggests a variety of actions or job modifications a facility can implement, including reassigning staff to remote work, mandatory routine Covid-19 testing in accordance with Occupational Safety and Health Administration (OSHA) and CDC guidelines, and requiring staff to wear N95 or higher-level respirators. CMS suggests similar actions for unvaccinated staff who are exempt from the vaccination requirements. The guidance for hospitals and PRTFs clarifies that “[s]taff who exclusively provide telehealth or telemedicine services outside of the hospital setting” and “[s]taff who provide support services for the hospital that are preformed exclusively outside of the hospital setting” are exempt from the vaccination requirements. The guidance also notes, however, “that these individuals may be subject to other federal requirements for Covid-19 vaccination.” In addition, the guidance notes that hospitals and PRTFs are not required to ensure that “one-off” vendors, volunteers, and professionals that provide infrequent, ad hoc, non-healthcare services (such as annual elevator inspections) are vaccinated. Hospitals and PRTFs must track and securely document the following information:
  • Each staff member’s (including contractors, volunteers, and students) vaccination status including specific vaccine, date of each dose, and date of next scheduled dose as well as each staff’s role, assigned work area, and how they interact with patients;
  • Staff who have obtained any booster doses (including specific vaccine and date);
  • Staff granted an exemption (including type of exemption and supporting documentation including documentation signed and dated by a licensed practitioner for medical exemptions);
  • Staff for whom vaccination must be temporarily delayed (including date when staff can safely be vaccinated); and
  • Staff who telework full-time.
The CMS guidance also recommends that hospitals and PRTFs refer to the following CDC informational document when assessing requests for medical exemptions: Summary Document for Interim Clinical Considerations for Use of Covid-19 Vaccines Currently Authorized in the United States. Regarding religious exemptions, the CMS guidance directs hospitals and PRTFs to the Equal Employment Opportunity Commission Compliance Manual on Religious Discrimination for information on evaluating and responding to such requests. The guidance also discusses contingency plans that hospitals and PRTFs must have in place for staff who do not comply with these vaccination requirements, including those who qualify for an exemption. These plans can include actively seeking replacement staff or temporary vaccinated staff until permanent vaccinated replacements can be hired. Surveyors will begin evaluating for compliance 30 days after this guidance was issued during full surveys for recertification or reaccreditation, federal initial surveys, or complaint surveys. This guidance includes detailed instructions for surveyors, including levels of deficiency that may be assigned based on levels of staff vaccination and other factors including whether policies and procedures regarding staff Covid-19 vaccination have been developed and implemented by a facility.  In addition, the guidance specifies that surveyors may lower a citation level and/or enforcement action if they identify that prior to the survey that:
  • A hospital or PRTF “has no or has limited access to vaccine, and the hospital [or PRTF] has documented attempts to obtain vaccine access (e.g., contact with health departments and pharmacies)”; or
  • A hospital or PRTF “provides evidence that they have taken aggressive steps to have all staff vaccinated, such as advertising for new staff, hosting vaccine clinics, etc.”
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SAMHSA Extends Take-Home Methadone Flexibilities to OTPS for One Year

Written by Emily Wilkins (NABH) on . Posted in Alerts.

[vc_row][vc_column][vc_column_text]The Substance Abuse and Mental Health Services Administration (SAMHSA) on Thursday said it will extend for one year the methadone take-home flexibilities it provided to opioid treatment programs (OTPs) at the start of the Covid-19 pandemic in March 2020 and is “considering mechanisms to make this flexibility permanent.” This flexibility has allowed OTPs to dispense 28 days of take-home methadone doses for stable patients and up to 14 days of take-home methadone medication to less stable patients, based on provider assessments. SAMHSA’s announcement said it is extending the flexibilities for a year “effective upon the eventual expiration of the Covid-19 Public Health Emergency.” Click here to read SAMHSA’s announcement.[/vc_column_text][/vc_column][/vc_row]
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CMS to Require COVID-19 Vaccinations for Medicare and Medicaid Providers

Written by Administrator on . Posted in Resources.

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  • CMS is requiring that all staff of certain providers and suppliers participating in the Medicare or Medicaid programs receive the COVID-19 vaccine.
  • The IFR does not allow for weekly testing in lieu of vaccination.
  • The agency expressly preserves an employer’s right to require its employees to be fully vaccinated, regardless of the exemptions provided by the IFC.
Today, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule with comment (IFC), establishing COVID-19 vaccination requirements for staff at specified Medicare- and Medicaid-certified providers and suppliers. The IFC, entitled, “Medicare and Medicaid Programs: Omnibus COVID-19 Health Care Staff Vaccination” (rule; press release; FAQ) stipulates that all staff members, including those who perform their duties outside of a formal clinical setting, of certain providers and suppliers participating in the Medicare and Medicaid programs must be fully vaccinated against COVID-19 unless exempt. The IFC provides that individuals who provide services 100 percent remotely are not subject to the vaccination requirements; however, staff that primarily provide services remotely via telework who occasionally encounter fellow staff are still bound by the IFC’s provisions.
  • Background: On September 9, 2021 President Biden issued an executive order  (EO) entitled “Path out of the Pandemic,” a multifaceted COVID-19 response plan  that seeks to boost vaccinations and testing amid the surge in the delta variant. The President’s new plan focuses on six core components, including: (1) “Vaccinating the Unvaccinated;” (2) “Further Protection for the Vaccinated;” (3) “Keeping Schools Safely Open;” (4) “Increased Testing and Requiring Masking;” (5)  “Protecting Our Economic Recovery”; and (6) “Improving Care for Those with COVID-19.” To further the mission of this EO, CMS and the Occupational Health Services Administration (OSHA) issued regulations requiring certain individuals in the workforce to be vaccinated against COVID-19. In today’s IFC, CMS indicates that providers and suppliers may be covered by both the OSHA rules and the CMS IFC.
CMS is providing two implementation phases for the IFC in order to ensure efficiency in carrying out these requirements — effective 30 and 60 days after publication of this IFC in the Federal Register for Phases 1 and 2, respectively. The IFC notes that non-compliant facilities may be subject to civil money penalties, denial of payment for new admissions, or termination of their Medicare and Medicaid provider agreement. The agency also stated that it intends to retain these provisions beyond the conclusion of the public health emergency (PHE) as relevant, adding that it may deem these provisions permanent for facilities. To this end, CMS highlighted that this rulemaking is not associated with or tied to the PHE declarations, nor is there a sunset clause.
  • What’s Next? The final rule is expected to be published in the Federal Register on November 5, 2021, with an expected effective date of January 4, 2022. Comments to the IFC must be received no later than 60 days after the publication of the IFC in the Federal Register. While legal challenges to these guidelines are expected, CMS has already notably indicated in today’s IFC that, to the extent a court may enjoin any part of the rule, it intends that all other provisions or parts of provisions are to remain in effect.
Key policy items outlined in the IFC include:
  • Applicable Entities — The IFC provides that Medicare- and Medicaid-certified providers and suppliers must require that all applicable staff are fully vaccinated for COVID-19. Specifically, the entities subject to these requirements include:
    1. ambulatory surgical centers (ASCs);
    2. hospices;
    3. psychiatric residential treatment facilities (PRTFs);
    4. programs of all-inclusive care for the elderly (PACE);
    5. hospitals, including acute care hospitals, psychiatric hospitals, long term care hospitals, children’s hospitals, hospital swing beds, transplant centers, cancer hospitals, and rehabilitation hospitals;
    6. long term care (LTC) facilities, including skilled nursing facilities (SNFs) and nursing facilities (NFs);
    7. intermediate care facilities for individuals with intellectual disabilities (ICFs-IID);
    8. home health agencies (HHAs);
    9. comprehensive outpatient rehabilitation facilities (CORFs);
    10. critical access hospitals (CAHs);
    11. clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services;
    12. community mental health centers (CMHCs);
    13. home infusion therapy (HIT) suppliers;
    14. rural health clinics (RHCs)/federally qualified health centers (FQHCs); and
    15. end-stage renal disease (ESRD) facilities.
  • In the IFC, CMS refers to the above facilities as residential congregate-care facilities, acute care settings, outpatient clinical care and services, and home-based care, generally. Notably, the requirements outlined in the IFC do not apply to assisted living facilities, group homes, or physician’s offices because they are not regulated by CMS health and safety standards.
  • Applicable Staff — CMS is requiring that all staff, regardless of patient contact or clinical responsibility, be fully vaccinated against COVID-19. The IFC stipulates that facility employees; licensed practitioners; students, trainees, and volunteers; and individuals who provide care, treatment, or other services for the facility and/or its patients, under contract or other arrangement, are subject to this requirement. The agency notes that staff who perform their duties outside of a formal clinical setting — such as home health, home infusion therapy, hospice, PACE programs, and therapy staff — are not precluded from the rule. Further, CMS asserts that individuals who provide services 100 percent remotely — including fully remote telehealth or payroll services — are not subject to the vaccination requirements. However, staff that primarily provide services remotely via telework who occasionally encounter fellow staff are still bound by the rulemaking.
  • Definition of “Fully Vaccinated” — Under the IFC, an individual is considered to be “fully vaccinated” if it has been two weeks or more since such individual completed a primary vaccination series defined as a single-dose or all doses of a multi-dose vaccine approved by the Food and Drug Administration (FDA). Importantly, individuals who receive vaccines listed by the World Health Organization (WHO) for emergency use but have not been approved or authorized by the FDA will also be counted as fully vaccinated for the purposes of the rulemaking. Additionally, individuals are not required to receive a booster or third dose of a vaccine in order to be considered fully vaccinated. However, providers and suppliers covered by the IFC must have a process for tracking and securely documenting the vaccination status of individuals who have obtained any booster.
  • Exceptions — CMS is requiring that applicable providers and suppliers establish and implement a process to allow staff to request an exemption from COVID-19 vaccination requirements based on applicable Federal law. The agency cites certain allergies; recognized medical conditions; or religious beliefs, observances, or practices as possible grounds for exemption. Providers and suppliers covered by the IFC are also required to document exemption requests from the vaccine requirements as well as the outcomes of those requests. Further, the agency is requiring that all applicable providers and suppliers establish a process to ensure the implementation of additional precautions to mitigate the transmission of COVID-19 for all staff who are not fully vaccinated. Notably, CMS expressly preserves an employer’s right to require that employees be fully vaccinated, regardless of the exemptions provided by the IFC.
  • Implementation — CMS is providing two implementation phases for the IFC in order to ensure efficiency in carrying out these requirements.
    • Phase 1. This phase includes a large majority of provisions in the IFC, including requirements that: (1) all staff have received at least the first dose of the COVID-19 vaccine, or a single dose COVID-19 vaccine, or have requested and/or been granted a lawful exemption to the requirement and (2) facilities have developed and implemented the aforementioned policies and procedures. Phase 1 is effective 30 days after the publication of this IFC in the Federal Register.
    • Phase 2. This phase requires that all applicable staff are fully vaccinated for COVID-19, unless granted an exception, which must be fully approved at this phase. Staff who have completed a primary vaccination series by this date are considered to have met these requirements, even if they have yet to complete the 14-day waiting period required for full vaccination. Phase 2 is effective 60 days after the publication of this IFC in the Federal Register.
  • Enforcement — CMS plans to issue interpretive guidelines, which include state survey procedures, to aid in assessing compliance with the new requirements among providers and suppliers following the publication of this IFC. The agency provides that non-compliant facilities may be subject to civil money penalties, denial of payment for new admissions, or termination of their Medicare and Medicaid provider agreement.
  • Other Provisions — This rule does not provide any prevention and control requirements for PRTFs, RHCs/FQHCs, and HIT suppliers. However, it does require that these entities create procedures in accordance with nationally recognized guidelines to limit the spread of COVID-19. Further, this IFC requires that providers and suppliers retain proper documentation of the vaccination status of each staff member, such as: (1) CDC COVID-19 vaccination card or legible photo of the card; (2) documentation of vaccination from a health care provider or electronic health record; or (3) a state immunization information system record.
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NABH and Other Organizations Applaud CDC for Adding Mental Illnesses to List of Underlying Conditions Associated with Higher Risk for Severe Covid-19.

Written by Emily Wilkins (NABH) on . Posted in News Releases.

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CMS Proposes Audio-Only Communication for Telehealth to Treat Mental Health and Substance Use Disorders

Written by Emily Wilkins (NABH) on . Posted in Alerts.

[vc_row][vc_column][vc_column_text]In its Medicare physician fee schedule proposed rule for 2022, the Centers for Medicare & Medicaid Services (CMS) has proposed extending Medicare coverage to audio-only communication technology for telehealth services to diagnose, evaluate, or treat established patients with mental health disorders and providing Medicare coverage for telemental health services for beneficiaries who are in their homes for appointments. CMS has proposed limiting the use of an audio-only interactive telecommunications system for mental health services for cases in which practitioners have the capability to provide two-way, audio/video communications, but the beneficiary is not capable of using, or does not consent to using, two-way, audio/video technology. CMS has also proposed requiring a new modifier for services provided using audio-only communications that would certify that the practitioner had the capability to provide two-way, audio/video technology, but instead used audio-only technology due to beneficiary choice or limitations. In addition, CMS has proposed allowing certain services added to the Medicare telehealth list to remain on the list until Dec. 31, 2023 to create a glide path to evaluate whether the services should be added permanently to this list after the Covid-19 public health emergency (PHE) ends. CMS is also seeking comment on these proposed recommendations: (1) whether additional documentation should be required in the patient’s medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not the agency should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) if there are other “guardrails” the agency should establish to minimize concerns about program integrity and patient safety. The agency also proposed implementing recently enacted legislation that removes statutory restrictions to provide Medicare coverage of telehealth services for mental health disorders for beneficiaries in any geographic location and in their homes. CMS recommends requiring that an in-person, non-telehealth service be provided by the physician or practitioner furnishing mental health telehealth services within six months prior to the initial telehealth service, and at least once every six months thereafter. CMS is seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology. The agency is also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to provide a mental health service due to unavailability of the beneficiary’s regular practitioner. For opioid treatment programs (OTPs), the proposed rule recommends allowing OTPs to provide counseling and therapy services via audio-only interaction (such as telephone calls) after the Covid-19 PHE ends in cases where audio/video communication is not available to the beneficiary, including circumstances in which the beneficiary is not capable of, or does not consent to using, devices that permit a two-way audio/video interaction, provided all other applicable requirements are met. CMS has proposed requiring that OTPs use a service-level modifier for audio-only services billed using the counseling and therapy add-on code (not bundled services) and document in the medical record the rationale for a service provided using audio-only services, in order to facilitate program-integrity activities. CMS also proposed coverage for the newly approved, higher dose naloxone hydrochloride nasal spray product, and is delaying compliance with electronic prescribing of controlled substances (EPCS) from January 2022 to January 2023. Click here for more information about the proposed rule, which will be published in the Federal Register on July 23. CMS will accept comments on the rule until 5 p.m. ET on Monday, Sept. 13, 2021.[/vc_column_text][/vc_column][/vc_row]
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Biden to Nominate Former West Va. Health Official Rahul Gupta as Drug Czar

Written by Emily Wilkins (NABH) on . Posted in Alerts.

[vc_row][vc_column][vc_column_text]President Biden is expected to nominate Rahul Gupta, M.D. M.PH., M.B.A. to serve as director of the Office of National Drug Control Policy (ONDCP), according to multiple news outlets. If confirmed, Gupta, a buprenorphine-waivered physician, will be the first physician to serve as the office’s director. Most recently Gupta served as senior vice president and chief medical and health officer at the March of Dimes. Previously he served as West Virginia’s health commissioner and is known to be an ally of Sen. Joe Manchin (D-W.Va.). NABH has learned that harm-reduction advocates do not support Gupta’s nomination because of their concerns about how he managed an HIV outbreak in West Virginia, citing a lack of support for needle exchanges, an evidence-based practice that reduces HIV, viral hepatitis, and other infections. ONDCP’s drug policy priorities published in April 2021 have strong harm-reduction priorities, including funding support syringe exchange programs and amplifying best practices for fentanyl test strips. Gupta has been a frontrunner for the position, along with Regina LaBelle, currently ONDCP’s acting director who took a leave of absence from her role as a distinguished scholar and program director at the Addiction and Public Policy Initiative at Georgetown University’s O’Neill Institute. NABH coordinated a stakeholder letter to the Biden Administration that requested the president appoint an ONDCP director to address the highest rates of opioid overdose deaths ever recorded, stating that the pandemic exacerbated what was already an inadequate level of treatment for people with a substance use disorder in the United States.[/vc_column_text][/vc_column][/vc_row]
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The NABH Denial-of-Care Portal is Now Live!

Written by Emily Wilkins (NABH) on . Posted in Alerts.

[vc_row][vc_column][vc_column_text]The National Association for Behavioral Healthcare is pleased to introduce the NABH Denial-of-Care Portal, a resource for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee has worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. “One of the best ways we can advocate for parity enforcement with policymakers and regulators is to provide hard data from our members that show how insurers are not complying with the landmark 2008 parity law,” said NABH President and CEO Shawn Coughlin. “We hope to gather this critical data through our new Denial-of-Care Portal.” Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions. As always, thank you for all you do each day to support and advance NABH’s mission and vision![/vc_column_text][/vc_column][/vc_row]
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HHS Provides Exemptions for Buprenorphine Prescribers for Fewer Than 30 Patients

Written by Emily Wilkins (NABH) on . Posted in Alerts.

[vc_row][vc_column][vc_column_text]The U.S. Department of Health and Human Services (HHS) announced Tuesday that practitioners prescribing buprenorphine, a controlled substance, for opioid use disorder to fewer than 30 patients are exempt from certain regulatory requirements codified under 21 U.S.C. 823(g)(2)(B)(i)-(ii). Under the new guidance, physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives are exempt from having to make certain training related certifications and certifying their capacity to provide counseling and other ancillary services. The guideline does not remove the DATA 200 Waiver, otherwise known as the ‘X-Waiver.’ Providers are still required to file a Notice of Intent with the Substance Abuse and Mental Health Services Administration. The exemption applies to practitioners who are state-licensed and DEA-registered. It also generally limits prescribing to patients who are located in states where the practitioner is licensed. Practicing under this exemption does not count toward the time requirements for prescribing to a higher patient limit under 21 U.S.C. 823(g)(2)(B)(iii). This exemption also applies to other Schedule III, IV, and V drugs. Tuesday’s guidance encourages practitioners to provide access to psychosocial services to improve treatment retention and outcomes. In addition, medical education institutions are strongly encouraged to implement comprehensive training in substance use disorder diagnosis and management. In late January, the Biden administration placed a freeze on Trump administration guidelines that intended to exempt physicians from the X-Waiver. That notice cited clinical concerns and stated the Executive Branch did not have the legal authority to make the change.[/vc_column_text][/vc_column][/vc_row]
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Behavioral Health Slides from MACPAC’s April 2021 Public Meeting

Written by Emily Wilkins (NABH) on . Posted in Resources.

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Access to Mental Health Services for Adults

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Access to Behavioral Health Services for Children and Youth: Draft Chapter and Recommendations

1 file(s) 362.32 KB
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Promoting Behavioral and Physical Clinical Integration Through EHRs

1 file(s) 262.00 KB
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Panel Discussion: What States Are Learning From Expanded Telehealth Use

1 file(s) 1.51 MB
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NABH Highlights Residential Treatment as Critical Service for Youth in New White Paper

Written by Emily Wilkins (NABH) on . Posted in Alerts.

NABH is pleased to share with you Residential Treatment: A Vital Component of the Behavioral Healthcare Continuum, a white paper that emphasizes the importance and effectiveness of psychiatric residential treatment services for children and adolescents. Together the NABH team and Youth Services Committee developed the paper as a resource for policymakers, regulators, the media, and other stakeholders to help explain how and why residential treatment is a vital component in the behavioral healthcare continuum—and how children and adolescents benefit from services in this setting. NABH has posted the paper on the association’s new Youth Services page, which also includes shareable social media messages about the paper’s content for members to post on Twitter and LinkedIn. We urge you to share the link to the new page and the messages with your teams. If you have questions about the paper or a comment to share with the Youth Services Committee, please contact John Snook, NABH’s director of government relations and strategic initiatives, who serves as the association’s staff liaison to the committee. As always, thank you for the work you do each day to advance NABH’s mission and vision!
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CMS Proposes 2.1% Payment Increase to Per-Diem Base Rate for IPFs in FY 2022 

Written by Emily Wilkins (NABH) on . Posted in Alerts.

The Centers for Medicare & Medicaid Services (CMS) on April 7 proposed a 2.1-percent, Medicare payment increase to the per-diem base rate for inpatient psychiatric facilities (IPF) for fiscal year (FY) 2022. This adjustment would increase the per-diem base rate to $833.50 from $815.22 and the electroconvulsive therapy (ECT) rate to $358.84 from $350.97. CMS proposed several changes for inpatient psychiatric care in 2022, such as aligning an IPF policy regarding displaced residents from IPF closures and closures of IPF teaching programs with the policy changes that the agency made final in its FY 2021 IPPS rule. In its FY 2022 proposed rule, CMS recommended the following changes to the IPF Quality Reporting Program:
  • Starting in FY 2023, the agency would add a requirement to report Covid-19 Vaccination Coverage Among Healthcare Personnel in the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network web portal;
  • For FY 2024, CMS would substitute the Follow-up After Psychiatric Hospitalization (FAPH) measure for the Follow-up After Hospitalization for Mental Illness (FUH) measure. The FAPH includes patients with substance use disorders and also expands the provider types who can provide follow-up care to include primary care providers;
  • For FY 2024, the agency would remove the three following measures:
    • Alcohol Use Brief Intervention Provided or Offered and Alcohol Use Brief Intervention Provided (SUB-2/2a),
    • Tobacco Use Brief Intervention Provided or Offered and Tobacco Use Brief Intervention Provided (TOB-2/2a), and
    • Timely Transmission of Transition Record -Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care.
CMS is requesting information about how to develop a patient experience-of-care measure, as well as comments on including a patient-reported outcomes measure that assesses functional outcomes. The agency also wants feedback on measures either included in the IPFQRP now or that could be added that would be appropriate for digital data collection. The agency is also seeking comment about how to modify reporting in a way that would improve collecting information on health disparities. CMS asked specifically for feedback on stratification of quality measure results by dual eligibility, race and ethnicity, improving demographic data collection, and potential creation of a facility equity score synthesizing results across multiple social risk factors. CMS will accept public comments on the rule until June 7.
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U.S. Labor Department Issues Guidance on Parity Compliance

Written by Emily Wilkins (NABH) on . Posted in Alerts.

The U.S. Labor Department (DOL) has issued guidance on new implementation requirements for the Mental Health Parity and Addiction Equity Act (MHPAEA) that the 2021 Consolidated Appropriations Act requires. Enacted on Dec. 27, 2020, the 2021 Consolidated Appropriations Act requires group health plans and health insurance issuers offering group or individual health insurance to perform and document analyses of how they comply with MHPAEA in their application of non-quantitative treatment limits (NQTLs) to mental health/substance use disorder (MH/SUD) benefits, compared with their application of NQTLs to medical/surgical benefits. As of Feb. 10, 2021, health plans and insurers must make these comparative analyses available upon request to three federal agencies that oversee MHPAEA implementation: DOL, the U.S. Department of Health and Human Services, and the U.S. Treasury Department. The required NQTL analyses by health plans and insurance issuers must include the following information:
  1. A description of the NQTL, plan terms, and policies at issue;
  2. Identification of the MH/SUD and medical/surgical benefits to which the NQTL applies;
  3. The factors used in applying the NQTLs to MH/SUD benefits and medical or surgical benefits;
  4. The evidentiary standards used for these factors;
  5. The comparative analyses demonstrating that the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to MH/SUD benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to medical/surgical benefits in the benefits classification; and
  6. The specific findings and conclusions reached by the plan or issuer, including any results of the analyses that indicate that the plan or coverage is or is not in compliance with the MHPAEA requirements.
The new law also requires the federal agencies to share findings regarding these analyses of MHPAEA compliance with the state governments where the plans or issuers are located and submit an annual report to Congress on these findings. The guidance provides additional detail regarding the following topics:
  1. What information plans and issuers must make available to support their their comparative analyses demonstrating compliance with MHPAEA in their use of NQTLs;
  2. Examples illustrating when the federal agencies might determine that a comparative analysis of NQTLs is insufficiently specific and detailed;
  3. The types of documents that plans and issuers should be prepared to make available to the federal agencies to support their analyses and conclusions regarding their NQTL comparative analyses;
  4. What actions the federal agencies will take if they determine that a plan or issuer has not submitted sufficient information or is not in compliance with MHPAEA;
  5. Whether state agencies and plan participants and beneficiaries may request to see a plan or issuer’s comparative analysis of its use of NQTLs;
  6. Which specific NQTLs the federal agencies plan to focus on in the near term when requesting comparative analyses from plans and issuers for review, namely:
    • Prior authorization requirements for in-network and out-of-network inpatient services,
    • Concurrent review for in-network and out-of-network inpatient and outpatient services,
    • Standards for provider admission to participate in a network, including reimbursement rates, and
    • Out-of-network reimbursement rates (plan methods for determining usual, customary, and reasonable charges).
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Biden Administration Releases Drug-Policy Priorities for Year One

Written by Emily Wilkins (NABH) on . Posted in Alerts.

The Biden administration on Thursday released a statement outlining its first-year, drug-policy priorities to address America’s overdose and addiction crises. White House Office of National Drug Control Policy (ONDCP) Acting Director Regina LaBelle noted in an announcement that these priorities will complement President Biden’s American Rescue Plan, which includes an investment of nearly $4 billion in behavioral health services. In the next year, the ONDCP will work across government to implement seven priorities:
  • Expanding access to evidence-based treatment
  • Advancing racial equity in our approach to drug policy
  • Enhancing evidence-based harm reduction efforts
  • Supporting evidence-based prevention efforts to reduce youth substance use
  • Reducing the supply of illicit substances
  • Advancing recovery-ready workplaces and expanding the addiction workforce
  • Expanding access to recovery support services
The strategy identified several issues that NABH has discussed with the ONDCP, including, but not limited to, enforcing parity, improving reimbursement for services, permitting medications through telehealth without an in-person evaluation, and removing policy barriers to using contingency management and motivational incentives. In addition, harm reduction appears to have a more visible role in the Biden administration than with previous administrations, as do issues related to workforce, recovery-ready workplaces, and recovery-support services.
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Changes to Medicare Coverage for Substance Use Disorder (SUD) Treatment Services

Written by Emily Wilkins (NABH) on . Posted in Issue Brief.

This NABH Issue Brief highlights changes to coverage for substance use disorder (SUD) treatment services that the Centers for Medicare & Medicaid Services (CMS) included in its 2021 Medicare Physician Fee Schedule (PFS) and other final rules. The PFS rule also contains many changes related to telehealth for substance use disorder (SUD) services. For a review of these modifications, please see NABH Issue Brief CMS Expands Medicare Telehealth Coverage for Mental Health and Addiction Treatment Services.

SECTION I: PFS and Other Rules

  1. CMS adopted the proposal to expand the PFS bundled payments to include all SUDs, not just OUD treatment services.
    • To avoid duplicate billing for treating individuals who require treatment for more than one substance, HCPCS codes G2086-G2088 should not be billed more than once per month.
2. The agency adopted a new code to reimburse for medication assisted treatment (MAT) and additional services in the emergency department. The drug is paid for separately. There are no minimum number of minutes required. The following code was established for this purpose:
    • HCPCS code G2213: Initiation of medication to treat OUD in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services. (List separately in addition to code for primary procedure).
3. The Initial Preventive Physical Examination (IPPE) and Annual Wellness Visit (AWV) was modified to include a) screening for potential SUDs and b) review of any current opioid prescriptions. CMS adjusted the valuation of these services to reflect the changes in value for office/outpatient E/M visits to which they are cross-walked. 4. CMS finalized the proposal to make the Query of PDMP measure under the Electronic Prescribing objective for MIPS eligible clinicians an optional measure eligible for 10 bonus points in CY 2021, an increase of five points from last year.

SECTION II: Coverage for OUD Treatment Services in OTPs

Nasal Naloxone
  1. CMS revised the definition of OUD treatment services to include short-acting opioid antagonist medications, such as naloxone, including nasal and injectable forms.
    • CMS finalized the proposed drug costs of ASP+0 for nasal naloxone. CMS noted NABH’s concern related to pricing methodology for nasal naloxone and indicated it will monitor utilization of claims data to determine whether payment policies are suppressing naloxone access and need changes in future rulemaking.
    • Injectable naloxone is based on contractor pricing. CMS will monitor the data to determine typical dosages and national pricing in future rulemaking.
2. The agency revised its definition of OUD treatment services to include overdose education. The reimbursement rate for overdose education is $2.53. Payments are attached to the provision of naloxone (see Naloxone add-on codes below).
    • CMS will consider the need for independent coding for overdose education in future rulemaking.
3. Naloxone add-on codes consist of both a drug component and a non-drug component that would account for the provision of overdose education each time the OTP furnishes naloxone.
    • HCPCS G2215: Take-home supply of nasal naloxone (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure.
Drug Cost Non-Drug Cost Total
89.63 2.53 92.16
    • HCPCS G2216: Take-home supply of injectable naloxone (provision of the services by a Medicare-enrolled Opioid Treatment Program); list separately in addition to code for primary procedure.
Drug Cost Non-Drug Cost Total
Contracted Price 2.53 Contracted Price
  4. CMS noted that the brand and authorized generic formulation of the auto-injector naloxone have been discontinued. Therefore, an add-on code for auto-injector naloxone was not finalized. 5. The proposed frequency limit on Medicare payments to OTPs for naloxone was finalized at one add-on code (HCPCS code G2215 or G2216) every 30 days. 6. However, CMS noted NABH’s clinical concern about limiting naloxone and allowed for exceptions to the frequency limitation when it is a medically reasonable and necessary part of the treatment for OUD (e.g., when the beneficiary overdoses and uses the initial supply). Exceptions must be documented in the medical record. 7. CMS finalized its proposal to recoup duplicative payments of naloxone from the OTPs, based on the rationale that as coordinators of patient care, OTPs are best positioned to know whether naloxone is part of the OTP treatment plan or is supplied by another provider or supplier. 8. CMS finalized enrollment through use of Form CMS-855A (Medicare Enrollment Application for Institutional Providers) OR CMS-855B (Medicare Enrollment Application: Clinics/Group Practices and Certain Other Suppliers).
    • OTPs currently enrolled via CMS-855B may switch to enrollment via CMS-855A without an additional site visit and, if applicable, fingerprinting. This is also true if an OTP is currently enrolled under CMS 855-A and switches to CMS-855B.
    • The effective billing date that was established for the OTP under the original enrollment continues to apply.
    • Application fees still apply.
9. As proposed, CMS finalized that periodic assessments (add-on) via audio-visual technology require a face-to-face interaction.
      • Therefore, periodic assessments are permitted to continue after the public health emergency ends but are not permitted to be performed via audio-only
      • Audio-only is permitted to be included as part of the bundled rate but not as an add-on code.
      • Periodic assessments are permitted when medically necessary and documented in the medical record.
10. CMS confirmed the permitted use of “standard billing cycles” in which episodes of care for all patients begin on the same day of the week and “weekly billing cycles” that vary across patients based on patient admission date (or when Medicare billing began). 11. CMS did not finalize its proposal to stratify the bundle.
    • CMS will consider refinements to account for resource variation for different service intensity, such as induction and maintenance periods.
Please click here for comprehensive information about billing and payment and here for comprehensive information about enrollment.
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HHS Announces Delay in Provider Relief Fund Reporting Deadline and Revisions to ‘Lost Revenue’ Definition

Written by Emily Wilkins (NABH) on . Posted in Resources.

The U.S. Health and Human Services Department (HHS) has announced a new reporting portal for providers to register and submit information about how they have used payments from the Provider Relief Fund (PRF) to cover Covid-19-related costs and lost revenues. HHS also said the deadline for reporting is extended, although it did not specify the deadline. The agency said providers can register and become familiar with the reporting portal in the meantime. Previously HHS said that providers who received payments amounting to more than $10,000 from the PRF were required to report by Feb. 15, 2021 on how they used those funds. The department had also said providers had until July 31, 2021 to report on funds not expended by the end of 2020. Late last month, Congress passed the Coronavirus Response and Relief Supplemental Appropriations Act, which added $3 billion to the PRF. This legislation changed the reporting requirements to allow more flexibility in how providers may use PRF funds to cover lost revenues. HHS said in its recent announcement that it is updating PRF reporting requirements to align with the new law. The department highlighted reporting requirement changes in the highlighted section of this document.
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CMS Expands Medicare Telehealth Coverage for Mental Health and Addiction Treatment Services

Written by Emily Wilkins (NABH) on . Posted in Issue Brief.

The Centers for Medicare & Medicaid Services (CMS) extended some Medicare coverage of telehealth services that the agency authorized during the Covid-19 pandemic. The changes were included in the final 2021 Medicare Physician Fee Schedule rule that was published in the Federal Register on Dec. 28, 2020. Extended Coverage of Certain Services CMS permanently extended Medicare coverage of the following services provided via telehealth:
  • Home Visits, Established Patients (only for treatment of substance use disorders (SUDs) and co-occurring mental health disorder when less complex, lasting typically 25 minutes) (99347 & 99348),
  • Group Psychotherapy (other than of a multiple-family group) (90853),
  • Psychological and Neuropsychological Testing (96121),
  • Care Planning for Patients with Cognitive Impairment (99483),
  • Domiciliary, Rest Home, or Custodial Care services (99334),
  • Domiciliary, Rest Home, or Custodial Care services (99335),
  • Visit Complexity with certain office/outpatient evaluation and management services (G2211),
  • Prolonged office or other outpatient evaluation and management service(s) (G2212), and
  • New codes for the initial month or subsequent months of psychiatric collaborative care model services (G2214).
CMS also finalized a long list of telehealth services that are covered temporarily until the end of the calendar year in which the public health emergency (PHE) ends. Here are some examples:
  • Home Visits, Established Patients (only for the treatment of substance use disorder or co-occurring mental health disorder when moderate to severe, typically lasting 60 minutes) (99349, 99350),
  • Psychological and Neuropsychological Testing (96130- 96133, 96136- 96139),
  • Therapy Services, Physical, and Occupational Therapy (97161-97168, 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507),
  • Emergency Department Visits (99281-99285),
  • Domiciliary, Rest Home, or Custodial Care services, Established patients (99336 & 99337),
  • Initial Hospital Care and Hospital Discharge Day Management (99221-99223, 99238, 99239), and
  • Subsequent Observation and Observation Discharge Day Management (99217, 99224-99226).
CMS said it intends these temporary extensions of coverage to allow time for the agency to consider whether these services should be extended permanently. Special Coverage of Mental Health and Substance Use Disorder Treatment via Telehealth This rule implements a change in the Medicare statute enacted in the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) authorizing Medicare coverage as of July 2019 of telehealth visits in a patient’s home (instead of a healthcare facility that qualifies as originating site) and regardless of whether the patient lives in a rural area, but only for treatment of substance use disorders (SUDs) and co-occurring mental illnesses. This final rule states that permanent Medicare coverage of home visits for treatment of SUDs and co-occurring mental health conditions is limited to established patients with less complex conditions. Medicare coverage of home visits via telehealth for moderate to severe SUDs or co-occurring mental illnesses will be covered temporarily until the end of the calendar year in which the PHE ends. CMS also finalized regulations allowing periodic assessments, which are part of opioid use disorder treatment services for opioid treatment programs, to be furnished via two-way interactive audio-video communication technology, as clinically appropriate, if all other applicable requirements are met. With a late-breaking addition, the FY 2021 Appropriations and Covid-19 Relief legislation enacted into law on Dec. 27, 2020 includes a provision authorizing Medicare coverage of mental health services via telehealth to beneficiaries in their homes regardless of geographic location. This provision adds mental health to the existing Medicare coverage authorized in the SUPPORT Act of telehealth services for beneficiaries in their homes, regardless of geographic location, to treat SUDs and co-occurring mental health conditions. The new law adds a requirement that a provider must have seen the beneficiary within six months before receiving the telehealth service to treat a mental health condition. The provision in the latest Covid-19 Relief legislation also states that the Health and Human Services (HHS) secretary may implement this section by interim final rule or “program instruction.” NABH will advise members when HHS takes action to implement the important provision. Coverage of Audio-only and Some Other Services Not Extended Medicare will no longer cover audio-only telehealth visits by physicians (99441-99443) and non-physician practitioners (98966-98968) after the PHE ends. CMS explained that its longstanding interpretation of the statutory provision that authorizes coverage of telehealth refers use of an “interactive telecommunication system” that CMS interprets to exclude audio-only technology. However, CMS did create a new code (G2252) to be used for coverage of longer virtual check-ins (11 to 20 minutes of medical discussion when the acuity of the patient’s problem is not likely necessary to warrant a visit, but the needs of the patient require more assessment time from the practitioner). This new code is valued at the same rate as 99442, whereas the pre-existing virtual check-in service (G2012) is valued at the rate of 99441. Telehealth visits will also no longer be covered for the initial visit with patients in skilled nursing facilities (SNFs) after the PHE. But CMS will allow more frequent subsequent SNF visits via telehealth, every 14 days instead of every 30 days. Continued Coverage of Telehealth Physician Supervision of Residents and Services “Incident To” Physicians’ Services CMS is continuing Medicare coverage of telehealth services delivered incident to the services of a billing professional until the later of the end of the year when the PHE ends or on Dec. 31, 2021. To bill Medicare, the supervising physician must be immediately available to intervene using live, two-way, audio-visual technology (e.g., a Zoom call with the patient, non-physician practitioner and physician). In addition, CMS will continue to cover services for residents who are supervised by physicians via telehealth until the end of the PHE. Teaching physicians must use real-time audio-visual technology. This coverage will be extended after the PHE only in rural areas. CMS clarified that Medicare will continue covering e-visits provided by licensed clinical social workers, clinical psychologists, (as well as physical therapists, occupational therapists, and speech-language pathologists) on a permanent basis. E-visits include brief online assessment and management services via telehealth as well as virtual check-ins and remote evaluation services. CMS has created two new codes for this expanded coverage:
  • Brief communication technology-based service, e.g. virtual check-in, by a qualified healthcare professional who cannot report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous seven days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion (G2251); and
  • Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous seven days nor leading to a service or procedure within the next 24 hours or soonest available appointment (G2250).