9 Behavioral Health Changes from CMS Final Rules & the Omnibus Bill

The final quarter of 2022 brought significant developments for the behavioral health industry — developments providers should know about because of their immediate and potentially long-term impact on the delivery of mental health care. There were significant changes included in the 2023 Physician Fee Schedule (PFS) final rule, the 2023 hospital outpatient prospective payment system (OPPS) and ambulatory surgery center payment (ASC) system final rule, and the 2023 omnibus appropriations bill (i.e. Consolidated Appropriations Act, 2023), as well as other noteworthy news as we closed out the year.

Below is a summary of nine of the biggest behavioral health developments to know.

1. Revised behavioral health supervision requirements

The PFS final rule created an exception to behavioral health supervision requirements. This allowed professionals including marriage and family therapists, licensed professional counselors, addiction counselors and certified peer recovery specialists to provide behavioral health services while being under general supervision rather than "direct" supervision. In other words, these practitioners are now able to provide services without a doctor or nurse practitioner physically on site. The new rule will hopefully help increase access to behavioral health services, particularly in underserved and rural communities.

2. Reimbursement for psychologists and social workers

The final rule finalized Medicare payments to clinical psychologists and licensed clinical social workers who help manage behavioral health needs as part of the primary care team. As attorneys from Dickinson Wright note, "This coordination and integration of specialty care through existing primary care provider networks are designed to ease the process of receiving behavioral health services for Medicare beneficiaries."

3. Expanded opioid treatment coverage

Opioid treatment programs (OTPs) got some welcome news in the PFS final rule. This included the following:

• OTPs may now bill Medicare for services performed by mobile units (e.g., vans) without obtaining a separate registration.
• Payment rates to OTPs were increased "to better reflect the costs of individual therapy services," CMS stated.
• The policy to pay for the initiation of buprenorphine to treat opioid use disorder using telecommunications was finalized.
• CMS extended allowing payment to OTPs for periodic assessments furnished over audio-only telephone calls through the end of 2023.

4. Hospital outpatient remote behavioral health services made permanent

The OPPS/ASC final rule made permanent the temporary policy allowing clinical staff of hospital outpatient departments, including staff of critical access hospitals (CAHs), to provide remote behavioral health services to patients in their homes. The policy was instituted in response to the COVID-19 public health emergency (PHE).

This change has some limitations and stipulations, which CMS noted includes the following:

• Payment for behavioral health services furnished remotely to beneficiaries in their homes may only be made if the beneficiary receives an in-person service within six months prior to the first time that hospital clinical staff provides the behavioral health services remotely.
• There must be an in-person service without the use of communications technology within 12 months of each behavioral health service furnished remotely by hospital clinical staff.
• Exceptions to the in-person visit requirement are permitted when the hospital clinical staff member and beneficiary agree the risks and burdens of an in-person service outweigh the benefits of it.
• In instances where there is an ongoing clinical relationship between practitioner and beneficiary at the time the PHE ends, the in-person requirement for ongoing, not newly initiated, treatment will apply.
• Audio-only interactive telecommunications systems may be used to furnish these services in instances where the beneficiary is unable to use, does not wish to use or does not have access to two-way, audio/video technology.

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5. Substantial federal funding toward behavioral health initiatives

The $1.7 trillion omnibus bill included more than $10 billion devoted to behavioral health initiatives. Included in this bill are the following:

• $4.9 billion in funding to address opioid abuse (an increase of 6% over 2022) 
• $5.27 billion for mental health treatment, prevention and research (an increase of 18% over 2022) 
• An overall increase in these two areas of 12%. 

6. Significant behavioral health workforce development funding

The omnibus bill allocates at least $197 million focused on behavioral health workforce education and training programs and graduate education programs. These should help provide more behavioral health clinicians at a time when they are needed the most.  

7. Funding for the Substance Abuse and Mental Health Services Administration

As part of the appropriations for the Department of Health and Human Services (HHS), money in the omnibus bill will go toward Substance Abuse and Mental Health Block Grants provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). As SAMHSA notes, "Grantees use the block grant programs for prevention, treatment, recovery support, and other services to supplement Medicaid, Medicare and private insurance services."

The American Hospital Association noted SAMHSA also received funding to invest in several mental health programs designed to expand access to services. This included funding for:

• Certified Community Behavioral Health Centers;
• the new 988 number and Behavioral Health Crisis Services; and
• creation of mobile behavioral health crisis response teams.

8. Updates to Medicaid mental health policies

There were updates to Medicaid mental health policies. Mandated in the omnibus bill: development of a searchable directory of mental health providers and guidance from CMS on access to crisis response networks under Medicaid.

9. New behavioral health screening recommendations

In October, the U.S. Preventive Services Task Force (USPSTF) issued new behavioral health-related recommendations for primary care physicians concerning screening for anxiety in children and reaffirmed its recommendations for screening for depression in children. We previously covered this announcement here.

Progress Made, But Much Work Remains

2022 ended with positive momentum for the behavioral health industry. Access to resources is a key component to abating our mental health crisis, and the government's commitment to increasing funding for more clinicians and programs is a tremendous step in the right direction.

But these steps alone are not adequate. We will not be able to address this crisis simply by adding more clinicians. In addition, until reimbursement models change, and we see greater coverage parity between physical and mental health, we will struggle to fix the behavioral health provider and service problems we're currently facing.

At Proem, we're working to help reduce some of the challenges facing today's behavioral health providers in their efforts to assess, treat and deliver positive outcomes for their patients with mental illness. Our platform provides clinicians with efficiency, accuracy and consistency in their practice of behavioral health care, helping them make more accurate decisions so people can lead healthier lives.

To see how it works, click here, then schedule a demo.