CMS proposes expanding telehealth reimbursement for mental health as part of Physician Fee Schedule

Black patient talking on conference video call to female doctor
The Centers for Medicare & Medicaid Services wants to reimburse providers who are able to offer mental health services via telehealth, not just via video. (insta_photos/GettyImages)

The Biden administration proposed expanding reimbursement for telehealth for mental and behavioral health services, including paying providers for audio-only services.

The provisions were included in the proposed 2022 Physician Fee Schedule released Tuesday by the Centers for Medicare & Medicaid Services (CMS). The proposed rule includes payment rates for Medicare next year and several other policy proposals that could affect physicians.

The schedule is required under law to be budget neutral, and CMS is proposing a conversion factor of $33.58 for each relative value unit, which is what Medicare payments are based on. The conversion factor is a $1.31 decline from the 2021 conversion factor of $34.89.

A major spending package passed late last year by Congress did give physicians a 3.75% payment increase, but that expires after this year.

CMS wants to pay providers when they give certain mental or behavioral health services to patients via audio-only telehealth calls, but only when certain conditions are met. This would include counseling and therapy for opioid treatment.

“The changes would be particularly helpful for those in areas with poor broadband infrastructure and among people with Medicare who are not capable of, or do not consent to the use of, devices that permit a two-way, audio/video interaction for their healthcare visits,” a release on the rule said.

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The spending package removed geographic restrictions that could be a barrier to telehealth services for mental health.

CMS is also proposing to allow certain services that have been added to the Medicare telehealth list to remain on that list through the end of Dec. 31, 2023. This will ensure there is a “glide path to evaluate whether the services should be permanently added to the telehealth list following the COVID-19 [public health emergency],” a fact sheet on the rule said.

Currently, the public health emergency is expected to last through 2021, and CMS has asked Congress for more flexibility to make telehealth changes permanent.

The agency is also asking for feedback on collecting data from physicians on health equity. CMS wants to know how it can collect data on race, ethnicity, sexual orientation, rural population and other data points.

“Access to these data may enable a more comprehensive assessment of health equity and support initiatives to close the equity gap,” CMS said in a release. “In addition, hospitals and healthcare providers may be able to use the results from the disparity analyses to identify and develop strategies to promote health equity.”

The request is the latest attempt by the Biden administration to close healthcare equity gaps. The agency has mulled such data collection as part of payment models as well.

Other proposals in the rule include:

  • Expanding the reach of the Medicare Diabetes Prevention Program, which aims to help people with prediabetes from developing Type 2. As part of the COVID-19 public health emergency, CMS has been waiving the Medicare enrollment fee for new suppliers. This led to an increase in supplier enrollment, and, now, CMS is proposing to waive the fee for all organizations that submit an application to enroll as a supplier on or after Jan. 1, 2022.
  • Requiring physicians to meet a higher performance threshold to get incentives under the Quality Payment Program. The agency also seeks to implement a statutory change that authorizes Medicare to give direct payments to physician assistants for services made under Part B.
  • Feedback on how to update payment rates to physicians for preventive vaccines such as flu, pneumonia and hepatitis B. CMS has noticed that Medicare payments for these vaccines has declined by 30% over the past seven years. Now, CMS wants feedback on updating the payment rates and on its recently adopted $35 add-on payment to providers that vaccinate certain underserved patients in their homes.

A comment period on the proposed rule is in effect until Sept. 13.