The groundbreaking 2024 Medicare Final Rule has officially been released by the Centers for Medicare & Medicaid Services (CMS). In this article, we’ll delve into two crucial aspects of this rule – addressing health-related social needs and expanding access to behavioral health services – to understand how it’s reshaping the healthcare landscape.
Understanding the 2024 Medicare CME Final Rule
The 2024 CME Final Rule signifies CMS’s commitment to patient-centered care. It introduces substantial coding and payment changes to better account for resources involved in delivering comprehensive care through multidisciplinary teams. This commitment aligns with the HHS Social Determinants of Health Action Plan and the Biden-Harris Cancer Moonshot initiative, aiming to provide covered patient navigation services to every American with cancer.
Expanding Coverage for Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs)
A significant aspect of this 2024 Medicare CMS rule is the inclusion of Marriage & Family Therapists (MFTs) and Mental Health Counselors (MHC) in Medicare Part B coverage and payment under the Medicare Physician Fee Schedule. Additionally, addiction counselors meeting specific requirements can now enroll in Medicare as MHCs, significantly enhancing access to critical behavioral health services.
Behavioral Health Integration Codes
CMS is making corresponding changes to Behavioral Health Integration codes to ensure comprehensive coverage. This adjustment empowers MFTs and MHCs to bill for these essential services, promoting holistic patient care. Behavioral Health Integration (BHI) Codes: These are specific codes used in healthcare billing and reimbursement. They are associated with services integrating behavioral health (mental and emotional well-being along with substance use) with primary healthcare.
Comprehensive Coverage. This phrase ensures that all aspects of a patient’s healthcare needs are addressed. In this context, it means that healthcare services should focus on physical health and mental and emotional well-being.
CMS. The Centers for Medicare & Medicaid Services (CMS) is a US government agency responsible for administering healthcare programs, including Medicare and Medicaid.
Making Corresponding Changes. CMS is modifying or updating the BHI codes to align with healthcare policy and practice changes. These changes are intended to reflect the evolving healthcare landscape better.
Empowers MFTs and MHCs. MFTs and MHCs are behavioral health professionals who specialize in addressing mental and emotional health concerns. The adjustment allows these professionals to provide and bill for behavioral health integration services.
Billing for Essential Services. With these changes, MFTs and MHCs can submit claims for reimbursement when they provide essential behavioral health integration services as part of a patient’s overall healthcare. This means they can be compensated for the valuable care they deliver.
Promoting Holistic Patient Care. By enabling MFTs and MHCs to bill for these services, CMS encourages a holistic approach to patient care. This approach recognizes that mental and emotional well-being are integral to a person’s health. It ensures that patients receive comprehensive care that addresses their physical and behavioral health needs.
Psychotherapy for Crisis Services
Section 4123 of the CAA, 2023, introduces new HCPCS codes for psychotherapy for crisis services, complete with an enhanced payment structure. These services can be furnished in various service sites, expanding the reach of crisis mental health care.
Health Behavior