CMS seeks to expand telehealth mental health access
Proposed rule asks for feedback on data collection on LGBTQ+, race and ethnicity, rural populations and more.
Photo: Luis Alvarez/Getty Images
The Centers for Medicare and Medicaid Services is proposing to lift restrictions on telehealth access in the home for the treatment of mental health disorders and to expand rural access to mental health services through interactive telecommunications.
CMS proposes to implement recently enacted legislation that removes certain statutory restrictions to allow patients in any geographic location and in their homes access to telehealth services for diagnosis, evaluation and treatment of mental health disorders.
Along with this change, CMS is proposing to expand access to mental health services for rural and vulnerable populations by allowing, for the first time, Medicare to pay for mental health visits when they are provided by Rural Health Clinics and Federally Qualified Health Centers, to include visits furnished through interactive telecommunications technology.
This proposal would expand access to Medicare beneficiaries, especially those living in rural and other underserved areas, CMS said.
Eligible practitioners would be paid when they provide certain mental and behavioral health services to patients via audio-only telephone calls from their homes when certain conditions are met. This includes counseling and therapy services provided through opioid treatment programs.
These 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, CMS said.
WHY THIS MATTERS
These changes address the widening gap in health equity highlighted by the COVID-19 Public Health Emergency by expanding patient access to care, especially for underserved populations, CMS said.
"The COVID-19 pandemic has put enormous strain on families and individuals, making access to behavioral health services more crucial than ever," said Brooks-LaSure. "The changes we are proposing will enhance the availability of telehealth and similar options for behavioral healthcare to those in need, especially in traditionally underserved communities."
WHAT ELSE: DATA COLLECTION
CMS is soliciting feedback on the collection of data, and on how the agency can advance health equity for people with Medicare, while protecting individual privacy.
This is potentially through the creation of confidential reports that allow providers to look at patient impact through a variety of data points, including, but not limited to, LGBTQ+, race and ethnicity, dual-eligible beneficiaries, disability and rural populations.
The goal is to close the equity gap. Hospitals and healthcare providers may be able to use the results from the disparity analyses to identify and develop strategies to promote health equity, CMS said.
UPDATING VACCINE PAYMENT RULES
Medicare payments to physicians and mass immunizers for administering flu, pneumonia, and hepatitis B vaccines have decreased by around 30% over the last seven years.
In the physician fee schedule proposed rule, CMS is requesting feedback to help update payment rates for administration of preventive vaccines covered under Part B.
In addition to seeking information on the types of healthcare providers who furnish vaccines and their associated costs, CMS is looking for feedback on its recently adopted payment add-on of $35 for immunizers who vaccinate certain underserved patients in the patient's home. CMS is also seeking comments on the treatment of COVID-19 monoclonal antibody products as vaccines, and whether those products should be treated like other monoclonal antibody products after the COVID-19 public health emergency.
BOOSTING THE DIABETES PREVENTION PROGRAM
CMS is proposing a change to expand the reach of the Medicare Diabetes Prevention Program, a model developed to help people with Medicare with prediabetes from developing type 2 diabetes.
The expanded model is implemented at the local level by MDPP suppliers, or organizations which provide structured, coach-led sessions on dietary change, increased physical activity and weight loss strategies.
Approximately one in three American adults have prediabetes and more than eight in 10 do not know they have it, CMS said. Many are at risk for developing type 2 diabetes within five years.
Several underserved communities – including African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans – are at particularly high risk for type 2 diabetes.
During the COVID-19 public health emergency, CMS waived the Medicare enrollment fee for new MDPP suppliers and has observed increased supplier enrollment. CMS is proposing to waive this fee for all organizations that submit an application to enroll in Medicare as an MDPP supplier on or after January 1, 2022.
Additionally, CMS is proposing to shorten the MDPP services period from two years to one year. This proposal would reduce the administrative burden and costs to suppliers. CMS is also proposing to restructure payments so MDPP suppliers receive larger payments for participants who reach milestones for attendance and weight loss.
PHASING OUT COLORECTAL SCREENING ADDITIONAL SERVICES
CMS is also proposing to implement a recent statutory change to provide a special coinsurance rule for procedures that are planned as colorectal cancer screening tests, but become diagnostic tests when the practitioner identifies the need for additional services, such as the removal of polyps.
Currently, the addition of any procedure beyond the planned colorectal screening (for which there is no coinsurance) results in a patient having to pay coinsurance.
Under the proposed change, beginning January 1, 2022, the amount of coinsurance patients will pay for such additional services would be reduced over time, so that by January 1, 2030, it would be down to zero.
THE LARGER TREND
CMS has recommended these changes in a proposed Physician Fee Schedule rule.
During the public health emergency, CMS waived many of the restrictions on the use of telehealth. The proposed rule seeks to make some of these changes permanent.
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com
