CMS Proposes 2.7% Increase to Inpatient Psychiatric Facilities in 2023
The Centers for Medicare & Medicaid Services (CMS) on Thursday
proposed increasing payment rates to the nation’s inpatient psychiatric facilities by 2.7% in fiscal year (FY) 2023, reflecting a 1.5% increase in payments, or about $50 million, relative to FY 2022.
According to the agency’s inpatient psychiatric facility prospective payment system (IPF PPS) proposed rule for FY 2023, the IPF PPS federal, per-diem base rate would increase to $856.80 from $832.94 and the electroconvulsive therapy payment rate would increase to $368.87 per treatment from $358.60 per treatment.
CMS said the increase is based on the proposed IPF market basket update of 3.1% less a 0.4% percentage point productivity adjustment.
For FY 2023 and subsequent years, CMS has proposed to apply a 5% cap on decreases in the IPF PPS wage index in order to mitigate instability in IPF PPS payments due to significant wage index decreases that may affect providers in any given year.
CMS did not propose any changes for the IPF Quality Reporting Program for FY 2023.
Meanwhile, the agency is seeking comments via a request for information (RFI) about what CMS should consider when advancing the use of measurement and stratification as tools to address healthcare disparities and advance healthcare equity.
Specifically, CMS would like comments related to goals and approaches for measuring disparities and using measure stratification across CMS Quality Reporting Programs; guiding principles for selecting and prioritizing measures for disparity reporting; principles for social risk factor and democratic data selection and use; identification of meaning performance differences; guiding principles for reporting disparity measures; and measures related to health equity.
CMS is considering and requesting comment about applying the following measures of health equity in the Inpatient Psychiatric Facility Quality Reporting Program: Health Equity Summary Score (HESS) and a structural measure assessing the degree of hospital leadership engagement in health equity performance data. Both of these measures are under consideration for the Medicare Inpatient Quality Reporting Program.
Please send any comments that your organization may have to
Kirsten Beronio, NABH’s director of policy and regulatory affairs.
President Biden’s 2023 Budget Seeks to Transform U.S. Behavioral Healthcare Delivery
President Biden proposed new, mandatory investments totaling $51.7 billion over 10 years to enhance behavioral healthcare in America in the fiscal year (FY) 2023 budget
proposal that he released on March 28.
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.
NABH is pleased to see President Biden’s 2023 budget proposal 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 president’s 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.
To learn more, please read the
NABH Analysis that the association sent to members earlier this week.
Senate Finance Committee Releases ‘Mental Health Care in the United States: The Case for Federal Action’
In a bipartisan
report released this week, the Senate Finance Committee concluded that “overwhelmingly, access to affordable, reliable, and high-quality behavioral health care escapes Americans when they need it most” and offered some potential solutions to address the nation’s myriad behavioral healthcare challenges.
The 36-page report is divided into eight chapters and examines behavioral health definitions, prevalence, and spending; workforce; children, adolescents, and young adults; access, integration, and coordination; mental health and substance use disorder (SUD) parity; telehealth; and next steps.
“As Chairman of the Senate Finance Committee, I am partnering with Ranking Member Mike Crapo on a major bipartisan effort to bring behavioral health care to the forefront of the U.S. health system by leveraging the programs under this Committee’s jurisdiction, including Medicare, Medicaid, and the Children’s Health Insurance Program,” Senate Finance Committee Chairman Ron Wyden (D-Ore.) said in a letter at the start of the report. Wyden added that 10 members of this committee, including five Democrats and five Republicans, are working on policy areas that Wyden deemed “vital for a path forward.”
The Center of Excellence for Protected Health Information Video Offers Guidance about SUD Personnel and 42 CFR Part 2
The Center of Excellence for Protected Health Information (CoE-PHI) has released a
video that offers guidance about when identified SUD personnel within a general medical facility must follow the federal privacy protections for SUD treatment known as 42 CFR Part 2.
The Substance Abuse and Mental Health Services Administration funds CoE-PHI to help people and organizations understand and apply federal health privacy laws and regulations at work that are specific to certain tasks and roles. CoE-PHI also works to help patients and families understand their rights when seeking treatment for SUD and mental health.
MHA, American Psychological Association, and American Psychiatric Association to Host Webinar on Digital Therapeutics in Mental Health and SUD
Mental Health America, the American Psychological Association, and the American Psychiatric Association will host a webinar next Wednesday, April 6 that examines the role digital therapeutics have in addressing America’s mental health and SUD crises.
Participants will learn from Meena Seshamani, M.D., Ph.D., director of the Center for Medicare at CMS; Bakul Patel, director of the Digital Health Center of Excellence at the U.S. Food and Drug Administration; and other experts in the field.
The hourlong webinar will begin at 2 p.m. ET. Click
here to register.
Reminder: NABH Denial-of-Care Portal is Open to Members
NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials.
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.
Please e-mail
Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.
Register Today for the 2022 Annual Meeting!
NABH will host its 2022 Annual Meeting—
Shaping the Future of Behavioral Healthcare—from June 13-15 at the Mandarin Oriental Washington, DC.
Please remember to
register for the meeting and
reserve your hotel room today!
Fact of the Week
Of the approximately 5.9 million adults living with severe bipolar disorder in the United States in 2020, about 51%, or 3 million adults, were untreated at any given time, the Treatment Advocacy Center
reports.
For questions or comments about this CEO Update, please contact Jessica Zigmond.