NABH Comments on 2024 OPPS and Physician Payment Proposed Rules
This week NABH submitted a comment
letter to the Center for Medicare & Medicaid Services (CMS) about the agency’s proposed rules pertaining to both the outpatient prospective payment system (OPPS) and physician fee schedule (PFS) for 2024.
Outpatient PPS Proposed Rule. Among the rule’s multiple behavioral healthcare provisions, a key item was CMS’ proposed design and implementation of the congressionally mandated intensive outpatient program (IOP) as a new Medicare benefit in hospital outpatient departments, community mental health centers, federally qualified health centers, rural health clinics, and opioid treatment programs. NABH generally supports CMS’ proposed approach of basing many of the new IOP design features on the existing partial hospitalization program (PHP) framework because PHPs treat a similar mix of patients, although with a higher level of intensity.
That said, NABH raised concerns regarding some of the proposed design features, including the need to align the new IOP patient eligibility criteria with the clinical characteristics of current IOP populations. Specifically, NABH urged CMS to remove these criteria: “adequate support system at home” and “risk of danger to self or others” as they would exclude a significant portion of the patient population for whom this benefit is intended.
NABH expressed additional concerns related to the implementation of IOP benefit by opioid treatment programs including that the physician-driven IOP certification and treatment planning requirements do not align with the scopes of practice of non-physician professionals nor with the ASAM requirements for IOP and other level of care assessments; that additional specialty care settings should be considered for IOP services; and that CMS develop a contingency management bundle for individuals with stimulant use disorder.
Physician Fee Schedule Proposed Rule. NABH’s comments about the PFS rule respond to CMS’ proposed 2.0% increase for psychiatric service payments, relative to CY 2023 rates, which starkly contrasts to the proposed decrease for overall PFS payments of negative 3.3%. Our comments recommend increases for both overall and psychiatric services due to significant workforce and other pressures facing all healthcare providers. We also support the agency’s provision to set payments to 150% of facility-based payments for “psychotherapy for crisis” services that are furnished in a setting other than a physician’s office or mobile unit or home.
In addition, we support CMS’ proposal to allow three new behavioral healthcare practitioners to bill under Medicare Part B: marriage and family therapists, mental health counselors (MHCs), and addiction counselors that meet Medicare criteria for MHCs. NABH also called for a 10 percentage-point increase in payments for these providers and the addition of psychiatric mental health nurse practitioners to this group.
We also recommended that telehealth services offered by community health integration, social determinants of health, and principal illness navigation specialists be covered; that remote monitoring codes be developed for opioid treatment programs and office-based opioid treatment providers; and that progressively decreasing buprenorphine reimbursement rates be re-evaluated and increased.
Providers Share the Negative Impact of Returning to DEA’s Pre-Pandemic Telemedicine Rules
The Drug Enforcement Administration held a two-day listening session this week in response to almost 40,000 comments it received earlier in the year about its proposal to reimpose in-person visits for the prescribing of controlled substances, including buprenorphine.
DEA Administrator Anne Milgram announced that the agency would provide an additional comment period for telemedicine. This would likely require an extension of the telemedicine flexibilities offered during the COVID-19 pandemic.
Testimony over the course of two days addressed how changes to pandemic-era telemedicine rules would impede care for individuals needing medication for attention-deficit/hyperactivity disorder and opioid use disorder, individuals in end-of-life care needing opioids for pain relief, individuals receiving gender-affirming care, and many others.
The listening session requested recommendations on a “special registration” process that Congress requested many years ago.
National Academies Seeking Experts to Participate in Study to Develop National Prevention Infrastructure for Behavioral Health Disorders Blueprint
The National Academies of Sciences, Engineering, and Medicine is seeking suggestions for experts to participate in a study to develop a
Blueprint for a National Prevention Infrastructure for Behavioral Health Disorders.
The study also will identify funding needs and strategies to support the infrastructure; identify gaps in policy research and health services research that may serve as barriers to implementing the program; and recommend state and federal policies to support the financing and infrastructure, including workforce development and data interoperability for promoting behavioral health. Click
here to learn more about the scope of work for the ad hoc committee that will develop the blueprint and click
here to submit recommendations of volunteer experts.
The deadline to submit recommendations is
Wednesday, Sept. 20.
SAMHSA Releases Resources to Help Communities Address Opioid Overdose Crisis
The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released two resources to help community practitioners end America’s opioid crisis.
SAMHSA commissioned RTI International to develop—together with a SAMHSA technical expert panel—
Engaging Community Coalitions to Decrease Opioid Overdose Deaths and
Opioid-Overdose Reduction Continuum of Care Approach.
The guides are based on insights and tools from the ongoing National Institutes of Health (NIH) HEALing Communities Study. NIH and SAMHSA launched that study in 2019 to test the effect of an integrated set of evidence-based practices across healthcare, behavioral health, justice, and other community-based settings.
Reminder: Sept. 28 Deadline for Health Data Privacy Feedback to Senate HELP Committee
Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) last week announced he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research.
According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly.
The deadline to submit feedback is Thursday, Sept. 28. Click
here to read Cassidy’s full request and
here to submit comments.
Reminder: CMS to Host Webinar on Person-Centered Approaches to Improving Behavioral Health Condition Management
CMS’ Medicare-Medicaid Coordination Office recently announced an upcoming webinar that will examine how traditional silos of care impede comprehensive approaches to care coordination and explore potential solutions to improve behavioral health condition management in persons with intellectual and developmental disabilities.
Presenters include Andrea Witwer, Ph.D., associate clinical professor in psychiatry and behavioral health at Ohio State; family caregiver Patricia Nobbie, Ph.D.; and Olivia Ayers, LMCH, LPC, clinical director at Elevate Certified Community Behavioral Health Clinic in Iowa.
The 90-minute webinar will be held on Wednesday, Sept. 27 starting at 2:30 p.m. ET. Click
here to learn more and to register.
Deadline Extended! 2023 NABH Membership Directory Updates Are Due Sept. 27
NABH has extended the deadline for system members to submit changes about their organizations for the 2023 NABH Directory to
Wednesday, Sept.27.
NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information.
The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media.
Please be sure to enter information for all of your system’s facilities to help provide NABH with an accurate picture of our membership.
If you need assistance, please contact Maria Merlie
maria@nabh.org or 202-393-6700, ext. 104.
Reminder: Please Submit Your Managed Care Denials Data to Support NABH Advocacy
Thank you to all members who have submitted data to NABH’s denial-of-care portal!
We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator
Emily Wilkins for support.
Fact of the Week:
Recent
research found that, overall, people with mental health conditions seemed to have an elevated risk of heat-related death. This was even more severe for people with schizophrenia: a 200% increase compared with typical summers.
For questions or comments about this CEO Update, please contact Jessica Zigmond.