On July 13, 2021, CMS published its proposed physician fee schedule rule for FY 2022. One of the key items is the proposal to make the temporary change allowing Medicare providers to deliver healthcare services via telehealth a permanent part of Medicare Part B.
The Proposed Medicare Changes
During the public health emergency (PHE), Congress added the home of the beneficiary as a permissible originating site for telehealth services for the purposes of diagnosis, evaluation or treatment of a mental health disorder. In addition to updating the fee schedule, the proposed CY2022 rule would allow certain services added to the Medicare telehealth list to remain on the list until the end of December 2023. This would allow CMS to continue to evaluate whether the temporary expansion of telehealth services adopted as an expediency during the pandemic should be permanently added to the telehealth list after the PHE ends.
The 4 Proposed Changes for Mental Telehealth
CMS is also proposing the following four rules for mental telehealth services:
- The 6-Months’ Requirement
Under the CMS proposal, the physician or practitioner furnishing mental health telehealth services, would have to provide the patient in-person, non-telehealth services within six months before the initial telehealth service and at least once every six months after that. CMS is seeking comments on whether a different interval is appropriate for mental health services furnished through audio-only communication technology.
- Audio Only Communication Technology
CMS is looking into amending current requirements for interactive telecommunications systems to allow audio-only communication technology for telehealth diagnosis, evaluation or treatment of mental health disorders of established patients in their homes. The proposal would limit the use of an audio-only interactive telecommunications system to mental health services furnished by practitioners who have the capability to furnish two-way, audio/video communications where the beneficiary is incapable of using or doesn’t consent to the use of two-way audio/video technology.
- New Billing Modifiers
The CMS proposal would include a new modifier for billing services furnished using audio-only communications to certify that the practitioner had the capability of providing two-way audio/video communication, but the beneficiary was incapable of using or didn’t consent to use of that technology. There would also be a new modifier for services furnished through audio-only technology due to beneficiary choice or limitations.
- Rural Health Clinics Payments
CMS would allow Rural Health Clinics and Federally Qualified Health Centers to use the same methods they do to report and receive payment for in-person mental health visits for visits furnished via real-time telecommunication technology, including audio-only visits when the beneficiary is incapable of or doesn’t consent to the use of video technology.
Proposed Changes for MDPP
CMS also proposed changes to its Medicare Diabetes Prevention Program (MDPP) “to make delivery of MDPP services more sustainable and to improve patient access by making it easier for local suppliers to participate and reach their communities.” Specifically, CMS is proposing to:
- Continue to waive the provider enrollment Medicare application fee the way it has during the PHE on or after January 1, 2022, and beyond the PHE;
- Shorten the MDPP services period to one year by removing the ongoing maintenance sessions phase (months 13 to 24) of the MDPP set of services for beneficiaries starting on or after January 1, 2022;
- Redistribute a portion of the ongoing maintenance sessions phase performance payments to certain core and core maintenance section performance payments, in conjunction with removing the maintenance sessions phase from the MDPP services. This includes payments for the beneficiary’s 5 percent weight loss goal and continued attendance in the core maintenance interval.
If finalized, these changes would apply to beneficiaries who start the MDPP set of services on or after Jan. 1, 2022. Beneficiaries who began participating before December 31, 2021 would continue with the maintenance phase if they maintain their 5 percent weight loss and meet other requirements.
Significantly, these proposals do not include reimbursement for MDPP services delivered by telehealth or virtual care programs.
Takeaway
CMS is also proposing and/or asking for public comments about:
- Changes to the Quality Payment Program that would raise the eligibility threshold, making it more difficult for clinicians to earn bonuses (CMS also unveiled its first seven MIPS Value Pathways, including rheumatology, stroke care and prevention, heart disease, chronic disease management, emergency medicine, anesthesia and lower-extremity joint repairs, such as knee replacements);
- The potential phase out of coinsurance for diagnostic tests resulting from scheduled colorectal screenings;
- Whether to require additional documentation in the patient’s medical record to support the clinical appropriateness of audio-only telehealth; and
- Whether CMS should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis.
