CAMFT recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) on its proposed rules about incident-to billing and other payment policies. CMS’s proposed rules impact incident-to billing requirements and future policies related to telehealth services and integrated care models. CAMFT submitted comments to the CMS in support of:

• the proposed changes to the incident-to-billing provisions which would allow for general supervision of MFTs working under the direction and control of a Medicare-eligible provider when billing Medicare;
• the proposals to extend Telehealth flexibilities; and
• the proposed changes to improve integrated care.

For a summary of the changes relevant to our members, see below. CAMFT will keep members apprised of any updates on this matter.

Summary of CMS’s Physician Fee Schedule Proposed Rules

The annual Physician Fee Schedule outlines the Center for Medicare and Medicaid Services new proposed policies, suggested changes to services and provider payments for the year. The Rule makes changes to the incident-to billing requirements and may also impact future policies related to telehealth services and integrated care models.

Incident-to Billing
As a result of the projected shortage of behavioral health care providers by 2025, CMS is proposing to allow Licensed Marriage and Family Therapists (LMFTs) and Licensed Professional Clinical Counselors (LPCCs), addiction counselors, certified peer recovery specialists and others to offer services under general, instead of direct, supervision. [1] The term “general supervision” means that the service is furnished under the physician’s or other non-physician practitioners’ (e.g., nurse practitioners, physician assistants, clinical nurse specialists) overall direction and control, but the physician’s or non-physician practitioner’s presence is not required during the performance of the service. The change in policy comes with the caveat that CMS’ incident-to requirements and state licensure requirements must still be met.

Telehealth
CMS is proposing to implement the telehealth provisions in the Consolidated Appropriations Act, 2022. This means, under the proposed rule, certain telehealth flexibilities that are provided during the Public Health Emergency (PHE) will remain on Medicare’s Telehealth Services List for 151 days after the PHE ends. These flexibilities include: 1) allowing telehealth services to be furnished in any geographic area and in any originating site setting, including a patient’s home; 2) allowing certain services, such as mental health services, counseling services and education services, to be furnished via audio-only telecommunication systems. While CMS acknowledges that audio-only technology can be used to offer mental health telehealth services to patients in their homes under certain circumstances after the PHE ends, the agency’s long-term stance on telehealth services is that two-way, audio-video communications technology continues to be the appropriate standard that will apply for Medicare telehealth services generally following the PHE and the 151-day extension period.

Telehealth provisions will require appropriate place of service (POS) codes, instead of the modifier “95,” after the 151 days following the end of the PHE. A modifier of “93” will be available to indicate that the telehealth service was offered via audio-only technology where allowed and appropriate.

Proposed telehealth policies for Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) would include: 1) payment for telehealth services offered by RHCs and FQHCs under the payment methodology created for the PHE; and 2) allowing telehealth services to be furnished in any geographic area in any geographic area and in any originating site (including the beneficiary's home) as well as on an audio-only basis for behavioral health, counseling and educational services. The proposal to implement CAA 2022 provisions also delays the in-person visit requirements for behavioral health visits furnished by RHCs and FQHCs via telecommunications technology until 152 days after the end of the PHE.

Integrated Care
CMS is proposing to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient's primary care team. Specifically, the proposed rule creates a new G-code to allow Clinical Psychologists (CPs) and Clinical Social Workers (CSWs) to bill for general behavioral health integration (GBHI). G-codes were established by CMS as of January 1, 2017 to allow physicians and non-physician practitioners to provide BHI services using the psychiatric Collaborative Care Model (CoCM). This approach is thought to enhance traditional primary care services by adding care management support and psychiatric specialty care.

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