Expansion of telehealth for behavioral health providers in 2022

The need for access to behavioral healthcare has increased over the last few years, which has only been exacerbated by the COVID-19 pandemic. Due to such needs, an increasing number of practices and their providers are providing integrated behavioral health services to their patients. Some barriers to providing such integrated care remain due to reimbursement requirements from payers and limitations on billable providers.

However, increasingly, due to evidence that integrated behavioral health services enhance patient outcomes, important new national payment policies are being put into place, such as the requirement that health insurance provided through the Affordable Care Act’s marketplaces must now include behavioral health benefits for beneficiaries. Payment reform is also taking place in several states through alternative payment models such as accountable care organizations (ACOs), providing capitated- and population-based payments for behavioral health services that are supported by performance-based incentives.

In this article, we explore the ongoing need for access to behavioral healthcare and detail some of the updates to the 2022 Physician Fee Schedule (PFS) that promote the expansion of meaningful patient access to healthcare via telemedicine and other digital health technologies.

Ongoing need for behavioral health services

As the pandemic and public health emergency wear on, more patients are experiencing behavioral changes that impact their overall mental and physical well-being than ever before.

Although some people use “behavioral health” and “mental health” interchangeably, there are crucial differences. During the 1970s and 1980s, behavioral health primarily referred to behaviors directed toward promoting health or preventing medical conditions. However, it has evolved to include behaviors to help patients improve their management of disease.

Most recently, behavioral health now includes mental health conditions and has come to describe the connection between our behaviors and the health and wellness of our bodies, mind, and spirit. The discipline now includes services provided by psychologists, psychiatrists, neurologists, social workers, and more. Behavioral health services include prevention, intervention, treatment, monitoring, and recovery support.

Telehealth in the age of COVID-19

As we all know, the U.S. federal government declared that COVID-19 was a nationwide public health emergency (PHE) on January 27, 2020, a declaration that has since been repeatedly renewed, most recently on October 18, 2021. In reaction to the PHE, the federal government began to take several steps to make providing and receiving care through telehealth easier for healthcare providers, patients, payers, and third-party vendors. Such provisions have included the following:

Listing of CMS Telehealth Services and Codes, effective January 1, 2022—last updated November 1, 2021
HIPAA flexibility for telehealth technology: Providers were given more flexibility to use widely available technology for virtual visits for the good-faith provision of telehealth as long as they are “non-public facing” technologies during the COVID PHE, without risk of penalties.
The federal government has also provided several waivers and regulatory changes to make it easier for healthcare providers to deliver telehealth to Medicare and Medicaid patients. Such changes to telehealth coverage and reimbursement include, but are not limited to, the following:

Enabling all healthcare providers who are eligible to bill Medicare for telehealth services
Removing any geographic restrictions for providers or patients
Enabling providers to provide services outside their state of enrollment. For questions about new enrollment flexibilities or to enroll for temporary billing privileges, click here to obtain a listing of Medicare Administrative Contractors (MACs) to call the appropriate hotline for your area.

New guidelines regarding billing and coding Medicare claims during the COVID-19 PHE, including Medicare Fee-for-Service claims and Medicare as a safety-net provider
Via the Connected Care Pilot Program, the COVID-19 Telehealth Program, which was introduced to provide funding to eligible healthcare providers to help support the telecommunication services, information services, and connected telecommunications devices required to provide critical care. Established in the Coronavirus Aid, Relief, and Economic Security Care (CARES) Act, the program includes $200 million in funding to help healthcare providers offer telehealth and connected healthcare services to patients at home or mobile locations due to the COVID-19 PHE. As of October 27, 2021, the Commission awarded 93 Pilot projects for providers who are serving patients in 35 states and Washington D.C, totaling over $69 million in funding. A second round of funding closed on May 6, 2021.

For more details about Medicare’s flexibilities and waivers that are in effect, you can:

View a CMS video entitled “Medicare Coverage and Payment of Virtual Services.”
Download Current State Laws & Reimbursement Policies from the National Policy Center – Center for Connected Health Policy.
Download COVID-19 Telehealth Coverage Policies, also from the National Policy Center – Center for Connected Health Policy. The CMS describes this telehealth coverage policy documentation as a “living document that could change frequently as new information and new policies become available and are enacted … as evidence evolves regarding what we know about COVID-19.”

Changes in our healthcare system secondary to COVID-19

There’s no argument that the COVID-19 PHE has changed our society in countless ways, including nearly every aspect of our healthcare system. As we still face the COVID-19 PHE at nearly two years and counting, Medicare has recognized that the telehealth services they had originally intended as temporary measures may need to remain in place for some time.

Therefore, CMS has deemed that telehealth services originally meant to be removed at the end of the COVID-19 PHE or December 31, 2021, whichever came later, will remain on the list of available telehealth services through December 31, 2023. This will allow additional time for CMS to assess whether the services should be permanently added to the Medicare telehealth services list.

Behavioral health telehealth services

In addition, the 2022 Physician Fee Schedule (PFS) Final Rule is promoting the expansion of meaningful patient access to healthcare via telemedicine and other digital health technologies, both during the continued COVID-19 PHE as well as via a post-pandemic strategic plan. This includes providing behavioral healthcare via telemedicine technologies, particularly for traditionally underserved communities; promoting growth in diabetes prevention programs (another important aspect of behavioral health); and increasing payments for vaccine administration. CMS is actively pursuing such strategies to achieve the following:

Promote health equity
Ensure increased access to comprehensive care
Provide innovative, high-quality services to address health system challenges that incentivize clinicians to deliver enhanced patient outcomes

CMS recognizes that behavioral medicine (as with all other areas of medicine) has greatly changed due to the COVID-19 PHE and has significantly increased access to behavioral health services via telemedicine to many whom had previously had trouble obtaining such health measures. By enabling reimbursement, removing geographic restrictions (see below), and allowing provision of care at patients’ homes, such changes enhance options for convenience, privacy, and safety.

Eliminating geographic restrictions

Passed into law in December 2020, Section 123 of the Consolidated Appropriations Act (CAA) 2021 spending bill included a statement that to many appeared to restrict provision of telehealth services for mental health: “Payment may not be made under this paragraph for telehealth services furnished by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth.”

However, the new law has removed geographic restrictions and made a patient’s home a permissible location for the provision and receipt of telehealth services provided to evaluate, diagnose, and treat mental health disorders. To clarify, the updated language indicates that the physician or provider must have an in-person, non-telehealth visit with the patient within six months before the first telehealth service and establish a schedule for subsequent in-person visits. CMS indicates that an in-person, non-telehealth visit must be provided at least every year for such services and that exceptions may be made depending on the patient’s circumstances as documented in the patient’s medical record. Additional visits are also allowed, depending on the patient’s clinical needs as determined on a case-by-case basis.

Changing the definition of an “interactive telecommunications system”

Further, CMS is changing the current definition of an interactive telecommunications system for telehealth services. Previously, this referred to multimedia communications equipment that included a minimum of video and audio equipment, enabling two-way, real-time interactive communication between the distant site provider and the patient.

The revised definition now includes audio-only technology used for telehealth services to evaluate, diagnose, and treat mental health disorders provided to established patients in their homes under certain circumstances. CMS indicates that it is limiting the use of audio-only telecommunications to clinicians who provide mental health services and can provide two-way audio/video communications, yet where the patient is not capable of or does not provide consent to use the two-way technology. CMS also clarified that mental health services include those provided for the treatment of substance use disorders.

Learn How Practice Fusion’s cloud-based EHR suite of telehealth features can help your virtual practice thrive, enabling you to provide high-quality behavioral health services directly to your patients’ homes.