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Reimbursement and scope of practice

Improving access to behavioral health services for Medicare beneficiaries

APA Services applauds CMS for adopting key changes to Medicare policy in the CY2025 Physician Fee Schedule final rule

Date created: November 13, 2024 2 min read
APA Style leaf logo Cite This Article in APA Style
American Psychological Association. (2024, November 13). Improving access to behavioral health services for Medicare beneficiaries. https://www.apaservices.org/advocacy/news/behavioral-health-access-medicare

Senior woman consulting with a psychologist on a video call

On Monday, December 9, 2024, the Centers for Medicare and Medicaid Services (CMS) will publish its final rule in the Federal Register outlining Medicare coverage and reimbursement policies in calendar year 2025 (CY2025). According to an unpublished versionopens in new window of the final rule released on November 1, the final rule contains several positive changes affecting services provided by psychologists, including:

  • finalization of Healthcare Common Procedure Coding System codes that allow certain digital therapeutics products, as well as related treatment management services, to be covered and reimbursed by Medicare when furnished under the order of a psychologist;
  • finalization of new coding and payment for caregiver training services, safety planning interventions, and post-discharge follow-up services;
  • adding several services to the list of permitted telehealth services in Medicare, including caregiver training services and safety planning interventions;
  • delay of in-person visit requirement for patients receiving telemental health treatment in their own homes from Rural Health Clinics and Federally Qualified Health Centers;
  • preservation of certain privacy protections for psychologists furnishing services via telehealth from their own homes; and
  • continued access to services furnished via audio-only telehealth in situations where the practitioner can use an interactive audio-video communications system, but the patient is not capable of, or does not consent to, the use of video technology.

APA Services thanks the psychologists and State, Provincial and Territorial Psychological Associations who sent messages to the Biden administration in support of these proposals. There is also a pending 2.93% cut to the Medicare conversion factor that is mandated by Congress and therefore outside CMS’ authority to control. However, APA Services continues to work alongside our partners in other health care provider organizations to include a fix for these pending reimbursement cuts in a year-end package of legislation. Additionally, more than 3,500 psychologists sent over 13,000 messages to Congress calling for the immediate passage of the Strengthening Medicare for Patients and Providers Act (H.R. 2474opens in new window), which would instead tie Medicare reimbursement to the Medicare Economic Index (MEI).

Although a long-term solution like the one provided in H.R. 2474 is still needed, advocates are now focusing their efforts on new bipartisan legislation, the Medicare Patient Access and Practice Stabilization Act of 2024 (H.R. 10073), to replace the CY2025 cut in the Medicare conversion factor with a small increase, to partially mitigate the expected rise in the MEI next year. Visit APA Services' Action Centeropens in new window to take action and ask your representative to support H.R. 10073. APA will also be releasing more detailed information on the final rule in the coming weeks.

For more information, contact Stephen Gillaspy or Scott Barstow.

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