The omnibus appropriations package enacted at the end of December 2022 did more than just fund the government through the rest of fiscal year 2023; APA Services staff worked doggedly to ensure that it also include several provisions aimed at improving access to mental health, substance use, and behavioral health services. While this portion of the package collectively fell short of the scale envisioned by behavioral health advocacy organizations and many members of Congress, the provisions that were included will nonetheless advance access to care and are a testament to the power of advocacy by the association partnering with psychologists around the country.
See a summary of policies and programs included in the legislation:
- Mitigating Medicare reimbursement rate cuts: The package partially alleviates the 4.5% reduction in Medicare payments scheduled to take place this year by providing a 2.5% increase (resulting in a 2% reduction for 2023). A similar increase of 1.25% is included for provider services for 2024. While helpful, APA Services and dozens of other national organizations were united in urging Congress to offset the full 4.5% payment cut. Medicare payment rates will continue to be a priority of our work this year.
- Telehealth: Current Medicare telehealth flexibilities—including coverage of audio-only services, patient homes as the “originating site” for services, and delay of the in-person visit requirement—were extended through the end of 2024.
- Integrated care: The package authorizes a new $60-million grant and technical assistance program to promote the adoption of evidence-based or evidence-informed models and practices for coordinating and delivering behavioral and physical health services. Funding will flow through state agencies and can be used to assist primary care practices with tasks including hiring staff and upgrading software. A separate section of the legislation requires the Center for Medicare and Medicaid Services to conduct outreach to Medicare providers on the program’s coverage of behavioral health integration services, and the use of applicable codes.
APA Services and psychologist advocates from across the country successfully urged that any new grant program to support integrated primary and behavioral health care encompass all evidence-based models. We will be closely monitoring the implementation of these initiatives:
- Medicare coverage of mobile crisis and intensive outpatient services: Crisis psychotherapy services furnished by mobile units and in other nonfacility settings will receive a 50% payment increase in Medicare payment rates beginning in 2024, and the program will begin covering intensive outpatient services for patients determined to have a need for care for at least nine hours per week.
- Consideration of a safe harbor protections for contingency management: The Office of the Inspector General within the U.S. Department of Health and Human Services is required to conduct a review on whether to establish a safe harbor against anti-kickback statute violations for the use of evidence-based contingency management in treating substance use disorders. The office is required to submit recommendations to Congress within two years for improving access to contingency management services.
- Opioid use disorder treatment: States will be allowed to use federal opioid response grants for addressing stimulant use disorders, supporting recovery services, community-based education and outreach, peer support and recovery coaches, and housing services. The legislation also ends the requirement that individuals have an opioid use disorder (OUD) for at least 1 year before being admitted to an opioid treatment program, eliminates the “X-waiver” requirement for prescribing buprenorphine for OUD treatment, and allows opioid treatment programs to operate mobile medical components without separate registration with the Drug Enforcement Administration.
- Veterans’ mental health legislation: Veterans will no longer be charged copayments for the first three outpatient mental health or substance use treatment visits each year. The end-of-year package also included House-passed legislation (the viper Act and strong Veterans Act) that allows Veterans Affairs (VA) researchers to continue their long-standing practice of receiving compensation from private academic affiliations in addition to their federal salary, averting the potential disruption of mental health and other medical research, and expands the mental health workforce within the VA by adding paid trainee positions, scholarships, loan repayment and debt reduction awards.
- Extending parity protections and enforcement: Under the legislation, non-governmental health plans will no longer be allowed to claim an exemption from the Mental Health Parity and Addiction Equity Act (MHPAEA) requirement for coverage of mental health and substance use treatment services on par with that for general medical care. If state or municipal health plans have “opted out” of MHPAEA, they will not be allowed to continue doing so when their plans are renewed. The package also authorizes a new $10 million grant program to states for the express purpose of examining private sector health plans’ use of tightly restricted provider networks, low payment rates for mental health and substance use providers, and inconsistently developed and applied authorization or review requirements.
For more information, contact Scott Barstow.