HHS Finalizes Physician Payment Rule That Strengthens Access to Behavioral Health Services and Whole-Person Care

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The Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS), are now increasing access to dental care, cancer screening coverage, and behavioral health services. Through Accountable Care Organizations, the Calendar Year 2023 Physician Fee Schedule (PFS) final rule that was released today also encourages innovation and coordinated care in the Medicare program (ACOs).

This regulation directly advances President Biden’s Cancer Moonshot Goal to reduce cancer-related deaths by at least 50%. It also advances the Administration’s commitment to improving behavioral health, which was outlined in the President’s first State of the Union Address, as well as the comprehensive plan to address the nation’s mental health crisis, which HHS leaders have advanced through the National Tour to Strengthen Mental Health. 

According to HHS Secretary Xavier Becerra, “the Biden-Harris Administration is committed to extending access to essential preventive and treatment programs.” Medicare’s provision of whole-person care will benefit millions of Americans’ health and wellbeing, even saving lives. 

According to CMS Administrator Chiquita Brooks-LaSure, “access to programs supporting behavioral health, wellness, and whole-person care is vital to helping people achieve the greatest health possible.” “The Physician Fee Schedule final rule assures that the people we serve will receive coordinated care and have access to services for pain management, mental health services, drug abuse prevention and treatment, and crisis intervention.” 

Dr. Meena Seshamani, Deputy Administrator and Director of the Center for Medicare, stated that “together, we are constructing a stronger Medicare program.” These improvements will make sure that Medicare treats the complete person—taking care of physical health, behavioral health, and social needs that are integral to health—and ensure access to the high-quality treatment everyone deserves, regardless of who you are or what diagnosis you have. 

The 2022 CMS Behavioral Health Strategy is in line with how CMS is improving access to essential behavioral health care. By permitting behavioral health specialists, including marriage and family therapists and licensed professional counselors, to provide services under general (rather than direct) supervision of the Medicare practitioner, CMS is making it simpler for Medicare beneficiaries to get behavioral health services.

Medicare will pay for opioid treatment programs that start buprenorphine treatments with patients via telecommunication. Additionally, CMS is making it clear that, in accordance with recommendations from the Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Enforcement Administration (DEA), opioid treatment programs may bill for services related to treating opioid use disorders delivered via mobile units like vans. Access may be improved in rural and other underserved areas because to these programs. 

As part of a primary care team, CMS is also finalizing regulations to pay for clinical psychologists and licensed clinical social workers to provide integrated mental health treatment. The final step is that Medicare will provide a new monthly payment for comprehensive pain management and treatment services for patients. These innovative services provide care that is holistic to the individual. 

The nation’s largest ACO program, the Medicare Shared Savings Program, which includes more than 500,000 healthcare providers and more than 11 million Medicare beneficiaries, is currently undergoing final revisions by CMS. Since the program’s inception in 2011 and the first Accountable Care Organizations (ACOs), groups of healthcare providers who collaborate to offer coordinated, high-quality care to Medicare beneficiaries started participating in 2012; these rules represent some of the most significant developments.

The CMS will make significant progress toward our 2030 objective of having 100% of Traditional Medicare beneficiaries in an accountable care relationship with their healthcare provider through these policies, which are key to the Medicare Value-Based Care Strategy exit disclaimer mark. The Shared Savings Program will be supported by advance shared savings payments to a select number of new ACOs, which can be utilized for things like hiring more staff or addressing the social needs of Medicare beneficiaries. CMS is finalizing these plans.



Additionally, in order to increase participation in rural and underserved areas, CMS is completing a health equity adjustment to an ACO’s quality score, revising the benchmarking methodology, and extending the amount of time ACOs have to get used to accountable care before they are responsible for downside risk. 

With higher new incidence and death rates among Black Americans, American Indians, and Alaska Natives, colon and rectal cancers remain one of the major causes of death in the US. In accordance with newly updated policy recommendations by the U.S. Preventive Services Task Force, Medicare will now lower the minimum age for colorectal cancer screening from 50 to 45 years.

Additionally, Medicare will now pay for a follow-up screening colonoscopy as a preventative service if a non-invasive stool-based test results in a positive finding. This implies that beneficiaries won’t be responsible for paying for both tests out of pocket. 

By codifying current practices, CMS will ensure that Medicare Parts A and B continue to cover dental care where it is essential to treating a beneficiary’s medical condition. Medicare will now cover dental exams and procedures in a wider range of situations, such as preventing infection before organ transplants, before some cardiac surgeries starting in CY 2023, and before head and neck cancer treatments starting in CY 2024. Finally, CMS is establishing a yearly procedure to evaluate public feedback on additional scenarios in which payment for dental care may be permitted. 

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