CMS Proposes to Expand BH Services under Medicare

Jun 9, 2023 | Insights and Highlights

CMS’s new proposed rule seeks to expand behavioral healthcare under Medicare by creating an intensive outpatient program for psychiatric services.  The proposed program defines the scope of benefits for intensive outpatient behavioral health services for patients battling an acute mental illness or substance use disorder. If finalized, the services covered may be offered in hospital outpatient departments, community mental health centers, federally qualified health centers, and rural health clinics, according to a July 13 fact sheet from CMS.

The proposal aligns with the Consolidated Appropriations Act 2023, which requires the HHS’s Substance Abuse and Mental Health Services Administration to identify and establish behavioral health practices to best care for individuals experiencing mental health and substance use crises. The cost of services and treatments will be determined based on the amount of money that Medicare has already paid for similar services, according to the report.

More and more providers are eyeing intensive outpatient programs (IOPs) to care for patients that need either a step down from an inpatient program or a step up from a traditional outpatient program. IOPs typically consist of at least nine hours of treatment a week for adults, according to the National Alliance of Mental Illness.

Although IOPs have traditionally had an important role in substance use disorder treatment, this type of program is now gaining steam in the mental health space as payers look to help patients stay out of the hospital and patients seek ways to return to their community.

While IOPs may provide clinicians an alternative spot to refer patients needing sub-acute care, Richard Clark, CEO of Odyssey, noted that this type of service is most effective when placed in a continuum of care.

Sources:  CMS.gov and NAMI.org