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In its Medicare physician fee schedule proposed rule for 2022, the Centers for Medicare & Medicaid Services (CMS) has proposed extending Medicare coverage to audio-only communication technology for telehealth services to diagnose, evaluate, or treat established patients with mental health disorders and providing Medicare coverage for telemental health services for beneficiaries who are in their homes for appointments.

CMS has proposed limiting the use of an audio-only interactive telecommunications system for mental health services for cases in which practitioners have the capability to provide two-way, audio/video communications, but the beneficiary is not capable of using, or does not consent to using, two-way, audio/video technology. CMS has also proposed requiring a new modifier for services provided using audio-only communications that would certify that the practitioner had the capability to provide two-way, audio/video technology, but instead used audio-only technology due to beneficiary choice or limitations.

In addition, CMS has proposed allowing certain services added to the Medicare telehealth list to remain on the list until Dec. 31, 2023 to create a glide path to evaluate whether the services should be added permanently to this list after the Covid-19 public health emergency (PHE) ends.

CMS is also seeking comment on these proposed recommendations: (1) whether additional documentation should be required in the patient’s medical record to support the clinical appropriateness of audio-only telehealth; (2) whether or not the agency should preclude audio-only telehealth for some high-level services, such as level 4 or 5 E/M visit codes or psychotherapy with crisis; and (3) if there are other “guardrails” the agency should establish to minimize concerns about program integrity and patient safety.

The agency also proposed implementing recently enacted legislation that removes statutory restrictions to provide Medicare coverage of telehealth services for mental health disorders for beneficiaries in any geographic location and in their homes. CMS recommends requiring that an in-person, non-telehealth service be provided by the physician or practitioner furnishing mental health telehealth services within six months prior to the initial telehealth service, and at least once every six months thereafter.

CMS is seeking comment on whether a different interval may be necessary or appropriate for mental health services furnished through audio-only communication technology. The agency is also seeking comment on how to address scenarios where a physician or practitioner of the same specialty/subspecialty in the same group may need to provide a mental health service due to unavailability of the beneficiary’s regular practitioner.

For opioid treatment programs (OTPs), the proposed rule recommends allowing OTPs to provide counseling and therapy services via audio-only interaction (such as telephone calls) after the Covid-19 PHE ends in cases where audio/video communication is not available to the beneficiary, including circumstances in which the beneficiary is not capable of, or does not consent to using, devices that permit a two-way audio/video interaction, provided all other applicable requirements are met.

CMS has proposed requiring that OTPs use a service-level modifier for audio-only services billed using the counseling and therapy add-on code (not bundled services) and document in the medical record the rationale for a service provided using audio-only services, in order to facilitate program-integrity activities.

CMS also proposed coverage for the newly approved, higher dose naloxone hydrochloride nasal spray product, and is delaying compliance with electronic prescribing of controlled substances (EPCS) from January 2022 to January 2023.

Click here for more information about the proposed rule, which will be published in the Federal Register on July 23. CMS will accept comments on the rule until 5 p.m. ET on Monday, Sept. 13, 2021.

President Biden is expected to nominate Rahul Gupta, M.D. M.PH., M.B.A. to serve as director of the Office of National Drug Control Policy (ONDCP), according to multiple news outlets.

If confirmed, Gupta, a buprenorphine-waivered physician, will be the first physician to serve as the office’s director. Most recently Gupta served as senior vice president and chief medical and health officer at the March of Dimes. Previously he served as West Virginia’s health commissioner and is known to be an ally of Sen. Joe Manchin (D-W.Va.).

NABH has learned that harm-reduction advocates do not support Gupta’s nomination because of their concerns about how he managed an HIV outbreak in West Virginia, citing a lack of support for needle exchanges, an evidence-based practice that reduces HIV, viral hepatitis, and other infections. ONDCP’s drug policy priorities published in April 2021 have strong harm-reduction priorities, including funding support syringe exchange programs and amplifying best practices for fentanyl test strips.

Gupta has been a frontrunner for the position, along with Regina LaBelle, currently ONDCP’s acting director who took a leave of absence from her role as a distinguished scholar and program director at the Addiction and Public Policy Initiative at Georgetown University’s O’Neill Institute.

NABH coordinated a stakeholder letter to the Biden Administration that requested the president appoint an ONDCP director to address the highest rates of opioid overdose deaths ever recorded, stating that the pandemic exacerbated what was already an inadequate level of treatment for people with a substance use disorder in the United States.

The National Association for Behavioral Healthcare is pleased to introduce the NABH Denial-of-Care Portal, a resource for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials.

NABH’s Managed Care Committee has worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard to parity or the effects on patients.

This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more.

The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts.

“One of the best ways we can advocate for parity enforcement with policymakers and regulators is to provide hard data from our members that show how insurers are not complying with the landmark 2008 parity law,” said NABH President and CEO Shawn Coughlin. “We hope to gather this critical data through our new Denial-of-Care Portal.”

Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions.

As always, thank you for all you do each day to support and advance NABH’s mission and vision!