Archive: Medicare

Mindy Klowden

Director,Training and Technical Assistance

The Centers for Medicare and Medicaid Services (CMS) recently issued final policy changes for Year 3 (2019) of the Quality Payment Program (QPP), as part of the final 2019 Medicare Physician Fee Schedule rule. The final rule updates payment rates and key policies applicable to physicians and other professionals under Medicare. Most notably, the rule expands the types of clinicians (including clinical psychologists) that are eligible to participate in the QPP through the Merit-based Incentive Payment System (MIPS).

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

Last week, the Centers for Medicare and Medicaid Services (CMS) released its final rule for the 2019 payment year under Medicare. The rule finalizes policies around reducing provider burden, increasing electronic health record (EHR) interoperability, coverage expansions for telehealth, virtual care, and substance use disorder treatment. Notably, CMS decided to modify its original proposal to significantly change the payment and documentation requirements for traditional outpatient, office-based visits by modifying some elements to address concerns raised by provider groups like the National Council and other stakeholders.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

This week the National Council for Behavioral Health submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its proposed rules for the 2019 Medicare Physician Fee Schedule (MPFS). The proposed rules update payment rates and key policies applicable to physicians and other professionals under Medicare. Among the key changes supported by the National Council were initiatives to reduce billing documentation requirements for Evaluation and Management (E/M) services, base reimbursement for office visits on the level of medical decision-making required, allow for same-day visits and create a bundled payment for the care and management of substance use disorders (SUD) in Medicare.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

CMS is planning significant changes to a value-based payment model known as Accountable Care Organizations (ACOs) in a sweeping rule proposed last week. The rule would give new ACOs just two years before they must start sharing savings and losses with the agency. The proposal has drawn criticism from hospital groups and ACO stakeholders, who say the plan will cause many ACOs to leave the program. Comments on the proposed rule are due by October 16, 2018.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

Last week, the Centers for Medicare and Medicaid Services (CMS) released its proposed rules for the 2019 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP). The proposed rules update payment rates and key policies applicable to physicians and other professionals under Medicare. Among the key changes, the proposed rule would reduce billing documentation requirements, expand telehealth options and potentially create a bundled payment for the care and management of substance use disorders (SUD) in Medicare.

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Shelley Starkey

Following an action-packed week for opioid-related legislation in the House, multiple Senate committees took up the mantle this week, hosting hearings, releasing new bills and considering legislation ahead of the Memorial Day recess. As bills advance out of committees, the full Senate is expected to consider the large package of opioid legislation later this summer. Meanwhile, similar efforts in the House are expected to make it to the floor in the coming weeks. The collective work of both chambers of Congress seek to address the opioid crisis from a number of fronts including prevention, treatment and recovery.

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Samantha Sears

Behavioral Health Policy and Practice Intern

The House Committee on Ways & Means Wednesday approved seven bipartisan bills aimed at reducing opioid misuse and abuse in Medicare. The package would expand Medicare coverage of medication-assisted treatment (MAT), promote non-opioid alternatives for pain management and require Part D plans to have drug management plans for Medicare beneficiaries at risk of opioid addiction. The bills now move to the House floor, joining dozens of other opioid-related bills approved by the House Energy and Commerce Committee.

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Samantha Sears

Behavioral Health Policy and Practice Intern

The Congressional Budget Office (CBO) projects the country’s annual budget deficit will reach $1 trillion by 2020 in a new report released this week. The annual report was delayed this year to incorporate analysis on the impact of the Tax Cuts and Jobs Act passed in late 2017. The report highlights not only growing deficits but also growing health care spending for programs like Medicare, Medicaid and social safety net programs.

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Katiri Zuluaga

Manager, State Initiatives

The Centers for Medicare and Medicaid Services (CMS) released final rules for Medicare Part D and Medicare Advantage (MA) plans for calendar year 2019 that are meant to tackle the opioid crisis and decrease drug costs. The CY19 Rate Announcement and Call Letter represents CMS’ priorities for the next year, and will implement new requirements on opioid prescribing and monitoring, require lower co-payments for prescription drugs under Part D, increase availability to generics and, hopefully, decrease costs for consumers and the federal government.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

On Thursday, the National Council for Behavioral Health, on behalf of the Medicare Access Coalition, hosted two congressional staff briefings on improving Medicare to better serve seniors with mental illness. The briefing featured community mental health professionals from Peak Wellness Center, who shared the challenges they face in finding Medicare-eligible providers to treat their older adult clients. The event highlighted pending bipartisan legislation that would expand the mental health workforce by adding marriage and family therapists (MFTs) and licensed professional counselors (LPCs) to the Medicare program.

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Shelley Starkey

The Centers for Medicare and Medicaid Services (CMS) have released its proposed changes to Medicare Advantage and Part D plans for 2019, which include a few provisions to combat the opioid crisis. These changes come in reaction to the soaring opioid prescription and substance use disorder rates among Medicare beneficiaries. CMS is accepting public comments through March 5, and will publish its final rule on April 2.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

The Senate voted to confirm former pharmaceutical executive Alex Azar as the new Secretary of Health and Human Services (HHS) on Wednesday. Six Democrats and Independent Sen. Angus King (I-ME) joined all but one Republican Senator in supporting Azar. As the nation’s top health official, Azar will oversee critical health programs like Medicaid and Medicare and take over the implementation of the Affordable Care Act (ACA). Azar’s confirmation gives HHS its first permanent leader since September, when former Secretary Tom Price resigned due to a scandal regarding his use of public funds for travel.

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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

The Senate Finance Committee held a confirmation hearing on Monday on the nomination of Alex Azar as Secretary of Health and Human Services (HHS). This is the second hearing on his nomination Mr. Azar has participated in. In late 2017, he appeared before the Senate Health, Education, Labor and Pensions Committee. The Finance Committee will vote on his nomination in the coming weeks.

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Stephanie Pellitt

Policy and Advocacy Associate

Members of Congress returned to Capitol Hill this week following a holiday break. Neither chamber starts the new year with a clean slate, however, as Congress faces deadlines on government funding and a host of individual programs after voting to delay those decisions at the end of last month. Congress has less than three weeks to avert another government shutdown as well as sort through several competing health care priorities. Here is a preview of what to watch for in early 2018.

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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

President Trump, on Monday, nominated former pharmaceutical executive Alex Azar to be his next Secretary of Health and Human Services. Azar, who spent most of the last decade at Eli Lilly and Co., previously served for six years in the George W Bush administration – first as General Counsel for four years and then as Deputy Secretary for two years under President George W. Bush. The Senate will consider his nomination later this month.

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Stephanie Pellitt

Policy and Advocacy Associate

The Centers for Medicare & Medicaid Services (CMS) recently released Final Rule Year 2 (Performance Year 2018) of Medicare’s Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The QPP, which went into effect on January 1, 2017, includes two paths to payment for eligible clinicians who bill Medicare using the Physician Fee Schedule: The Merit-based Incentive Payment System (MIPS), and Advanced Alternative Payment Models (Advanced APMs). Performance in the QPP each year impacts payments two years later; in other words, performance in 2018 will impact Medicare Part B payments in 2020. By moving from volume-based payment to payment for quality and value, both systems change the way behavioral health providers are reimbursed under Medicare Part B.

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Elizabeth Arend

Quality Improvement Advisor

Mark your calendars: all eligible professionals (EPs) who are first time participants in the Medicare electronic health records (EHR) incentive program must attest by October 1, 2017 to avoid a negative payment adjustment in 2018.  EPs who do not successfully demonstrate meaningful use for the 2017 reporting period will receive reduced Medicare payments for that year.

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Elizabeth Arend

Quality Improvement Advisor

Last week, the National Council submitted comments to the Centers for Medicare and Medicaid (CMS) on a proposed rule that will make changes to Medicare’s Quality Payment Program (QPP) in 2018. The QPP, which went into effect on January 1, 2017, includes two paths to payment for eligible clinicians who bill Medicare using the Physician Fee Schedule: The Merit-based Incentive Payment System (MIPS), and Advanced Alternative Payment Models (APMs). By moving from volume-based payment to payment for quality and value, both systems change the way behavioral health providers are reimbursed under Medicare Part B.

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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

A new bipartisan House bill would create greater access to mental health care in rural communities across the country. The bill – the Mental Health Access Improvement Act (H.R. 3032) – would allow marriage and family therapists (MFTs) and licensed mental health counselors to directly bill Medicare for their services. Similar legislation has been introduced in previous sessions of Congress and again has the support of the National Council.

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Elizabeth Arend

Quality Improvement Advisor

Last week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that will make changes to the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA). The Quality Payment Program is part of a larger effort to reform the way clinicians are reimbursed by Medicare by moving from volume-based payment to payment for quality and value. The proposed rule describes how clinician participation in QPP will change in 2018 and beyond. The proposal will take effect on January 1, 2018 and will apply to 2020 Medicare Part B reimbursements. The vast majority of behavioral health organizations that bill Medicare Part B will be subject to these changes in 2017 and 2018.

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