On Nov. 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule announcing finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after Jan. 1, 2024. CMS is finalizing conforming regulatory text changes to implement:
- Extending payment for telehealth services furnished in FQHCs/RHCs through Dec. 31, 2024.
- Delaying the in-person requirements under Medicare for mental health visits furnished by FQHCs/RHCs.
- Including marriage and family therapists (MFTs) and mental health counselors (MHCs) as eligible for payment.
- Aligning enrollment policies so that addiction, drug, or alcohol counselors who meet all of the requirements of MHCs to enroll with Medicare as MHCs will also apply for FQHCs/RHCs.
- Medicare coverage and payment for intensive outpatient program (IOP) services furnished by an FQHC/RHC.
- Extension of the definition of direct supervision to permit virtual presence in FQHCs/RHCs through Dec. 31, 2024.
- A change to the required level of supervision for behavioral health services furnished “incident to” a physician or NPP’s services in FQHCs/RHCs to allow general supervision, rather than direct supervision, consistent with the policies finalized under the PFS during last year’s rulemaking for other settings.
- Inclusion of Remote Physiologic Monitoring and Remote Therapeutic Monitoring in the general care management HCPCS code G0511 when these services are furnished by FQHCs/RHCs.
- Inclusion of Community Health Integration (CHI) and Principal Illness Navigation (PIN) services in the general care management HCPCS code G0511 when these services are provided by FQHCs/RHCs. RHCs and FQHCs that furnish CHI and PIN services will be able to bill these services using HCPCS code G0511, either alone or with other payable services on an RHC or FQHC claim, for dates of service on or after Jan. 1, 2024.
- A change in the methodology to calculate the payment rate for the general care management HCPCS code G0511 that takes into account how frequently the various services are utilized.
- A clarification that obtaining beneficiary consent for chronic care management and virtual communications services is required, but the mode of obtaining the consent can vary and direct supervision is not needed.
Review the CMS press release on the PFS, a summary table, Expanded Medicare Reimbursement for FQHCs Starting Jan. 1, 2024, and a one-pager on the new Intensive Outpatient Program benefit.