Hospital outpatient departments may soon be able to bill Medicare for tele-behavioral health services delivered directly to patients in their homes on a permanent basis. This proposed change, included in the U.S. Centers for Medicare & Medicaid Services’ (CMS) 2023 Hospital Outpatient Prospective Payment System rule, reflects a growing commitment to expanding access to behavioral health care, particularly in rural and underserved communities.
During the COVID-19 public health emergency (PHE), CMS temporarily allowed hospitals to provide virtual behavioral health visits under its Hospitals Without Walls (HWW) policy. This flexibility enabled Medicare beneficiaries to access care remotely at a time when in-person visits were severely limited. However, these provisions are set to expire with the end of the PHE. The new proposal seeks to make tele-behavioral health services permanent, allowing hospital outpatient departments to continue delivering critical behavioral health care remotely.
Expanding Telecommunication Options
One of the key aspects of the proposed rule is the inclusion of a variety of telecommunication technologies. CMS has stated that both standard video telehealth and “audio-only interactive telecommunication systems” would be eligible for reimbursement. This ensures that beneficiaries who cannot use two-way video technology can still access tele-behavioral health services. By offering flexible technology options, CMS aims to reduce barriers to care and ensure that patients in all circumstances can benefit from remote behavioral health care.
“CMS is taking action to ensure that people with Medicare in rural and underserved areas have improved access to high-quality health care and to prepare for the next pandemic,” said CMS Administrator Chiquita Brooks-LaSure. “The proposals in this rule, if finalized, will expand access to care options in rural communities and permanently allow tele-behavioral health services to be provided to people in their homes.”
Revising In-Person Visit Requirements
Under current regulations, Medicare beneficiaries must have had an in-person visit within six months of their first virtual behavioral health visit. Additionally, beneficiaries are required to have an in-person service without the use of communications technology at least once every 12 months. CMS’ proposed rule would allow exceptions to these requirements when hospital clinical staff and the beneficiary agree that the risks and burdens of an in-person service outweigh the benefits. This change is designed to make tele-behavioral health more accessible while maintaining patient safety and care quality.
Telebehavioral Health’s Rapid Growth
Telehealth has become a defining feature of behavioral health care in recent years. The COVID-19 pandemic accelerated its adoption dramatically. Behavioral health, in particular, experienced a dramatic increase in telehealth utilization compared to other specialties. Data from the Office of the Assistant Secretary for Planning and Evaluation shows that tele-behavioral health visits for Medicare beneficiaries increased by 3,090% in 2020 compared to 2019—a 32-fold rise.
Even as telehealth use has declined in other areas of health care, behavioral health has maintained a high level of engagement. This demonstrates that tele-behavioral health is not only effective but increasingly essential for reaching patients in rural areas or those with mobility challenges.
Supporting Behavioral Health Providers
The proposed 2023 Medicare Physician Fee Schedule includes updates aimed at expanding the behavioral health workforce. CMS is seeking to relax supervision requirements for several types of behavioral health practitioners, allowing more providers to deliver tele-behavioral health care to Medicare beneficiaries. Additionally, CMS is proposing increased reimbursement for virtual medication-assisted treatment (MAT) for opioid-use disorder, further supporting remote behavioral health care.
Dr. Meena Seshamani, deputy administrator and director of CMS’ Center for Medicare, emphasized the significance of these proposals, stating, “With this proposed rule, we are taking important steps forward to ensure that CMS is doing our part to make sure that we have a competitive American health care system that works for all people with Medicare.”
Preparing for the Future of Behavioral Health
CMS’ proposal reflects lessons learned from the pandemic. Tele-behavioral health has proven that it can increase access, reduce barriers, and maintain high-quality care delivery. By making remote behavioral health services a permanent option for hospital outpatient departments, CMS is signaling a commitment to more flexible, patient-centered care. These changes are particularly meaningful for rural and underserved communities, ensuring patients receive timely and effective care regardless of their location.
As tele-behavioral health becomes a permanent fixture in behavioral health care, these proposals could encourage more providers to offer virtual services, expand the workforce available for remote care, and reduce the strain on traditional outpatient facilities. Overall, CMS’ proposed rule represents a significant step forward in modernizing behavioral health delivery and preparing the health care system for future emergencies.
