Final Rule Fills Gaps in Behavioral Health Services Under Medicare to Improve Health Outcomes

Today, the Centers for Medicare & Medicaid Services (CMS) announced it is expanding access to behavioral health services for people with Medicare through coverage of intensive outpatient services and that it is making it easier for the public to learn what a hospital charges for items and services through improved hospital price transparency requirements. These policies are included in the calendar year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule with comment period released today, which also updates payment rates by 3.1% for hospital outpatient and ASC services for calendar year 2024.

“HHS is committed to expanding access to behavioral healthcare for people with Medicare. This rule will fill longstanding gaps in behavioral health treatment for Medicare beneficiaries and advance health equity for Tribal communities, rural communities, and others who are underserved,” said HHS Secretary Xavier Becerra. “We believe the public should always know what a provider charges for their services. This rule shines a brighter light on hospital prices and gives CMS new tools to enforce these actions on behalf of patients.”

“CMS is committed to expanding access to behavioral health care and is finalizing coverage of intensive outpatient services for both mental health conditions and substance use disorders,” said CMS Administrator Chiquita Brooks-LaSure. “Additionally, the final rule strengthens hospital price transparency by improving the standardization of hospital standard charges and enhancing CMS’ enforcement capabilities, thereby better enabling the American people to understand and meaningfully use hospital standard charges for items and services.”

The CY 2024 OPPS and ASC final rule implements the Consolidated Appropriations Act, 2023 provisions that created a new benefit category for intensive outpatient program services for individuals with acute behavioral health needs. CMS is establishing payment and program requirements for the benefit across various settings, including hospital outpatient departments, Community Mental Health Centers, Federally Qualified Health Centers, and Rural Health Clinics, effective January 1, 2024. Across all of these settings, intensive outpatient program services are available for both individuals with mental health conditions and individuals with substance use disorders. CMS is further extending coverage for intensive outpatient services in Opioid Treatment Programs for the treatment of opioid use disorder. Together, these policies to establish coverage for intensive outpatient services across multiple settings and levels of care will further CMS’ efforts to address the country’s behavioral health crisis, as outlined in the CMS Behavioral Health Strategy.

“The final rule reflects CMS’ commitment to ensuring Medicare is comprehensive in its ability to address patient needs by filling critical gaps in behavioral health,” said Deputy Administrator and Director for the Center for Medicare, Dr. Meena Seshamani. “With this final rule, we will ensure people get timely access to quality care in their communities, leading to improved outcomes and better health.”

CMS is also strengthening hospital price transparency regulations to require hospitals to make standard charges publicly available in a more standardized manner. This will make it easier for the public to learn what a hospital charges for a particular service, for third parties to develop consumer-friendly materials, for hospitals to comply, and for CMS to enforce the regulations. CMS is also streamlining hospital price transparency enforcement capabilities, including the following improvements: certification by hospital officials as to the accuracy and completeness of the machine-readable file data; requiring hospital acknowledgment of warning notices; reserving the right for CMS to communicate directly with health system leadership when a hospital with a compliance issue is found to be part of a health system; and publishing other enforcement activities, in addition to civil monetary penalties, on a CMS website.

Additionally, through the final rule, CMS is advancing health equity by ensuring CMS’ programs support health for all people we serve, particularly those who are underserved. CMS is promoting health equity for Tribal communities by allowing Indian Health Service (IHS) and Tribal facilities that convert to the new Rural Emergency Hospital (REH) provider type to be paid for hospital outpatient services under an all-inclusive rate in addition to receiving the monthly facility payment that applies to all REHs.

For a fact sheet on the CY 2024 OPPS/ASC Payment System Final Rule with Comment Period, please visit: https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0

For a fact sheet on hospital price transparency, please visit: https://www.cms.gov/newsroom/fact-sheets/hospital-price-transparency-fact-sheet

The CY 2024 OPPS/ASC Payment System Final Rule with Comment Period can be viewed here: https://www.federalregister.gov/public-inspection/2023-24293/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment