Implications for Clinical Social Workers
On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released the CY 2022 Medicare Physician Fee Schedule (PFS) final rule. The 2400+-page rule includes updates to policies and payments that are pertinent to clinical social workers (CSWs) and other Medicare providers. NASW submitted comments on September 13, 2021 to CMS on the proposed rule. A number of NASW’s recommendations are reflected in the final rule. The final rule goes into effect on January 1, 2022. Below is a summary of the provisions and their implications for CSWs.
NASW will continue to monitor Medicare regulation and inform members of any further updates from CMS clarifying the CY 2022 final rule provisions. NASW also continues to undertake vigorous advocacy with CMS on behalf of CSWs and their clients, including efforts to increase the CSW reimbursement rate.
The final rule called for 3.75 percent reimbursement cuts to Medicare providers, including CSWs. An intense advocacy effort fueled by NASW members and other professional organizations has earned a win: Congress has passed legislation that offsets most of the proposed cuts and delays additional reductions that were looming due to sequestration and other budget requirements. Without congressional action, CSWs and other provider types were facing the 3.75 cut plus additional across-the-board reductions totaling an additional 6 percent. This included a 2 percent sequestration cut which has now been delayed until April 2022, when a 1 percent sequestration will be imposed until June 30, 2022, with the required 2 percent cut returning in July and remaining until the sequestration system expires in 2031. The legislation approved by the Congress also delays implementation of a 4 percent deficit control cut until 2023.
Before the public health emergency (PHE), Medicare telehealth coverage was limited.
The PHE brought a steep decline in the use of in-person services creating significant concerns about health equity and access to care. As a result, CMS temporarily expanded telehealth coverage under the PFS. This included the removal of geographic restrictions, as well as the addition of covered services and coverage of services provided via both smartphones and audio-only devices. The final rule continues many of these flexibilities.
Telehealth Services List: CMS will continue the use of the temporary services added to the list through December 31, 2023. During this time, CMS will continue to evaluate the effectiveness of these services for permanent inclusion. A current list of codes can be found here
The removal of the geographic restrictions continues, allowing the beneficiary’s home as an originating site for telehealth services for the purposes of evaluation, diagnosis, and treatment of a mental health disorder. The definition of “home” has also been expanded to include temporary lodging, such as hotels and homeless shelters as well as locations a short distance from the beneficiary’s home.
CMS is requiring that an in-person, non-telehealth service be furnished by a practitioner at least once within six (6) months before each telehealth service furnished for the evaluation, diagnosis, or treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder or co-occurring mental health disorder). The in-person non-telehealth service requirements apply only to telehealth services furnished to a patient in a home originating site. A 12 month in-person visit is required thereafter. Exceptions to the in-person visit is based on the beneficiary’s circumstance which must be documented in the clinical record. Payment will not be made to a telehealth service unless the above conditions are met.
In a provider group setting, the in-person requirement may be met by another provider of the same specialty in the same group if the provider rendering the telehealth service is not available. CMS plans to provide additional guidance on the in-person requirement.
In its public comment letter on the proposed rule, NASW urged CMS to remove the in-person requirement entirely. NASW is continuing to advocate for its removal.
The definition of interactive telecommunications system for telehealth services has been revised to include audio-only communications technology for the treatment of mental health and substance use disorders. The use of audio-only services is permissible when CSWs have the capability of using two-way, audio/video communications, but the beneficiary is not capable of, or does not agree to, using two-way, audio/video technology. CSWs must document the rationale for audio-only services in the patient’s record and use the appropriate claim modifier which clarifies the service performed.
CMS also finalized a requirement for the use of a new modifier for services performed using audio-only communications. NASW is delighted that audio-only has been continued beyond the PHE, as it has advocated vigorously for it to be made permanent.
Opioid Treatment Programs (OTP)
OTPs are able to deliver counseling and therapy services via audio-only interaction (e.g.. telephone calls) following the PHE in instances where the beneficiary does not consent to or have the capability to use two-way audio/video interaction. CSWs will be required to use the appropriate service-level modifier and document the rationale for audio-only use in the patient’s record.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
CMS now allows RHCs and FQHCs conduct mental health visits using real-time telecommunication technology, such as video conferencing or a smartphone. It also allows the use of audio-only services when the beneficiary does not consent to or has the capability of using video technology.
CMS has indicated the in-person, non-telehealth visit requirement must be provided at least every 12 months for these services. More visits are permitted under CMS policy, based on clinical need. Exceptions to the in-person requirement may be granted depending on the beneficiary’s circumstances. In this instance, CSWs should document the reason in the patient’s record.
RHCs and FQHCs will be able to bill for Transitional Care Management (TCM) and other care management services provided for the same beneficiary during the same service period, given all billing code requirements are met.
Tribal FQHC Payments
CMS is soliciting comments, per the request of American Indian and Alaska Native communities to revise its Medicare regulations to allow all Indian Health Service (IHS) and tribally operated outpatient facilities/clinics eligible for payment at the Medicare outpatient per visit. CMS has also been asked to consider flexibilities pertaining to cost reporting requirement for these facilities.
Quality Payment Program (QPP)
The Merit-Based Incentive Payment System (MIPS) is a component of Medicare’s Quality Payment Program. It is a value-based payment program that promotes the delivery of high-value care by Medicare providers through payment incentives. Beginning January 1, 2022, CSWs will be one of 15 eligible Medicare providers to perform and submit quality measures in their practice as an individual, a group practice, or virtual group. Additional information about QPP is available at Clinical Social Work Quality Payment Program
NASW will continue to monitor CMS policies for any future changes and advocate for members as needed. Questions about the final rule may be emailed to Mirean Coleman at email@example.com