Several new reimbursement policies, insurance parity requirements and other regulatory changes will take effect in 2025.
Here are 10 key policies affecting behavioral health providers to know:
- CMS will implement the Innovation in Behavioral Health model, a program designed to bridge gaps between behavioral and physical health. Four states will participate in the program in 2025.
- CMS will introduce policy changes aimed at promoting safety planning and follow-up for patients discharged from emergency departments after a mental health crisis. The agency will introduce separate coding and payment for safety planning intervention, which can help prevent suicide when properly implemented, according to CMS. The agency will also create a monthly billing code for follow-up contacts for patients discharged from the emergency room after a crisis.
- FDA-approved digital mental health devices when used by behavioral health providers as part of a care plan will become eligible for Medicare reimbursement.
- CMS will allow providers limited to diagnosing and treating mental illness, including clinical psychologists, social workers and marriage and family therapists, to bill for interprofessional consultations.
- New requirements for Medicare Advantage plans to maintain adequate networks of outpatient behavioral health providers will take effect.
- CMS will increase inpatient payment rates for behavioral health facilities by 2.8% for 2025. The agency will also reduce the rate for outlier payments, which will decrease aggregate payments by 0.3%, according to CMS estimates. The agency expects to pay inpatient psychiatric facilities $65 million more in 2025 than in 2024, an increase of 2.5%.
- CMS will require facilities to report 30-day, all-cause emergency department visits for patients discharged. The agency will not require facilities to report this metric on a quarterly basis, as it proposed in its March proposed rule.
- New regulations designed to toughen enforcement on mental health parity standards will take effect this year. The rules, finalized in September, will bar health plans from implementing stricter prior authorization requirements for mental healthcare than for medical or surgical benefits.
- The rule will also require health plans to study their mental health networks, payment rates and prior authorization policies to ensure they are not more restrictive than for medical care.
- Congress extended some telehealth flexibilities in place during the COVID-19 pandemic for three months in a stopgap spending bill. The bill extended the waiver of a requirement for behavioral telehealth providers to see patients in person once every six months to receive Medicare payments through the end of March 2025.