CMS releases final rule addressing behavioral health

On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) announced significant updates to healthcare policies with the release of the Calendar Year 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule.

What happened

The final rule encompasses two major initiatives: the expansion of behavioral health services for Medicare beneficiaries and improvements in hospital price transparency. This move aligns with their commitment to tackling the ongoing behavioral health crisis and improving health outcomes. 

The main points of the final rule include: 

• Intensive outpatient services will be accessible in various healthcare settings, including hospital outpatient departments, Community Mental Health Centers, Federally Qualified Health Centers, and Rural Health Clinics, covering individuals with mental health conditions and substance use disorders, including treatments for opioid use disorder.
• Aligning with CMS's Behavioral Health Strategy, the initiative expands coverage for intensive outpatient services to address the ongoing national behavioral health crisis.
• Hospitals are mandated to provide charges publicly in a standardized manner, simplifying the understanding of costs for specific services.
• CMS strengthens enforcement capabilities for compliance with transparency requirements, such as certifying data accuracy, issuing warning notices for non-compliance, and enabling direct communication with health system leadership in case of issues.
• CMS supports health equity for underserved communities, especially Tribal groups, by allowing specific payment structures for health services in Rural Emergency Hospitals, improving access to care and health outcomes for these populations.

What they're saying

Regarding the final rule, Deputy Administrator and Director for the Center for Medicare, Dr. Meena Seshamani, has said: "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, with this final rule we will ensure people get timely access to quality care in their communities, leading to improved outcomes and better health."

Why it matters

The expansion of Medicare's coverage for intensive outpatient services targeting mental health and substance use disorders is a significant step in filling gaps in behavioral healthcare during the ongoing national behavioral health crisis. Simultaneously, efforts to improve hospital price transparency provide standardized, accessible information about healthcare costs, aiding people in making informed decisions and better financial planning for their medical needs.

Sections within the final rule play a role in reinforcing HIPAA provisions. By strengthening enforcement measures, there's a focus on ensuring accurate and secure data sharing, which aligns with HIPAA's privacy and security guidelines. 

This move also enhances transparency within healthcare organizations. Additionally, the emphasis on promoting health equity, particularly for underserved communities, echoes HIPAA's fundamental principle of ensuring fair and unbiased access to healthcare services.

See also: HIPAA compliant text messaging for mental health support

What's next

This involves training, setting up infrastructure, and ensuring compliance with the new regulations. Regarding hospital price transparency, the emphasis is on enforcement, ensuring hospitals comply with the standardized disclosure requirements, enabling patients to access clear information about healthcare costs. 

See also: HIPAA Compliant Email: The Definitive Guide