📢 ALERT: Critical issue pertaining to our practice of neuropsychology requires your attention

CMS Proposed Rule on the CY2023 Physician Fee Schedule

Bottom Line: Submit a Message to the Biden Administration Asking for Its Newly Proposed Regulation to Protect and Strengthen Access to Psychological and Neuropsychological Services. 

This year’s CMS Physician Fee Schedule Proposed Rule holds great potential for increasing access to behavioral health services, but your advocacy is needed in order to maximize this potential.

Situation: The Centers for Medicare & Medicaid Services (CMS) is soliciting public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023.

The annual PFS rule has serious implications across the health care field – to researchers, clinicians, educators, and students alike. It often sets the benchmark for how other insurance programs and the VA cover and reimburse for specific services, sets the standard for how new and emerging forms of treatment are covered, and can have downstream financial implications for healthcare providers even when they do not participate in Medicare or other insurance programs. This year’s PFS proposed rule has a particular focus on mental and behavioral health, and has critical implications for neuropsychologists and other psychologists.

Directly impacting neuropsychologists, the proposed rule provides an opportunity to advocate for reimbursement for the Cognitive Assessment & Care code, reimbursement for interns and fellows, and telehealth reimbursement. 

For more information, see the CMS Fact Sheet.

Recommendation: Everyone representing the fields of neuropsychology and psychology – including practitioners, researchers, students and educators alike – is asked to submit comments to CMS to protect the delivery of mental and behavioral health care to those in need.

To make your voice heard, please take action through the American Psychological Association’s Action Center by Tuesday, September 6, 2022 by 11:59 PM EDT. Alternatively, you can comment directly at Regulations.gov. 

Please consider using the modified APA template below for a personalized message that integrates key messaging related to neuropsychology.

The LAAC provides periodic updates to inform members about recent advocacy efforts and to request input from members about their advocacy needs. To contact the LAAC, please email us at: LAACCommittee@nanonline.org.

Template for Comment to Ask the Biden Administration to Protect and Strengthen Access to Psychological and Neuropsychological Services

As a clinician, I urge CMS to ensure the final Physician Fee Schedule for 2023 strengthens access to psychological services and gives behavioral health professionals the tools they need to meet the mental health needs of diverse communities. Many of the issues raised in this year’s Physician Fee Schedule have serious implications for equity in access to behavioral health care. I urge CMS to adopt policies with the overall goal of facilitating access to mental and behavioral health treatment in underserved communities to the maximum extent. 

Strengthen the Practice of Psychology BHI Codes 
I support CMS’ proposed coding and payment for General Behavioral Health Integration (BHI) to recognize psychologists’ role in integrated care. I appreciate CMS’ support for multiple evidence-based models of integrated care, as it allows flexibility to support the behavioral health needs of the community. Neuropsychologists are frequently involved in management of behavioral symptoms associated with neurological disorders (e.g., agitation in dementia), and work closely with our neurology, psychiatry, and primary care colleagues.

Medicare Potentially Underutilized Services
I appreciate CMS’ request for comments on potentially underutilized services, as several of the services are performed by psychologists. I recommend CMS create additional Cognitive Assessment & Care codes without the medication reconciliation service because medication management is outside the scope of a psychologist’s license in many states. Neuropsychologists often provide follow-up monitoring of patients' functional abilities that may not require neuropsychological re-assessment due to severe levels of cognitive impairment, and the ability to utilize these codes can improve services and minimize the need for lengthy repeat evaluations.

Additionally, I recommend CMS allow reimbursement for Intensive Behavioral Therapy for Obesity services provided by psychologists. 

Telehealth
Many patients in rural/underserved areas are now able to access mental health services, often for the first time. Many patients prefer telehealth for varied reasons. Reverting to the non-facility rate for telehealth services after the end of the COVID public health emergency will lead practitioners to offer telehealth less frequently or to restrict the number of Medicare beneficiaries they treat using telehealth. Patients with significant cognitive impairment often have limited access to transportation, and the ability to provide services via telehealth allows greater opportunities for care.

Expand Psychology Training and Workforce Development Supervision by Psychologists 
I applaud CMS’ Proposed Revisions to the “Incident to” Physicians’ Services Regulation for Behavioral Health Services to allow reimbursement for Physicians and Non-Physician Providers (NPPs), including psychologists, who supervise these practitioners every day. This will help expand access to and coordination of mental health services in rural/underserved areas where masters’-level practitioners represent a substantial segment of the mental health providers.

Advanced Psychology Trainee Services 
I urge CMS to allow for Medicare reimbursement of services provided by advanced psychology trainees under the supervision of a licensed psychologist. Although psychology interns receive extensive clinical experience before internship, services provided by trainees under the supervision of a licensed psychologist are not reimbursable under Medicare. Without Medicare reimbursement of these services, training programs lack a steady source of funding. 

Support the Psychological Research-to-Practice Pipeline
Caregiving Behavior Management Training
I ask CMS to reconsider its position on the caregiver behavior management (CBM) training codes. There is extensive empirical support for CBM training, and it is the gold standard treatment for several health behavior issues. Although the patient is not present during CBM, these codes have many patient benefits, including reduction in disruptive/problematic behaviors for children with ADHD, improved weight management for individuals with obesity, and better management of patients with dementia. Caregivers of patients with dementia are often reluctant to discuss behavior concerns with the patient present, and allowing training with groups of caregivers will better address target behaviors and provide training in an effective and efficient manner.

Digital Therapeutics
I urge CMS to accept APA’s proposal to establish a new set of reimbursement codes for digital therapeutics—one for device purchase, one for patient education, and two for ongoing management.  Unlike the RTM codes, this structure reimburses for an active therapeutic intervention, not passive monitoring. A new set of reimbursement codes as outlined above will have a positive impact on access to treatment amongst patients who have limited access to traditional office-based treatment or who prefer the use of digital devices.