Congress has passed the Consolidated Appropriations Act of 2023 (CAA) and the document includes multiple provisions that are anticipated to impact Rural Health Clinic (RHC) operations and revenue. The following is a brief summary of those provisions.
Two Additional Provider Types Approved as RHC Providers
CMS has added two new provider types to the RHC benefit: Marriage and Family Therapists (MFTs) and Mental Health Counselors. A Mental Health Counselor is defined as an individual who:
- “(A) possesses a master’s or doctor’s degree which qualifies for licensure or certification as a mental health counselor, clinical professional counselor, or professional counselor under the State law of the State in which such individual furnishes the services described in paragraph (3);
- (B) is licensed or certified as a mental health counselor, clinical professional counselor, or professional counselor by the State in which the services are furnished;
- (C) after obtaining such a degree has performed at least 2 years of clinical supervised experience in mental health counseling; and
- (D) meets such other requirements as specified by the Secretary.”
These newly approved provider types will be eligible to provide services in the RHC setting and have their services reimbursed at the clinic’s all-inclusive rate (AIR) effective January 1, 2024. It should be noted that behavioral health is currently considered a specialty service in the RHC setting, so organizations will need to assess whether implementing these services into an RHC will not jeopardize the 51% primary care threshold for the RHC in which these providers may practice.
Intensive Outpatient Services Treatment Category Created
Effective January 1, 2024, RHCs will be eligible providers for “intensive outpatient services.” These mental health services are designed for patients who require more complex mental health care than would be able to be accomplished during a typical office visit, but not so severe that an inpatient mental service would be required. Additional details about these services are expected to be included in the next Medicare Physician Fee Schedule proposed rule so that requirements can be finalized prior to the January 1, 2024 effective date.
Medicare Telehealth Flexibilities Extended
The CAA extended Medicare telehealth flexibilities, which were previously set to expire on the 152nd day following the end of the public health emergency (PHE), through December 31, 2024. This extension allows RHCs to continue to provide services as a telehealth distant site provider and will delay requiring patients to have face-to-face visits for mental health services. It should be noted that telehealth visits billed using code G2025 will not be paid at the AIR, but rather under a “special payment rule” at a rate of $95.88 for dates of service in 2023 compared to $97.24 for dates of service in 2022.
These provisions may indicate CMS’ increased acknowledgment of the importance of mental health and telehealth services in rural communities and may lay the groundwork for future expansion of services and increased reimbursement. Healthcare organizations that either currently operate RHCs or are considering RHC designation by CMS should carefully consider the operational and reimbursement impact of these changes. Organizations also should consult with their cost report preparers to prepare an estimate of the impact to current or future RHCs.
If you have any questions about the new RHC reimbursement methodology or would like assistance in assessing the impact, please reach out to a professional at FORVIS or submit the Contact Us form below.