CMS Implements Significant Changes to Medicare and Medicaid, Enhancing Behavioral Health Services and Provider Oversight
In a series of recent developments, the Centers for Medicare and Medicaid Services (CMS) have introduced pivotal changes to both Medicare enrollment regulations and Medicaid provider eligibility, aiming to bolster the integrity of healthcare services and expand access to behavioral health care.
Medicare Enrollment Regulations Tightened for Hospice and Home Health Providers
As detailed in a report by McDermott Will & Emery on JD Supra, CMS has finalized critical adjustments to the Medicare enrollment rules that affect hospices and home health agencies (HHAs). These changes, part of the CY 2024 Home Health Prospective Payment System Final Rule, are designed to enhance program integrity and ensure compliance with Medicare requirements.
Key modifications include:
- Increased Scrutiny for Hospices: Hospices will now face heightened screening, particularly those undergoing a change in majority ownership. The new rules limit the ability of a Medicare-enrolled hospice to change its majority ownership to once every 36 months, aligning with the existing regulations for HHAs.
- The 36-Month Rule Expansion: Previously applicable only to HHAs, this rule now extends to hospices, preventing the transfer of Medicare provider agreements and billing privileges to new owners without a thorough re-enrollment process. This measure aims to prevent evasion of ownership scrutiny and ensure compliance with Medicare conditions of participation.
- High-Risk Provider Designation for Hospices: Hospices, especially those enrolling for the first time or reporting new ownership, will be categorized as high-risk providers. This designation mandates fingerprint-based criminal background checks for owners with a 5% or greater direct or indirect ownership interest.
- These changes underscore CMS’s commitment to safeguarding Medicare beneficiaries by preventing fraudulent or abusive practices among providers.
New Guidance to Medicaid Directors Enhances Behavioral Health Provider Pool
In a separate but equally impactful move, CMS has issued new guidance to State Medicaid Directors, significantly expanding the pool of providers eligible to offer behavioral health services to Medicaid beneficiaries. This guidance, as reported by Behavioral Health Business, introduces a new group of behavioral health professionals, including master’s level social workers, marriage and family therapists, and other master’s level behavioral health clinicians, who will now be eligible for enhanced Medicaid funding.
Additionally, the guidance allows for the use of federal funds to support nurse advice lines. These lines are intended to provide Medicaid beneficiaries with access to information on non-emergent care conditions, including behavioral health issues, thereby improving workforce capacity and facilitating real-time access to health professionals.
CMS Administrator Chiquita Brooks-LaSure highlighted the importance of these initiatives, stating that expanding access to health professionals to address health issues in real-time, including mental health concerns, is crucial for high-quality, affordable, person-centered health coverage.
Conclusion
These strategic changes by CMS to Medicare and Medicaid regulations represent a significant step forward in enhancing the quality and integrity of healthcare services in the United States. By tightening Medicare enrollment requirements for hospices and home health providers and expanding Medicaid’s behavioral health provider pool, CMS aims to ensure that beneficiaries receive the highest standard of care while safeguarding the system against fraud and abuse.
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