On July 13, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule regarding CY 2022 Medicare payments under the Physician Fee Schedule (PFS) and other Part B Payment Policies (CMS-1751-P). NASW will be submitting comments on the proposed rule on behalf of our members and chapters. We welcome many of the provisions to continue telehealth flexibilities and include our workforce in the Quality Payment Program, but we must fight the proposed 3.75% cut to our reimbursement rates and the proposed requirement that telemental health services include an in-person visit.

Please submit your own comments as a social worker using this template letter by September 13, customizing your letter to reflect your unique experiences and perspectives, and providing supportive examples whenever possible.

The agency will issue the final rule later this year.

Below are the key provisions of the proposed rule regarding billing and reimbursement for social workers.

Reimbursement Rates

Faced with the need to meet budget neutrality requirements instituted by Congress, CMS proposes in this rule to reduce the conversion factor (CF), the figure by which all code values are multiplied to achieve a payment amount for each service. For CY 2022, CMS proposes to reduce the CF by 3.75%, which would lead to significant payment losses for social workers who bill Medicare. Congress waived this cut for CY 2021 due to the COVID-19 pandemic.

Telehealth

CMS is proposing the following, some of which would continue much-needed flexibilities implemented by the agency during the pandemic:

  • Implementation of a provision included in a late 2020 congressional appropriations bill to remove geographic restrictions and permitting the home as an originating site for telehealth services furnished for the purpose of diagnosis, evaluation, and treatment of a mental health disorder.

  • Implementation of a provision included in a late 2020 congressional appropriations bill requiring that an in-person, non-telehealth service be furnished by a provider at least once within 6 months before each telehealth service furnished for the diagnosis, evaluation, and treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder or co-occurring mental health disorder).

  • Permitting use of audio-only (e.g., telephone) communications technology for mental telehealth services under certain conditions when provided to beneficiaries located in their home. Coverage would be limited to providers who have the capability to furnish two-way audio-visual services, but the beneficiary is unable to use, does not wish to use, or does not have access to two-way audio/video technology.

  • Extending through December 31, 2023, the telehealth services, known as Category 3 services, that were added on a temporary basis by CMS in response to the COVID-19 pandemic.

  • Providing payment for mental health visits when they are provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) through interactive telecommunications technology.

  • Permitting the provision of Opioid Use Disorder (OUD) therapy and counseling services via audio-only technology when two-way video is not available. CMS is proposing that during and after the pandemic, Opioid Treatment Programs (OTPs) would be required to indicate in a patient’s record when and why a visit for substance use counseling or therapy was audio-only.

Quality Payment Program

Beginning in January 2022, CMS proposes to revise the current eligible clinician definition to include clinical social workers. Being an eligible clinician in the Quality Payment Program allows clinical social workers to report measures and outcomes when appropriate.

To see the rule, go to 2022 Physician Fee Schedule. Advocacy is social work! Please share your expertise and opinions with CMS at this important time.