Ask Medicare to pay for peer support in primary care settings

Each year the U.S. Department of Health and Human Services releases a rule known as the Physician Fee Schedule. This rule sets the national standards for paying for health services in the Medicare program, including mental health and addiction services.

This summer, mental health advocates met with health officials in charge of releasing the 2022 Physician Fee Schedule proposed rule to request that they make it explicitly clear that peer support services may be included in the overall payment rates for team-based integrated behavioral health care services delivered in primary care. Peer support aids individuals in setting and achieving their recovery goals through emotional, informational, and other assistance and is an evidence-based practice that reduces hospitalizations and illness. However, the proposed rule did not include this clarification to allow payment for peer support as part of integrated care. 

Additionally, during the pandemic, Medicare gave increased flexibility to providers, allowing them to provide telehealth services through audio-only means for people who lack broadband or don’t want to use video and pay at the same rate as in-person care. The new rule allows audio-only services to continue for mental health care, and we want to support that change. However, CMS imposes a periodic in-person requirement that can be hard for people to meet given workforce shortages and transportation barriers.  The need for in-person visits should be a shared decision by the clinician and the person and in-person visits should be available when needed, but not required. In addition, the rule does not address equal reimbursement for telehealth and in-person care.

The agency is asking for public comment on this rule until September 13, 2021, and the more comments that they receive, the more likely they are to include payment for peers and expand tele-mental health options in the final rule. We would like you to help change policy by commenting on these two key issues: peer support and telehealth.

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