Lexology November 14, 2023
As part of CMS’ annual Medicare OPPS and ASC Final Rule, it finalized new Medicare coverage of intensive outpatient program (“IOP”) services performed in hospital outpatient departments, CMHCs, FQHCs, and RHCs. Coverage begins January 1, 2024. This new coverage is intended to address the gap between the previously covered inpatient and partial hospitalization program (“PHP”) coverage and outpatient therapy coverage for behavioral health conditions and substance use disorders.
CMS defines IOP services as distinct and organized intensive ambulatory treatment program that offers less than 24-hour daily care other than in an individual’s home or in an inpatient or residential setting and furnishes any of the services described in new 42 CFR § 410.44:
- Individual and group therapy with physicians...
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