CHCS July 31, 2024
In November 2023, the Centers for Medicare & Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rule and the Physician Fee Schedule final rule, both aimed at increasing Medicare coverage of community-based substance use disorder (SUD) and mental health services. These final rules established the scope for Medicare Part B coverage of intensive outpatient program (IOP) services, as required by the Consolidated Appropriations Act of 2023. As of January 1, 2024, Medicare now covers IOP services, closing a significant gap in Medicare coverage of mental health and SUD services. This new coverage may impact access and coordination of care for Medicaid enrollees, including dually eligible individuals, who use IOP services.
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