Medicare is catching up to other payers and will soon be reimbursing for intensive outpatient services (IOP) for behavioral health. Currently, the Medicare program covers inpatient psychiatric hospitalizations, partial hospitalization programs (PHP), and outpatient therapeutic services. This new rule fills the gap for beneficiaries who require services more intensive than individual outpatient therapy visits but less intensive than PHP services (see CMS Proposes Establishing Medicare Coverage Of Intensive Outpatient Programs In Various Settings).

IOP services can be provided by hospital outpatient departments, community mental health centers (CMHCs), federally qualified health centers (FQHCs), and rural health clinics. The Centers for Medicare . . .

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Medicare

The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.


Medicare mental health specialists with high uptake of telemedicine mental health services between 2018 and 2023 had a 0.88 percentage point higher share of services provided to fee-for-service (FFS) beneficiaries in rural areas, compared to mental health specialists in the lowest telemedicine uptake quartile, according to a recent study. Much of the increase in rural service use was due to existing patients moving farther away from their specialists, rather than new rural beneficiaries seeking out… Read