In December 2022, Congress passed The Mental Health Access Improvement Act, which recognizes mental health counselors as approved Medicare Part B providers. The provisions in the act were included in an end-of-the-year omnibus federal budget legislative package that included new spending priorities on behavioral health programs.
The key provision in the legislation allows mental health counselors and marriage and family therapists to receive payment under the Medicare Part B program for providing covered mental health services to beneficiaries beginning Jan. 1, 2024.
NBCC has prepared these fact sheets on key topics related to the Medicare program for counselors. Simply select your topic of interest to find pertinent information to aid in your Medicare journey. In addition, NBCC will continue to monitor the implementation of this legislation and provide regular updates via our website, newsletter, social media platforms, and webinars.
The Mental Health Access Improvement Act, which recognizes mental health counselors as approved Medicare Part B providers, passed as part of the end-of-the-year congressional omnibus federal budget legislative package that was signed by President Biden on Dec. 29, 2022.The official name of the legislation is "The Consolidated Appropriations Act, 2023 (H.R. 2617) - Public Law No.117-328."
The key provisions of the Mental Health Access Improvement Act embodied in the 2023 congressional omnibus legislative package allow counselors to do the following:
The ability of MFTs and counselors to bill Medicare for treating seniors with mental health conditions in their practices or the agencies where they work is the cornerstone of the Mental Health Access Improvement Act embodied in the omnibus legislation.
For counselors and MFTs who referred their clients to other providers and in many cases saw a disruption in their care (or their clients struggled to find another provider), those individuals will be able to continue to receive services for their conditions, and MFTs and counselors will receive Medicare reimbursement. We know based on recent surveys that a large percentage of counselors and MFTs provided pro bono services to clients over age 65 to prevent gaps in care. That will no longer be necessary, as continuity of care will remain in place, maintaining the critically important long-term engagement imperative.
The legislation creates parity between counselors and MFTs and other mental health providers under Medicare and other public insurance programs, as well as private payers. This new kind of recognition will not only open the private practice door for new and current clients but provide opportunities to participate in several innovative Medicare mental health programs (many multidisciplinary team-based approaches) highlighted above, such as accountable care organizations, patient-centered health homes, integrated care systems, and other demonstration programs developed by the Center for Medicare & Medicaid Innovation (CMS Innovation Center).
The key provision in the Mental Health Access Improvement Act allows mental health counselors and marriage and family therapists to receive payment under the Medicare Part B program for providing covered mental health services to beneficiaries beginning Jan. 1, 2024. Counselors will be able to bill Medicare directly for covered services rendered to beneficiaries over age 65 and people with disabilities who receive Medicare benefits.
Medicare Part B (medical insurance) helps cover mental health services that a beneficiary receives generally outside of a hospital (like in a clinic, doctor’s office, or therapist’s office) and services a hospital provides in its outpatient department.
All health care and mental health providers who participate in Part B must accept assignment. An assignment is an agreement by the provider or other supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill beneficiaries for any more than the Medicare deductible and coinsurance.
Part B helps pay for these outpatient mental health services:
Medicare covers opioid use disorder treatment services in opioid treatment programs. The services include medication (e.g., naloxone), counseling, drug testing, individual and group therapy, intake activities, and periodic assessments. Medicare covers counseling, therapy services, and periodic assessments both in person and, in certain circumstances, by virtual delivery.
Medicare covers one alcohol misuse screening each year for adults (including pregnant individuals) who use alcohol but don’t meet the medical criteria for alcohol dependency.
For more information about mental health benefits—and health care benefits—that Medicare beneficiaries are entitled to receive, please see the following sources:
To gain a better understanding of how NCCs become eligible for formal Medicare participation and enroll in the program this year, NBCC representatives have initially met with officials from the Centers for Medicare & Medicaid Services (CMS), which administers Medicare Part A through Part D (and the federal portion of the Medicaid program).
CMS is the agency within the U.S. Department of Health and Human Services (HHS) that administers the nation’s major health care programs. CMS oversees programs including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the state and federal health insurance marketplaces under the Affordable Care Act (ACA). CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud and abuse within the health care system. The agency aims to provide a health care system with better care, access to coverage, and improved health. CMS releases updated Medicare premium and deductible information each year.
NBCC has learned that there will be several CMS departments involved in the implementation of Medicare Part B coverage of counselors (These descriptions come from the CMS website. Visit for more information.):
Provider Relations Group With the CMS Office of Communications: Provides outreach to national stakeholders and facilitates webinars involving CMS leadership.
This group serves as CMS’s focal point for internal and external strategic and tactical communications, providing leadership for CMS in the areas of customer service; website operations; traditional and new media, including web initiatives such as social media supported by innovative, increasingly mobile technologies; media relations; call center operations, consumer materials; public information campaigns; and public engagement. It coordinates with external partners including the Department of Health and Human Services (HHS) and the White House on key communication and public engagement initiatives, leveraging CMS resources to strategically support these activities.
Center for Program Integrity: Works with suppliers, vendors, and providers.
This center serves as CMS’s focal point for all national and state-wide Medicare and Medicaid programs and CHIP integrity fraud and abuse issues. It promotes the integrity of the Medicare and Medicaid programs and CHIP through provider/contractor audits and policy reviews, identification, and monitoring of program vulnerabilities, and providing support and assistance to states.
Center for Clinical Standards and Quality: Handles clinical and provider issues.
This center serves as the focal point for all quality, clinical, medical science issues, survey and certification, and policies for CMS’s programs. Provides leadership and coordination for the development and implementation of a cohesive, CMS-wide approach to measuring and promoting quality and leads CMS’s priority-setting process for clinical quality improvement. It coordinates quality-related activities with outside organizations and monitors the quality of Medicare, Medicaid, and the Clinical Laboratory and Improvement Amendments (CLIA). It evaluates the success of interventions and develops best practices and techniques in quality improvement. Implementation of these techniques will be overseen by appropriate components.
Center for Medicare: Overall operations and coordination
This center serves as CMS’s focal point for the formulation, coordination, integration, implementation, and evaluation of national Medicare program policies and operations. It identifies and proposes modifications to Medicare programs and policies to reflect changes or trends in the health care industry, program objectives, and the needs of Medicare beneficiaries. It serves as CMS’s lead for management, oversight, budget, and performance issues relating to Medicare Advantage and prescription drug plans, Medicare fee-for-service providers, and contractors.
The center oversees all CMS interactions and collaboration with key stakeholders relating to Medicare (i.e., plans, providers, other government entities, advocacy groups, Consortia ) and communication and dissemination of policies, guidance, and materials to understand their perspectives and to drive best practices in the health care industry. The Hospital and Ambulatory Policy Group—specifically the Division of Ambulatory Services (DAS)—within the center, will also be a key entity in the implementation of Medicare Part B coverage of counselors. The group is responsible for setting Medicare fee-for-service payments for a wide range of health care and mental health services and is responsible for national fee-for-service (FFS) provider education development.
CMS holds webinars/chats with specific national stakeholder groups to discuss implementation issues and any questions or issues that CMS can address.
NBCC has learned that CMS medical directors are interested in Part B coverage of counselors and that they host online forums the first Friday of every month. We have indicated that NBCC would like to participate in these sessions and include our issues in the agenda of upcoming meetings.
MLN Connects is a weekly email newsletter for Medicare providers. You can subscribe or view back issues.
NBCC has reviewed the following online resources, and we think they may be of interest or help to counselors who want to learn more about Medicare in preparation for 2024.
To learn more about the Medicare program and how to enroll (counselors will likely be able to enroll in November 2023), CMS’s Medicare Learning Network (MLN) now offers provider education products designed to promote national consistency of Medicare provider information for CMS initiatives. CMS’s 60-minute introductory course titled “The World of Medicare” can be found here, and a complete list of MLN’s web-based trainings is here.
On an annual basis, CMS issues a notice of proposed rulemaking (NPRM) for the Medicare Physician Fee Schedule (MPFS) in early July and accepts comments on the NPRM before issuing a final rule in the fall. The calendar year 2024 MPFS (developed in the summer 2023) will include all of the language and guidance on participatory requirements for counselors in the Medicare program.
To help provide counselors with an example of how information is presented in a MPFS, the calendar year 2020 MPFS Final Rule offered some guidance on how CMS could potentially conduct rulemaking for Part B coverage of counselors.
In 2020, CMS added a new Enrollment Process Category for Opioid Treatment Providers (OTPs) to the Fee Schedule. The following paragraph, from the 2020 MPFS Final Rule, describes the process of adding a new category.
In furtherance of its objectives to help individuals recover from opioid addiction, the SUPPORT Act established a new Medicare benefit category for OTPs for the purposes of furnishing opioid use disorder treatment services. Prior to the Final Rule, OTPs were not recognized as Medicare providers, meaning that beneficiaries receiving medication-assisted treatment (“MAT”) at OTPs for their opioid use disorder had to pay out of pocket. In the Final Rule, CMS sets forth the eligibility definitions and requirements for OTP enrollment under this newly created benefit category, which will enable OTPs that meet applicable requirements to bill and receive payment under the Medicare program for such services, thereby promoting expanded access to care. For purposes of enrollment, the SUPPORT Act and the Final Rule require that OTPs enroll under Section 1866(j) of the Social Security Act, which requires the entity to enter into a provider agreement that meets standard Medicare requirements. The Final Rule also specifically directs an OTP to have a provider agreement that meets the requirements of Section 1866(a) of the Social Security Act. All typical enrollment processes (e.g., completing an enrollment application) will apply to OTP enrollment, as well as Medicare enrollment regulations designed to give CMS discretion and gatekeeper tools for program integrity purposes to prevent unqualified or potentially fraudulent individuals and entities from being able to enter and inappropriately bill the Medicare program. The Final Rule creates a new regulation at 42 C.F.R. § 424.67 that incorporates these general enrollment requirements and procedures and further establishes specific enrollment requirements that OTPs must meet in order to bill Medicare for the provision of opioid use disorder treatment services. These requirements include submission of a Form CMS-855B with program-specific supplemental information attached, including (i) a list of all physicians and other eligible professionals who are legally authorized to prescribe, order, or dispense controlled substances on behalf of the OTP to enable CMS to screen such providers qualifications and prescribing practices; and (ii) a certification that the OTP meets and will continue to meet specific requirements and standards.
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