The Mental Health Access Improvement Act (H.R. 432), which recognizes mental health counselors and marriage and family therapists as approved Medicare Part B providers, became law through passage of the Consolidated Appropriations Act, 2023, Public Law No.117-328 on Dec. 29, 2022.
Beginning in 2024, counselors in private practices and agencies will be able to bill Medicare for treating older Americans with mental health conditions. The legislation also creates parity between counselors and other mental health providers in the Medicare program and reinforces that status with other public insurance program officials, as well as private payers. During 2023, NBCC will move from a legislative advocacy strategy to a regulatory implementation effort regarding Medicare. We will update NCCs on the implementation of the law and actions that counselors will need to take to ensure they are eligible to provide services to Medicare beneficiaries.
Yes. The 2022–23 federal budget legislation (called the omnibus) included the Mental Health Access Improvement Act language that allows mental health counselors and marriage and family therapists (MFTs) to receive payment under the Medicare Part B program for providing covered mental health services to Medicare beneficiaries.
Medicare Part B covers one depression screening per year; a one-time “welcome to Medicare” visit, which includes a review of risk factors for depression; and an annual “wellness” visit where beneficiaries can discuss their mental health status. Part B also covers individual and group psychotherapy services provided by several licensed professionals, and depending on state rules, family counseling is covered if the main purpose is to help with treatment, psychiatric evaluation, medication management, and partial hospitalization.
Additionally, Part B covers outpatient services related to substance use disorders. These include opioid use disorder treatment services such as medication, counseling, drug testing, and individual and group therapy. Medicare covers one alcohol misuse screening per year, and for beneficiaries determined to be misusing alcohol, four counseling sessions per year. Medicare also covers some telehealth services, including for mental health and substance use disorder services as well as services unrelated to mental health, on both a permanent basis and on a temporary basis as part of the COVID-19 public health emergency.
The Mental Health Access Improvement Act specifically spells out who is eligible based on the following language:
The legislation defines a mental health counselor as holding a master's or doctoral degree as a mental health counselor, clinical professional counselor, or professional counselor in the state where they are licensed to provide services, and the counselor must have performed at least 2 years of supervised experience in mental health counseling.
Services provided by mental health counselors are for the diagnosis and treatment of mental illness (not for services for an inpatient in a hospital) that the mental health counselor is legally authorized to perform in the state where they practice.
The effective date of the provisions regarding counselor inclusion in the Medicare program is Jan. 1, 2024. At that time, you will be able to bill for services provided to Medicare beneficiaries.
During 2023, the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers all aspects of the Medicare program and issues rules and regulations, will develop guidance on how to apply for Medicare recognition. CMS will offer guidance to counselors as new Medicare providers prior to 2024. NBCC will work with CMS and share information as soon as that application process is open for counselors.
In addition to the provider application process, CMS will provide guidance to counselors on which codes to use for billing for services provided to Medicare beneficiaries. NBCC will also discuss this process in our meetings with CMS officials.
Yes, as long as you meet the requirements described in the legislation. The provisions are similar to licensing at the state level.
Yes. NBCC will be collecting questions and comments from NCCs about rule development and implementation on Medicare recognition of counselors. Further, NBCC plans to hold a series of training sessions this year on Medicare application procedures and coding issues, and regular updates into 2024 and beyond.
Yes. Counselors are now eligible Medicare Part B providers in Federally Qualified Health Centers (FQHCs). FQHCs are safety net providers that primarily provide services typically furnished in an outpatient clinic. FQHCs provide comprehensive services, including preventive health services and mental health and substance abuse services.
Counselors are also now eligible Medicare Part B providers in Rural Health Clinics (RHCs). The RHC program increases access to primary care services for patients in rural communities. RHCs are required to provide outpatient primary care services such as behavioral health care.
As part of the Mental Health Access Improvement Act, counselors are now required team members for Medicare hospice interdisciplinary teams. The hospice interdisciplinary team includes physicians, nurses, mental health providers, chaplains, and trained volunteers who work together to address a hospice patient's physical, emotional, and spiritual needs.
The legislation will provide opportunities to participate in Medicare Behavioral Health Integrated (BHI) services and primary care programs. Public and private insurance programs now widely consider integrating behavioral health care with primary care an effective strategy for improving outcomes for millions of Americans with mental or behavioral health conditions. Medicare makes separate payment to physicians and non-physician practitioners for BHI services they supply to patients over a calendar month service period. Counselors also will be able to participate in "Medicare Innovative Delivery and Payment Programs" such as Accountable Care Organizations (ACOs).
Yes. Counselors who referred their older clients who enrolled in Medicare to other providers will be able to resume providing treatment to those clients—as long as the clients have terminated services with the referred provider.
Many federal programs already recognize mental health counselors, including the National Health Service Corps, Department of Veterans Affairs, U.S. Army, and TRICARE.
On Dec. 29, 2022, the Consolidated Appropriations Act, 2023 (H.R. 2617) was signed into law by President Biden after a bipartisan vote of approval in both of the United States legislative chambers. Included in the omnibus package is language from the Mental Health Access Improvement Act (S. 828/H.R. 432), which has added mental health counselors to the list of Medicare providers. Coverage of counselors will begin Jan. 1, 2024.
S. 828/H.R. 432, the Mental Health Access Improvement Act of 2021, is introduced by Sen. John Barrasso (R-WY), Sen. Debbie Stabenow (D-MI), Rep. Mike Thompson (D-CA-5), and Rep. John Katko (R-NY-24).
The House Committee on Energy and Commerce reports S. 286/H.R. 945 favorably out of a markup, the first time the legislation has been included in a markup in 11 years.
In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services issues a temporary emergency rule that allows mental health counselors working in Rural Health Centers and Federally Qualified Health Centers to be reimbursed by Medicare for telehealth services.
S. 286/H.R. 945 gains 123 cosponsors in the House and 31cosponsors in the Senate, the most in the bill’s history.
S. 286/H.R. 945, the Mental Health Access Improvement Act of 2019, is introduced by Sen. John Barrasso (R-WY), Sen. Debbie Stabenow (D-MI), Rep. Mike Thompson (D-CA-5), and Rep. John Katko (R-NY-24).
The President’s Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC), an advisory body composed of federal officials and behavioral health experts, recommended inclusion of counselors in the Medicare program. please feel free to download and read the full report.
U.S. Sens. John Barrasso (R-WY) and Debbie Stabenow (D-MI) introduce S. 1879, the Seniors Mental Health Access Improvement Act of 2017, seeking to establish mental health counselors and marriage and family therapists as authorized Medicare providers.
U.S. Reps. John Katko (R-NY) and Mike Thompson (D-CA) introduce H.R. 3032, the Mental Health Access Improvement Act of 2017, seeking to establish mental health counselors and marriage and family therapists as authorized Medicare providers.
Representative Chris Gibson (R-NY) , Senator John Barrasso (R-WY) and counselor/MFT organizations pushed to include Medicare legislation in the pending mental health reform package.
Retiring Representative Chris Gibson (R‐NY) made it a priority to pass H.R. 2759 and added 10 Republican cosponsors to the bill (the most House Republicans ever), raising the total to 50 cosponsors.
Representative Robin Kelly (D-IL) introduced H.R. 5475, the Health Equity and Accountability Act. H.R. 5475 was sponsored by the House Tri-Caucus and addresses health disparities for minority populations.
Senators John Barrasso (R‐WY) and Debbie Stabenow (D‐MI) introduced the Seniors Mental Health Access Improvement Act (S 1830), a companion Bill to H.R. 2759.
Congressmen Chris Gibson (R‐NY) and Mike Thompson (D‐CA) introduced H.R. 2759, The Mental Health Improvement Act of 2015. The bill provides Medicare reimbursement for counselors and MFTs, mirroring bills introduced in prior sessions.
On Dec. 29, 2022, the Consolidated Appropriations Act (H.R. 2617) was signed into law by President Biden after a bipartisan vote of approval in both of the United States legislative chambers. Included in the omnibus package is language from the Mental Health Access Improvement Act (S. 828/H.R. 432) adding mental health counselors as providers. Coverage of counselors will begin Jan. 1, 2024.
Congressmen John Katko (R-NY) and Mike Thompson (D-CA) introduced H.R. 3032, the Mental Health Access Improvement Act, on June 23. Senators John Barrasso (R-WY) and Debbie Stabenow (D-MI) introduced a companion bill in the Senate, S.1879, the Seniors Mental Health Access Improvement Act, on September 27.
Companion stand-alone bills S. 1830, the Seniors Mental Health Access Improvement Act of 2015, and H.R. 2759, the Mental Health Access Improvement Act, are introduced by Sens. John Barrasso (R-WY) and Debbie Stabenow (D-MI) and Reps. Chris Gibson (R-NY) and Mike Thompson (D-CA). The House TriCaucus health disparities bill, H.R. 5475, is introduced by Rep. Robin Kelly (D-IL).
Sen. Ron Wyden (D-OR) introduces stand-alone bill S. 604, the Seniors Mental Health Access Improvement Act of 2011. The MHC and MFT language is also included in S. 1680, the Craig Thomas Rural Hospital and Provider Equity Act of 2011, introduced by Sens. John Barrasso (R-WY), Pat Roberts (R-KS), Kent Conrad (D-ND) and Tom Harkin (D-IA).
Sen. Ron Wyden (D-OR) introduces stand-alone bill S. 604, the Seniors Mental Health Access Improvement Act of 2011. The MHC and MFT language is also included in S. 1680, the Craig Thomas Rural Hospital and Provider Equity Act of 2011, introduced by Sens. John Barrasso (R-WY), Pat Roberts (R-KS), Kent Conrad (D-ND) and Tom Harkin (D-IA).
The provision is re-introduced in companion stand-alone bills S. 671 and H.R. 1693 by Sens. Blanche Lincoln (D-AR) and John Barrasso (R-WY) and Rep. Bart Gordon (D-TN). The provision is included in H.R. 3200, the House reform legislation that passed the Energy and Commerce, Ways and Means, and Education and Labor Committees. The language passes the House as part of the health reform bill (H.R. 3962). The provision was reportedly in the final House-Senate compromise legislation until the election of Sen. Scott Brown (R-MA) changed the Senate balance.
Companion stand-alone bills S. 921 and H.R. 1588 are introduced by Sens. Craig Thomas (R-WY) and Blanche Lincoln (D-AR) and Rep. Barbara Cubin (R-WY). Rep. Pete Stark (D-CA) includes the MHC and MFT language in his omnibus Medicare mental health bill (H.R. 1663). The provision passes the House as part of the SCHIP Reauthorization Act (H.R. 3162). The Senate declines to consider the SCHIP bill.
In addition to companion bills S. 784 and H.R. 5324, introduced by Sens. Craig Thomas (R-WY) and Blanche Lincoln (D-AR) and Rep. Barbara Cubin (R-WY), the MHC and MFT provision is again included in the omnibus Medicare mental health bill (S. 927 and H.R. 1946) and the Medicare rural access bills (S. 3500 and H.R. 6030). The provision passes the Senate as part of the Deficit Reduction Act of 2005 (S. 1932) but does not make it through conference.
Sen. Craig Thomas (R-WY) introduces S. 310 as a stand-alone bill. The language is also included in the omnibus Medicare mental health bill (S. 646) and the omnibus Medicare rural access bill (S. 1185 and H.R. 2333). In 2003, the provision passes the Senate in the Medicare prescription drug bill (S. 1) but is not accepted during conference.
The provision to provide reimbursement for MHCs and MFTs in the Medicare program is introduced as stand-alone bill S.1760 by Sens. Craig Thomas (R-WY) and Blanche Lincoln (D-AR). The companion bill, H.R. 3899, is subsequently introduced on the House side by Rep. Brad Carson (D-OK). The same provision is additionally included in an omnibus Medicare mental health bill (S. 690 and H.R. 1522), but does not make it out of committee.
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