In reviewing federal mental health policy initiatives in 2023, it is clear that the past year was largely dedicated to implementing—through the federal regulatory process—major congressional mental health initiatives and policies passed in 2022.  

The following major pieces of legislation were signed into law in 2022 and implemented in 2023: 

• The Bipartisan Safer Communities Act 
• The Inflation Reduction Act 
• The Infrastructure Investment and Jobs Act  
• The CHIPs and Science Act 
• The Consolidated Appropriations Act of 2023 (which included Medicare recognition of counselors and marriage and family therapists) 

Federal Regulatory Actions

2024 Medicare Physician Fee Schedule (PFS) 

On November 2, 2023 (later officially codified on Nov. 16 through the Federal Register), the Centers for Medicare & Medicaid Services (CMS) issued a final rule for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective January 1, 2024. 

The key 2024 provisions pertain to including mental health counselors (MHCs) and marriage and family therapists (MFTs) in the Medicare program. 

CMS finalized all provisions pertaining to the implementation of Section 4121 of the Congressional Consolidated Appropriations Act of 2023 (CAA 2023), which provides for Medicare Part B coverage and payment under the PFS for the services of MHCs and MFTs. Additionally, the final rule also allows addiction counselors who meet the applicable requirements to enroll in Medicare as MHCs.   

MFTs and MHCs who have been approved through the enrollment process can bill Medicare for services as of Jan. 1, 2024. (Visit here for enrollment information.) 

On coding issues, CMS made several modifications affecting MHCs and MFTs. CMS made changes to what are called “Behavioral Health Integration” codes to allow MFTs and MHCs to bill for these services.  

CMS finalized their proposal to allow the “Health Behavior Assessment and Intervention (HBAI)” services described in several CPT codes, and any successor codes, to be billed by MFTs and MHCs. 

CMS is also implementing Section 4123 of the CAA 2023, which requires the HHS secretary to establish new HCPCS codes under the PFS for “psychotherapy for crisis services” that are furnished in an applicable site of service. 

Section 4121(b) of the CAA 2023 also established that the hospice interdisciplinary group (IDG) is required to include at least one social worker, MFT, or MHC. CMS finalized its proposal to modify the requirements for the hospice Conditions of Participation (CoPs) to allow social workers, MHCs, or MFTs to serve as members of the interdisciplinary group.  

Additionally, Section 4121(b) of the CAA 2023 allows MFTs and MHCs to furnish services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).  

The final rule also reflects Sections 4113 and 4121 of the CAA 2023, extending payment for telemental health services furnished in RHCs and FQHCs through Dec. 31, 2024, delaying the in-person requirements under Medicare for mental health visits furnished by RHCs and FQHCs, and including MFTs and MHCs as eligible for payment.  

The Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Final Rule 

On Nov. 2, 2023, CMS finalized Medicare payment rates for hospital outpatient and Ambulatory Surgical Center (ASC) services for 2024. The Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System Final Rule is published annually and contains two important provisions this year: 

• The final rule establishes payment for intensive outpatient program (IOP) services under Medicare. It includes the scope of benefits, coding and billing, and payment rates under the IOP benefit. 
• For Community Mental Health Clinics, the rule adds MFTs and MHCs to the list of practitioners who can lead interdisciplinary team meetings when deemed necessary. 

Medicare Advantage 

In November, CMS also issued a proposed rule that would make a number of changes to the requirements for Medicare Advantage plans. Notably, a provision would add a new facility type, “Outpatient Behavioral Health,” to the Medicare Advantage network adequacy requirements. This facility type includes MHCs and MFTs, and Medicare Advantage plans would be required to contract with these providers. 

Executive Actions

The White House funded several mental health programs utilizing monies authorized from key 2022 measures. 

School and Youth Initiatives 

• The U.S. Department of Education announced new funding for a center that will provide technical assistance to grantees working to address needs in K–12 schools for school-based mental health service providers.  
• The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded $9.7 million in grants through the infant and early childhood mental health program to improve outcomes for children from birth up to 12 years of age.  
• SAMHSA will award $30.4 million to grantees to provide resources to improve the mental health outcomes for children and youth at risk for or suffering serious emotional disturbances (SED) and their families. 

Workforce Capacity 

• The Health Resources and Services Administration (HRSA) announced a new Behavioral Health Workforce Education and Training (BHWET) funding opportunity for approximately $8.4 million to support 16 awards to recruit and train providers to provide behavioral support to children and adolescents. 
• SAMHSA released its National Model Standards for Peer Support Certification.  

Crisis Services  

• SAMHSA announced more than $9 million in awards in cooperative agreements for community crisis response partnerships.  
• SAMHSA announced grant opportunities for more than $200 million in funding for 988 and crisis related services.  

Improving Access to Care 

• The Department of Health and Human Services launched FindSupport.Gov, a new online resource for people to learn how to get support for mental health issues.  
• The Department of Labor launched a Mental Health at Work Initiative to promote key resources in support of employees and employers.  
• The Occupational Safety and Health Administration also rolled out the Workplace Stress Toolkit. 

Promoting Wellness and Recovery 

• The Department of Defense issued a new policy that makes it easier for service members to seek support by self-initiating a referral for a behavioral health evaluation through a commanding officer.  
• The Department of Veterans Affairs (VA) launched its Today I Am campaign to showcase veterans’ stories of getting help, to inspire other veterans to proactively seek support. 
• VA launched a pilot program to provide behavioral health services to caregivers enrolled in the Program of Comprehensive Assistance for Family Caregivers. This program will address the unique needs of veteran caregivers.  

Funding for New and Existing Certified Community Behavioral Health Clinics  

• SAMHSA awarded funds authorized by the Bipartisan Safer Communities Act (BSCA) for states to develop and transform Certified Community Behavioral Health Clinics (CCBHCs) to address the country’s mental health crisis.  

Congressional Behavioral Health Proposals in 2023

Last year, a handful of congressional mental health policies gained some traction, but no final action has been taken on these measures. 

Senate Mental Health Caucus 

In October, Senators Alex Padilla (D-CA), Thom Tillis (R-NC), Tina Smith (D-MN), and Joni Ernst (R-IA) announced the bipartisan Senate Mental Health Caucus. It is intended “to serve as a forum for Senators to collaborate on and promote bipartisan legislation and solutions, hold events to raise awareness of critical mental health issues, and destigmatize mental health.” Frequently, caucuses of this nature prepare Congress for new mental health legislation to elevate key issues.  

The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act 

On Nov. 8, the U.S. Senate Finance Committee passed a bipartisan comprehensive bill by unanimous vote, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act. If enacted, the bill would significantly expand mental health care and substance use disorder services under Medicare and Medicaid. The legislation next goes to the full Senate for consideration. 

Senate Finance Committee Bill on Addressing Opioid Addiction 

In 2018, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act—the largest congressional investment in overdose prevention at the time. A new Senate Finance Committee proposal would be a catch-all measure that would reauthorize several programs created under the 2018 SUPPORT Act and include related bills. This refreshed act would reauthorize programs that provide funding to community-based groups working to address the addiction crisis, make permanent certain provisions that expanded access to addiction medicines, and expand access to treatment.  

DHS Suicide Prevention and Resiliency for Law Enforcement Act 

This legislation would enable the Department of Homeland Security (DHS) to provide officers and agents with mental health resources, reduce stigma, and help prevent suicide. The bill establishes a mental health and wellness program for DHS, the largest federal law enforcement agency, with approximately 80,000 officers across nine agencies and offices. The bill requires annual interactive suicide awareness, suicide prevention, and resiliency training and support for law enforcement agents and officers and their families. 

Barriers to Suicide Act of 2023 

This bill would direct the Department of Transportation to create a grant program to facilitate the installation of evidence-based suicide deterrents on bridges. A required Government Accountability Office study would explore which other types of tall structures attract a high number of individuals attempting suicide-by-jumping and which types of barriers and deterrents are most effective.  

H.R. 2412, Helping Kids Cope Act 

This bipartisan legislation would create three new grants within the Health Resources and Services Administration (HRSA) targeted to expand the availability of community-based pediatric behavioral health care and support the pediatric behavioral health workforce. The bill would also strengthen the pediatric mental health infrastructure to support a full continuum of care.