NBCC’s Recommendations on Outpatient Payment System Rule Accepted by CMS

On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) finalized Medicare payment rates for hospital outpatient and ambulatory surgical center (ASC) services for calendar year 2024. The Hospital Outpatient Prospective Payment System (HOPPS) and ASC Payment Systems final rule is published annually.

NBCC provided comments in September regarding the proposed provisions in the HOPPS rule to implement Medicare payment under Medicare Part B for services provided by mental health counselors (MHCs). NBCC is pleased that CMS included our recommendations in the final rule, which will elevate the presence of counselors in the Medicare program. The following recommendations that NBCC provided were all accepted. This will promote the interests and address the needs of counselors in the hospital outpatient sector.   

Community Mental Health Centers Conditions of Participation  

1. Medicare recognizes MHCs to provide services in community mental health centers (CMHCs).   

2. As part of conditions of participation in CMHCs, MHCs are specifically identified in the regulation as members of the CMHC interdisciplinary team, on equal footing with clinical social workers. 

3. MHCs are included on the list of practitioners that can provide group psychotherapy.   

These changes help clarify that MHCs may lawfully take their place on CMHC interdisciplinary teams.    

Exclusion of MFT/MHC Services from HOPPS Payment  

NBCC previously requested clarity about what MHC services are covered under different parts of Medicare. In response, CMS has clarified that MHC services are not included within HOPPS prospective payments except when part of a bundled rate.   

Partial Hospitalization/Intensive Outpatient Services  

NBCC asked that the regulations concerning Medicare programs for partial hospitalization programs and intensive outpatient services be modernized to fully recognize the services of MHCs in this setting. The final rule includes amendments that:  

1. Specifically state that the services of MHCs constitute a portion of partial hospitalization services. 

2. Specifically reference the services of MHCs in providing therapy services. 

Like the 2024 Medicare Physician Fee Schedule final rule, the provisions of the HOPPS final rule will go into effect Jan. 1, 2024.  

NBCC will closely monitor the implementation of the relevant provisions in the HOPPS rule and provide further updates. 

For more information on Medicare Part B coverage of counselors, please visit our website.