The Mental Health Access Improvement Act which recognizes marriage and family therapists and mental health counselors as approved Medicare Part B providers, has passed as part of the 2023 Omnibus federal budget package that was signed by President Biden on December 29, 2022.
The Medicare Mental Health Workforce Coalition has developed this Frequently Asked Questions (FAQ) report – based on the questions from the attendees of the Coalition’s Medicare Webinars held in 2023 — to help respond to key queries about implementation of the legislation.
The effective date of the provisions regarding counselor and MFT inclusion in the Medicare program is January 1, 2024. At that time, MFTs and Counselors will be able to bill for services provided to Medicare beneficiaries.
The 2022-23 federal budget legislation (called 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, beginning January 1, 2024.
The proposed Medicare Physician Fee Schedule Rule specifically spells out who is eligible based on the following language:
The term ‘marriage and family therapist’ means an individual who ‘‘(A) possesses a master’s or doctor’s degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law of the State in which such individual furnishes the services described in paragraph; ‘‘(B) is licensed or certified as a marriage and family therapist by the State in which such individual furnishes such services; ‘‘(C) after obtaining such degree has performed at least 2 years or 3000 hours of clinical supervised experience in marriage and family therapy; and ‘‘(D) meets such other requirements as specified by the Secretary.
“The term ‘mental health counselor’ means an individual who—‘’(A) possesses a master’s or doctor’s degree which qualifies for licensure or certification as a mental health counselor, clinical professional counselor, or professional counselor under the State law of the State in which such individual furnishes the services described in the above paragraph; “(B) is licensed or certified as a mental health counselor, clinical professional counselor, or professional counselor by the State in which the services are furnished; “(C) after obtaining such a degree has performed at least 2 years or 3000 hours of clinical supervised experience in mental health counseling; and ‘’(D) meets such other requirements as specified by the HHS Secretary.’’
CMS did not define the term clinical supervised experience. We stated in the final rule, “regarding commenters’ requests for CMS to define the term “clinical supervised experience,” we did not propose, and are not finalizing a definition of this term, but rather, defer to State law and licensure requirements regarding the nature of the 2 years or 3,000 hours of clinical supervised experience.”
I have been licensed for over 20 years. As far as proof of the supervised hours, my supervisors have long since retired I am licensed in 3 states and I had to prove that I did those hours. Will proof of licensure from states where those hours are required be enough? Most licenses require 3000 hours of supervised clinical experience before you can apply for licensure, so if you have been licensed, shouldn’t that count as documentation that you already completed the supervision requirement?
We assume that the MFT/MHC would need to follow the appliable standard for whatever states that they are licensed. For example, let’s say the provider is licensed in Alabama and Georgia. If Alabama MFTs/MHCs are required to submit the degree and experience information but Georgia MFTs/MHCs are not, then the MFT/MHC would need to submit paperwork to the MAC for Alabama but not for the MAC covering Georgia, even if the MAC is the same?
That is correct. The provider will need to submit the documentation based on the state they are enrolling in, even if both states are under the same MAC jurisdiction.
The MACs are responsible for verifying the state licensure or certification requirements for the state within their jurisdiction.
Yes.
Providers may begin receiving approval letters once their application is finalized, however, the effective date will be January 1, 2024, which is when the MFT/MHC benefit becomes effective.
National credentialing organizations that can verify the accuracy of a provider’s clinical supervised experience are eligible to serve as credentialing organizations to meet this requirement.
Once enrollment opens, an MFT or counselor must be licensed by a State to practice independently in order to enroll as a Medicare provider. MFT and counselor associates, interns, and students are not eligible to enroll as Medicare-eligible providers. This eligibility standard is similar for other Medicare-eligible mental health professions, To enroll in Medicare an MFT must possess a master’s or doctoral degree which qualifies for licensure as an MFT, have two years of clinical supervised experience in marriage and family therapy, and be licensed as an MFT or counselor by a State.
The enrollment process began in November 2023.
The Centers for Medicare and Medicaid Services (CMS) – the federal agency that administers all aspects of the Medicare Program – has issued final rules that provide initial guidance to MFTs and counselors on how to apply for Medicare recognition. This guidance has been provided through the 2024 Medicare Physician Fee Schedule (MPFS).
The MPFS is a lengthy rule issued annually provides information on behavioral health codes and reimbursement rates for Medicare providers. This year since MFTs and counselors will be included in the Medicare program starting in 2024, the rule included information on the provider enrollment process. There is a 60-day comment period where providers and other stakeholders can submit comments on the MPFS rule.
Medicare Mental Health Workforce Coalition representatives have been working with CMS on this process.
The specific language in the proposed MPFS that outlines how providers can enroll is provided below:
A provider or supplier must complete, sign, and submit to its assigned Medicare Administrative Contractor (MAC) the appropriate Form CMS–855 (OMB Control No. 0938–0685) application in order to enroll in the Medicare program and obtain Medicare billing privileges. The Form CMS–855, which can be submitted via paper or electronically through the internet-based Provider Enrollment, Chain, and Ownership System (PECOS) process (SORN: 09–70– 0532; 104 Provider Enrollment, Chain, and Ownership System), captures information about the provider or supplier that is needed for CMS or its MACs to determine whether the provider or supplier meets all Medicare requirements. MFTs and MHCs that meet the proposed eligibility requirements , would enroll in Medicare via the Form CMS–855I application (Medicare Enrollment Application—Physicians and NonPhysician Practitioners; OMB No. 0938– 1355) and could begin submitting their enrollment applications after the publication of the CY 2024 MPFS final rule. However, as the new benefit categories do not take effect until January 1, 2024, MFT or MHC claims for MFT or MHC services furnished to Medicare beneficiaries with dates of service prior to January 1, 2024 will not be payable under Medicare Part B. For more information: MFTs and MHCs can visit https:// www.cms.gov/medicare/providerenrollment
There are key actions that counselors will need to take when the formal enrollment process for practitioners is announced in November 2023 (anticipated date). You will not be able to enroll until November, but here is a preview of the likely steps counselors will need to take:
The I&A System lets you create 1 user account to manage access to CMS systems such as PECOS. To register for the I&A:
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated standard unique identifiers for health care providers and health plans for electronic transmission of health information. CMS developed the NPPES to assign these unique identifiers called NPIs.
NPIs are:
PECOS is the preferred method for provider enrollment. Enrolling as a Medicare provider involves completing Form CMS-855 for your provider type. The form and the information that it collects are the same whether you complete the paper form or use PECOS.
PECOS is an electronic Medicare enrollment system through which providers and suppliers can:
The Medicare Contractor that serves your state or practice location will process your enrollment application and answers questions.
A Medicare Administrative Contractor A/B MAC processes applications for Part A and B providers, suppliers, and organizations.
Usually 30-45 days.
The MFT and MHC specialties are available in PECOS. MFTs/MHCs completing the paper CMS-855I application should select the Undefined Non-Physician Practitioner Specialty option in section 2H and specify MFT or MHC in the space provided.
Addiction counselors and ADCs may enroll as MHCs if they meet the MHC requirements. They should select the MHC specialty in PECOS. They cannot, however, enroll as addiction counselors or ADCs.
To learn more about the Medicare program and how to enroll (counselors will be able to enroll in November 2023), the CMS’ Medicare Learning Network (MLN) now offers provider education products designed to promote national consistency of Medicare provider information for CMS initiatives. The CMS’ 60-minute Medicare 101 course titled “The World of Medicare” can be found here and a complete list of MLN’s web-based trainings here.
The Medicare Learning Network:
https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlngeninfo
Web-based Training:
Becoming a Medicare Provider (World of Medicare):
https://www.cms.gov/Outreach-and-Education/MLN/WBT/MLN9329634-WOM/WOM/index.html
Weekly Email Newsletter for Medicare Providers:
CMS holds webinars/chats with specific national stakeholder groups to discuss implementation issues and any questions or issues that CMS can address.
The Medicare Coalition has learned that CMS medical directors are interested in Part B Coverage of Counselors and that they host online forms the first Friday of every month. We have indicated that NBCC would like to participate in these sessions and include our issues could in the agenda of upcoming meetings.
No.
Only under incident-to provisions
CMS has amended the direct supervision requirement under CMS’ “incident to” regulation to allow behavioral health services to be furnished by MFTs and counselors under the general supervision rather than direct supervison of a physician or non-physician practitioner (“NPP”), so long as CMS’ “incident to” requirements and state licensure requirements are met.
No.
In addition to the provider application process, CMS has provided guidance to MFTs and counselors through the MPFS rule on which codes to use for billing for services provided to Medicare beneficiaries:
The term ‘marriage and family therapist services’ means services furnished by a marriage and family therapist for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital), which the marriage and family therapist is legally authorized to perform under State law (or the State regulatory mechanism provided by State) of the State in which such services are furnished.
“The term ‘mental health counselor services’ means services furnished by a mental health counselor (as defined below for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital), which the mental health counselor is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are furnished
Yes, as long as you meet the requirements as described in the legislation. The provisions are similar to licensing at that state level.
No, unless the practitioner works in a group practice and only has a Group NPI.
No. However, the individual will need to make sure that a reassignment of benefits occurs. The updated version of CMS’s internet-based application system, PECOS 2.0, reportedly combines the individual CMS-855I form with the CMS-855R (reassignment of benefits) form where necessary and appropriate. PECOS 2.0 reportedly tailors the application to the applicant based on a questionnaire the applicant answers at the outset of the online enrollment process.
Yes, and they must meet the same requirements as counselors to enroll in the Medicare program.