The Mental Health Access Improvement Act recognizes marriage and family therapists and mental health counselors as approved Medicare Part B providers.

The passage of this legislation represents a major milestone for the individual organizations of the Medicare Mental Health Workforce Coalition that worked tirelessly over several years to achieve this incredible success. It was a comprehensive and integrated effort of lobbying, advocacy, messaging, and grassroots strategies that won the day. It was a textbook strategy on multiple fronts that is needed in this congressional policy environment where alliances like our diverse Coalition are required to be successful in the passage of legislation.

The passage of the bill is not only an inspiring outcome for counselors and MFTs, but heartening news for Medicare beneficiaries with mental health conditions, for several delivery settings and systems that now can employ counselors and MFTs and improving overall access to mental health care services for older Americans in our communities.

Moreover, passage of the Mental Health Access Improvement Act will incentivize counseling and MFT certification programs to focus on the unique mental health and addiction needs of the growing geriatric population, and for national professional associations to develop guidelines and standards for the treatment of older adults with mental health conditions.

Key Features of the Mental Health Access Improvement Act

The key provisions are:

• 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 Medicare beneficiaries beginning on January 1, 2024. MFTs and counselors will now be able to bill Medicare directly for covered services rendered to seniors and people with disabilities who receive health benefits from Medicare.
• Services will be reimbursed at 80 percent of the lesser of the actual charge for the services, or 75 percent of the amount determined for payment of a psychologist.
• MFTs and mental health 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 include community health centers, migrant health centers, health care for the homeless health centers, public housing primary care centers, and health center program “lookalikes.” They also include outpatient health programs or facilities operated by a tribe or tribal organization or by an urban Indian organization. FQHCs are paid based on the FQHC Prospective Payment System (PPS) for medically-necessary primary health services and qualified preventive health services furnished by a FQHC practitioner. FQHCs provide comprehensive services (either on-site or by arrangement with another provider), including preventive health services and mental health and substance abuse services.
• By broadening MFT and counselor eligibility to provide behavioral health services to Medicare beneficiaries, it is now clear that these additional services are covered and reimbursed as FQHC services and billable as FQHC visits. Previously, the limited list of reimbursable behavioral health providers has been a particular barrier to expanding behavioral health care in under-served areas.
• MFTs and mental health counselors are now eligible Medicare Part B providers in Rural Health Clinics (RHCs). The Rural Health Clinic (RHC) program increases access to primary care services for patients in rural communities. RHCs can be public, nonprofit, or for-profit healthcare facilities. To receive certification, they must be located in rural, underserved areas. They are required to use a team approach of physicians working with non-physician providers) to provide services. The clinic must be staffed at least 50% of the time with an NP, PA, or CNM. RHCs are required to provide outpatient primary care services such as behavioral health care. The main advantage of RHC status is enhanced reimbursement rates for providing Medicare and Medicaid services.
• To address the worsening behavioral health pandemic in rural areas, communities will now be able to employ an expanded mental health care workforce that can diagnose, treat, and support rural patients due to the inclusion of MFTs and counselors in the Medicare program.
• MFTs and mental health counselors are required team members for Medicare hospice interdisciplinary teams. The hospice interdisciplinary team (IDT) serves a very important function in hospice care. It includes physicians, nurses, home health aides, mental health providers, chaplains, and trained volunteers who work together to address a hospice patient’s physical, emotional, and spiritual needs.
• MFTs and counselors will have the ability to diagnose and treat people with disabilities who are covered by the Medicare program for their and mental health care needs. For example, many individuals living with Parkinson’s Disease (PD), mood disorders such as anxiety and depression, are often debilitating clinical symptoms that profoundly impact the individual’s health, quality of life, and independence. Up to half of all people with PD suffer from a mental health disorder at some point during the course of their disease. The Mental Health Access Improvement Act strengthens the capabilities and effectiveness of the overall health care workforce to better meet the needs of older and disabled individuals with medically complex conditions; especially those coping with mental illness and/or SUD along with conditions such as diabetes, lung disease, cardiovascular disease, and other comorbidities associated with early mortality, disability, and impairments in psychosocial functioning. MFTs and counselors who frequently practice in multi-disciplinary settings, are well-positioned to play a key role in collaborative care models designed to improve medical and mental health outcomes and functioning.
• MFTs and counselors will now have the ability to diagnose and treat people with substance use disorders (SUDs) who are covered by the Medicare program for their behavioral health care needs. With respect to SUD, as the Substance Abuse and Mental Health Services Administration (SAMHSA) has recognized, those who currently work most frequently with older individuals (e.g., primary care physicians, assisted living and nursing home staff, emergency department staff, inpatient hospital staff, and caregiver/family members) are not routinely trained to recognize or effectively address serious mental illnesses (SMIs).
• Counselors and MFTs are trained in treatment and prevention of mental health and routinely coordinate care with medical providers and other health care professionals, can bring much needed skills and integrative care experience to the delivery of coordinated, person-centered care. These integrated approaches are vital to improving health outcomes for older and disabled individuals and reducing the overall burden of mental and physical disease. It is important to note that older adults can be particularly vulnerable to the negative effects of substances such as alcohol and prescription drugs. Individuals with cognitive impairments such as dementia may have more difficulty using alcohol or prescription drugs safely, and are at greater risk of falls and accidents, as well as adverse effects from drug interactions. As SAMHSA has noted, most providers and professionals lack specialized training in geriatric substance misuse, and most family members and caregivers do not know how to recognize and respond to these issues in older family members. MFTs and counselors are providers who are able to adapt interventions to the physical, cognitive, and psychosocial needs prevalent for their older clients, and identify interventions that are more likely to be effective.
• MFTs and mental health counselors, beginning in 2024, will be able to bill for telehealth services to include certain individual psychotherapy services for Medicare beneficiaries. Medicare reimburses practitioners for specified services provided via telehealth to eligible beneficiaries under Current Procedural Terminology (CPT) codes 90804 through 90809 for insight-oriented, behavior-modifying or supportive psychotherapy in office or other outpatient facilities.
• MFTs and mental health counselor now have opportunities to participate in Medicare Integrated Behavioral Health and Primary Care Programs. Public and private insurance programs now widely consider integrating behavioral health care with primary care (behavioral health integration or BHI) 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. BHI is a type of care management service. In recent years, CMS updated the Medicare Physician Fee Schedule (MPFS) policies to improve payment for care management services.
• MFTs and mental health counselors now have opportunities to participate in Medicare Innovative Delivery and Payment Programs. For example, Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.
• For Dual-Eligible Beneficiaries who have been treated by counselors (those who qualify for both Medicare and Medicaid) and Veterans with Medicare the lack of access to coordinated benefits that was previously experienced due to the lack of recognition of counselors, has now been addressed.