Will MFTs and counselors be able to immediately bill Medicare for diagnosing and treating Medicare beneficiaries in my practice?
The effective date of the provisions regarding counselor and MFT inclusion in the Medicare program is January 1, 2024. At that time, you 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.
How do I know as a MFT or counselor if I am eligible Medicare provider?
The Mental Health Access Improvement Act 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 t 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 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 of clinical supervised experience in mental health counseling; and ‘(D) meets such other requirements as specified by the HHS Secretary.’’
How and when will I be able to apply for Medicare-approved provider status?
The Centers for Medicare and Medicaid Services (CMS) – the federal agency that administers all aspects of the Medicare Program and issues rules and regulation – will begin to develop guidance in 2023 to MFTs and counselors on how to apply for Medicare recognition. CMS needs this period to provide guidance to counselors as new Medicare providers. Medicare Mental Health Workforce Coalition representatives will be working with CMS on this process and timing, and will provide information as soon as that application process is completed by CMS.
How will I know which mental health service codes are eligible for reimbursement that I have provided to older clients?
In addition to the provider application process, CMS will also provide guidance in 2023 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. The Mental Health Access Improvement Act does provide guidance as well on this issue with the following language:
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.
Although I am not licensed as a “Mental Health Counselor” or “Marriage and Family Therapist” in my state as we have different designations, will I be eligible to participate in the Medicare program?
Yes, as long as you meet the requirements as described in the legislation. The provisions are similar to licensing at that state level.
How can practitioners opt out of the Medicare program?
Counselors and MFTs will need to complete a form in 2023 to opt out. A silver lining in the Medicare Access and CHIP Reauthorization Act of 2015. which was signed into law in mid-April 2015 to repeal the sustainable growth rate (SGR), is a provision in the bill that also repeals the irritating requirement of having to renew an opt-out status every two years. Practitioners opting out of Medicare after June 16, 2015, will need to file an affidavit to opt out of Medicare only once, and it will have permanent effect. The practitioner will no longer need to renew his opt-out every two years thereafter.
Are Medicare enrolled providers subject to site visits?
Rarely. The National Site Visit Contractor (NSVC) at CMS conducts unannounced site visits for all Medicare Part A and B providers and suppliers, including DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies) suppliers. A site visit helps prevent questionable providers and suppliers from enrolling or staying enrolled in the Medicare Program.
What entity serves as the Medicare Administrative Contractor (MAC) for our state/region?
Here is a list of MACs by state and region: