In a groundbreaking move, the landscape of mental health care and substance use disorder (SUD) treatment in the United States is undergoing a significant transformation. The shift began with the proposed 2024 Medicare Physician Fee Schedule, a document that outlined sweeping changes aimed at enhancing mental health and substance use services for millions of Americans.
First on the agenda was the proposal to allow licensed marriage and family therapists (LMFTs) and licensed professional counselors (LPCs), to enroll in Medicare and bill for their services. This pivotal change is designed to break down barriers and make mental health and substance use disorder care more accessible to those in need.
Shortly after the proposed Medicare Physician Fee Schedule was unveiled, the Centers for Medicare & Medicaid Services (CMS) released its 2024 proposed rule on Medicare payment rates for hospital outpatient and ambulatory surgical center (ASC) services. In a move that signaled a profound commitment to addressing mental health, CMS announced its intention to expand coverage of intensive outpatient services – an intermediate level of behavioral health care. This expansion marked a critical step forward in providing comprehensive care for individuals dealing with mental health conditions.
THE MENTAL HEALTH ACCESS IMPROVEMENT ACT: THE TURNING POINT
Against this backdrop of change, the Mental Health Access Improvement Act in December 2022 emerged as a turning point in mental health care legislation. Passed in December 2022, this act opened the doors wider, allowing Licensed Professional Counselors (LPCs) and Licensed Marriage and Family Therapists (LMFTs) to step into the realm of Medicare providers.
Previously, only Licensed Clinical Social Workers (LCSWs) were able to provide this service or professionals like LPCs and LMFTs were required to have constant, direct physical supervision from physicians or non-physician practitioners to provide services and receive Medicare reimbursement. However, starting from January 1, 2024, LPCs and LMFTs can independently submit claims to Medicare Part B for their services, securing reimbursement based on the approved Medicare rates without the need for direct supervision by other practitioners.
THE RIPPLE EFFECT: TRANSFORMING MENTAL HEALTH AND SUD CARE
The impact of these developments reverberates across the mental health care landscape:
Bridging Gaps in Access: The inclusion of LPCs and LMFTs in Medicare addresses a pressing issue: the shortage of mental health and SUD professionals. As of March 2023, 160 million Americans reside in regions facing a shortage of mental health professionals, according to the Commonwealth Fund. By allowing these professionals to join with LCSWs to participate in Medicare, there is now a broader network of qualified experts, effectively bridging the gap and ensuring that individuals have more options for their mental health care and substance use disorder treatment needs.
Addressing the Mental Health and SUD Crisis: The United States has been grappling with a mental health and substance use disorder crisis, magnified by the challenges of the COVID-19 pandemic. The inclusion of SUD intensive outpatient services in Medicare coverage, coupled with the participation of LPCs and LMFTs, addresses this crisis head-on. It acknowledges the urgency of the situation and ensures that individuals struggling with mental health and SUD conditions receive timely and comprehensive care. In 2021, older adults with low incomes (37%) or in poor health (48%) were even more likely to report symptoms of anxiety and depression, according to the American Counseling Association. This underscores the critical need for expanded mental health and SUD services within the Medicare system to support the vulnerable elderly population.
Diverse Approaches, Tailored Care: LPCs and LMFTs bring diverse therapeutic expertise to the forefront. With the ability to offer individual and group therapy, address family and relationship issues, and provide specialized care for various mental health and SUD concerns, these professionals ensure that mental health care and SUD treatment is not one-size-fits-all. Instead, it is a nuanced, personalized approach, addressing the unique needs of each individual.
Maximizing Value and Accessibility: Beyond their expertise, LPCs and LMFTs are known for providing cost-effective behavioral healthcare services. This cost-effectiveness ensures that mental health and SUD care remains accessible, particularly for Medicare beneficiaries with limited financial resources. By maximizing the value of Medicare dollars, these professionals uphold the principle that mental health and SUD treatment is a fundamental right, not a luxury reserved for a few.
EMBRACING CHANGE: THE PATH AHEAD
In this transformative era of behavioral health care, embracing change is essential. The Mental Health Access Improvement Act, coupled with CMS's initiatives, signals a new chapter in mental health care and SUD treatment accessibility and quality. Aspiring LPCs and LMFTs can now take concrete steps toward becoming Medicare providers, marking a significant leap toward a healthier nation. Visit the Become a Medicare Provider or Supplier webpage on the Centers for Medicare & Medicaid Services (CMS) website, which provides you with tentative information on how to become a Medicare provider. Begin by obtaining an NPI number to help you kickstart the process.
WORK WITH US
Need assistance with this process? By partnering with organizations like Ascension Recovery Services, you can streamline the process of hiring staff and ensure smooth insurance credentialing. This collaborative approach amplifies the impact of these legislative changes, creating a seamless pathway for mental health professionals to contribute meaningfully to the well-being of individuals and communities. As the behavioral health care landscape evolves, these changes emphasize a simple truth: mental health and substance use disorder treatment is not just an aspect of health care – it is health care.