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The Centers for Medicare & Medicaid Services (CMS) recently announced changes to Medicare beneficiaries’ ability to access behavioral health care.

Currently, Medicare covers psychiatric hospitalization for people with acute psychiatric needs, partial hospitalization program services, and outpatient mental health treatment and therapy services. As mental health diagnoses for Medicare-eligible Americans increase, there has been a notable gap in coverage for certain services and certain providers.

In response, Medicare has implemented the following changes:

1. Permitting Marriage and Family Therapists and Mental Health Counselors (including alcohol and drug counselors who meet the Mental Health Counselor requirements) to independently enroll in Medicare. To date, these providers could not independently enroll as Medicare providers.
2. Paying for Community Health Integration and Principal Illness Navigation services. Notably, CMS is permitting these services to be provided by community health workers and peer support specialists. These services are especially important for beneficiaries whose social needs (i.e., food, housing, and transportation) interfere with their receipt of health care.
3. Changing the required level of supervision for behavioral health services performed at federally qualified health centers (FQHCs) and rural health clinics (RHCs). Now, certain behavioral health services at FQHCs and RHCs can be provided with “general” supervision instead of “direct” supervision. Practically, this means that behavioral health providers can now provide certain vital services without a doctor or advanced practice practitioner physically present on-site.
4. Increasing reimbursement for crisis psychotherapy services to 150% of the usual Physician Fee Schedule rate when crisis care is provided outside of health care settings (i.e., in the community).
5. Increasing reimbursement for substance use disorder treatment provided in an office setting to better reflect the actual costs of the services.

These changes are part of the 2024 Physician Fee Schedule Final Rule, 2024 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule, and 2025 Proposed Medicare Advantage and Part D rules.

If you have questions about expanded Medicare coverage and what that means for your patients or organization, or Medicare coverage of behavioral health services, please contact Member Daphne Kackloudis at dlkackloudis@bmdllc.com or Associate Jordan Burdick at jaburdick@bmdllc.com.