Here’s some good news for Community Health Centers: Congress passed a provision in the end of year spending package last December that expands the list of billable providers under Medicare to include more behavioral health practitioners, specifically marriage and family therapists (LMFTs) and mental health counselors. These providers will be able to bill Medicare Part B and receive reimbursement for approved services starting next January. Community Health Center clinician services will also be added to the Medicare AND Medicaid benefits.
The measure provides a great opportunity for health centers to expand care teams and further integrate and coordinate mental health with primary care. It also brings the Medicare program into alignment with evolving clinical best practices in behavioral health.
Both provider types must be licensed and certified in the state where they provide services. Mental health counselors may be licensed or certified in their state as a mental health counselor, clinical professional counselor, or a professional counselor. From the American Association for Marriage and Family Therapy, there are up to 50,000 mental health professionals trained and licensed to diagnose and treat mental and emotional disorders within the context of marriage, couples and family systems. Additionally, the American Counseling Association estimates that up to 115,000 licensed professional counselors (LPCs) are likely to seek enrollment as Medicare providers as a result of passage.
Next steps will include working with the Centers for Medicare & Medicaid Services (CMS) on regulatory and payment policies to operationalize this provider expansion. CMS will release the 2024 proposed rule of the Physician Fee Schedule in July. The fee schedule includes updates and policy changes for Medicare payments and other Medicare Part B policies. NACHC encourages CMS to propose regulatory changes that will permit health centers to generate a billable encounter for LPCs and LMFTs visits. CMS will allow for public comment on this proposal and then on or around November 1st, 2023, CMS will publish a final version.
NACHC is excited about the ability to increase health center patient access to mental health services and will continue to advocate for policies to expand billable providers under Medicare. NACHC will continue to engage CMS on other pressing issues, such as ensuring states reimburse health centers that provide these services to Medicaid patients.
If your health center currently works with MFTs and mental health counselors, we would like to hear from you! We would value your insight on important considerations NACHC should be aware of for implementation. Please contact Erin Prendergast, Deputy Director, Federal Policy at eprendergast@nachc.org.