Medicare CY24 (Proposed) Impacts to BH Providers

Medicare posted their CY24 Proposed Physician Fee Schedule (PFS) and there are some interesting changes that impact BH providers including (but not limited to, so I encourage you to read!):

• Adding Marriage and Family Therapists (MFT) and Mental Health Counselors (MHC) (MHCs are proposed to include SUD providers with appropriate training) as billable Medicare providers (woohoo!) effective 1/1/2024
  • Qualifications proposed: 
    • Marriage and Family Therapist –
      • Possesses a master’s or doctor’s degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law of the State in which such individual furnishes the services defined as marriage and family therapist services;
      • After obtaining such degree, has performed at least 2 years or 3,000 hours of post master’s degree clinical supervised experience in marriage and family therapy in an appropriate setting such as a hospital, SNF, private practice, or clinic; and
      • Is licensed or certified as a marriage and family therapist by the State in which the services are performed.
    • Mental Health Counselor –
      • Possesses a master’s or doctorate’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 defined as mental health counselor services;
      • After obtaining such a degree, has performed at least 2 years or 3,000 hours of post master’s degree clinical supervised experience in mental health counseling in an appropriate setting such as a hospital, SNF, private practice, or clinic; and
      • Is licensed or certified as a mental health counselor, clinical professional counselor, or professional counselor by the State in which the services are performed. As previously explained for MFTs, and for the same reasons, we are proposing a requirement for MHCs to have performed at least 2 years or 3,000 hours of post master’s degree clinical supervised experience, if consistent with State licensure requirements. We believe that 3,000 hours is roughly equivalent to the statutory requirement to have performed 2 years of clinical supervised experience and note that the regulatory requirements for clinical social workers at §410.73(a)(3)(ii) allows 2 years or 3,000 hours.
    • For SUD Counselors –
      • “Additionally, we are proposing to allow Addiction Counselors who meet all of the applicable requirements (possess a master’s or doctor’s degree which qualifies for licensure or certification as a mental health counselor; after obtaining such degree have performed at least 2 years (or, as proposed, 3,000 hours) of clinical supervised experience in mental health counseling; and licensed or certified as a MHC, clinical professional counselor, or professional counselor by the State in which the services are furnished) to enroll in Medicare as MHCs.” Definition of the term “mental health” would be inclusive of both MH and SUD.
  • Rates proposed for the new provider types of MFT and MHC:
    • 80% of the lesser of the actual charge for the services of 75% of the amount determined for clinical psychologist services under the PFS.
  • IMPORTANT DATES:
    • MFTs and MHCs would be required to enroll as a Medicare non-physician practitioner via the CMS-855I application in PECOS. THEY WILL BE ABLE TO BEGIN SUBMITTING ENROLLMENT APPLICATIONS AFTER THE PUBLICATION OF THIS FINAL RULE. The comment period closes 9/11/2023 so sometime after then?
    • Although providers will be able to begin enrolling these new provider types upon finalization of this rule, the rule does not take effect until 1/1/2024 and claims rendered before 1/1/2024 by these provider types will not be payable under Medicare Part B.
  • Pages 345-355 Describe proposed changes to “Adjustments to Payment for Timed Behavioral Health Services”
  • Pages 356-360 Describes a  “Request for Information on Digital Therapies, such as, but not limited to, digital Cognitive Behavioral Therapy.”

Submit Comments by September 11 – CY 2024 Physician Fee Schedule Proposed Rule

CMS issued the https://public-inspection.federalregister.gov/2023-14624.pdf  (SEE PAGES 329- 361 FOR BH PROVIDER SPECIFIC TOPICS) proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. See https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule . We encourage you to review the rule and submit formal comments by September 11, 2023. Here is another helpful summary of the changes: https://www.cms.gov/blog/important-new-changes-improve-access-behavioral-health-medicare

The entire proposed rule can be found here: 2023-14624 – Proposed Medicare PFS CY24

Comments can be made here until 9/11/23: https://www.regulations.gov/document/CMS-2023-0121-0001