WHAT'S HAPPENING

IMPORTANT NEW CHANGES TO IMPROVE ACCESS TO BEHAVIORAL HEALTH IN MEDICARE

HELP IS ON THE WAY: Following Congressional action, CMS is proposing procedures to allow Marriage and Family Therapists and Mental Health Counselors to enroll as Medicare providers.

BY MEENA SESHAMANI, MD, PHD AND DOUGLAS JACOBS, MD, MPH

As we emerge from the COVID-19 public health emergency, it is abundantly clear that our nation must improve access to effective mental health and substance use disorder (collectively called "behavioral health") treatment and care.

For older Americans and individuals with disabilities enrolled in Medicare, many individuals have felt the effects of worsening depression and anxiety or have struggled with the use of substances like opioids or alcohol. And, as doctors, we have seen first-hand how behavioral health treatment can improve the health and well-being of our patients.

This is why the Centers for Medicare & Medicaid Services (CMS) is pleased to announce new proposed policies that, if finalized, will create some of the most significant changes to promote access to behavioral health in the history of the Medicare program. These new policies are proposed as part of the Physician Fee Schedule and Hospital Outpatient Prospective Payment System rules.

EXPANDING THE BEHAVIORAL HEALTH WORKFORCE

We need the help of every behavioral health practitioner to meet the behavioral health needs of every person with Medicare. Marriage and Family Therapists and Mental Health Counselors provide essential services, such as psychotherapy and group therapy – but to date, they could not enroll as Medicare providers. Following

Congressional action, CMS is proposing procedures to allow Marriage and Family Therapists and Mental Health Counselors (including Addiction Counselors who meet all the requirements to be a Mental Health Counselor) to enroll as Medicare providers, which means that the more than approximately 400,000 Marriage and Family Therapists and Mental Health Counselors would now be able to independently treat people with Medicare and be paid directly.

CMS is also proposing to pay for community health integration and principal illness navigation services that can be provided by community health workers and peer support specialists when unmet social needs, such as food, housing, or transportation problems interfere with health care. These workers can significantly help individuals with behavioral health conditions. For example, incorporating a peer support specialist who has lived experience and knowledge of substance use disorders into a person's substance use disorder treatment can inspire hope that recovery and effective treatment is possible and can help motivate a person to reach treatment goals. In fact, people receiving care from these workers are less likely to be hospitalized for substance use disorder. These types of workers can also help a person navigate unmet social needs that can negatively impact a person's mental and physical health if not addressed.

COVERING GAPS IN ACCESS TO BEHAVIORAL HEALTH

CMS' proposals would also close the gap in the types of behavioral health services covered by Medicare. Medicare has historically covered and will continue to cover services such as psychiatric hospitalization for people with acute psychiatric needs, partial hospi