Medicare Expands Access to Mental Health Providers
Since the pandemic, the need for mental health services has increased dramatically for people of all ages. Thanks to recent changes from the Centers for Medicare and Medicaid Services (CMS), individuals on Medicare now have improved access to mental health providers.
Medicare covers a variety of mental health and substance use disorder (SUD) services, such as inpatient, outpatient, intensive outpatient, and partial hospitalization. A comprehensive list of the services covered by Medicare can be found here. Despite the extensive coverage of services, the types of practitioners authorized to treat Medicare patients have always been more restricted compared to other health insurance programs, including Medicaid.
Effective January 1, 2024, CMS has included additional mental health practitioners who are now eligible to provide services to Medicare beneficiaries. Marriage and Family Therapists and Mental Health Counselors (including Addiction Counselors who meet all the requirements to be a Mental Health Counselor) with the necessary license or certification are now recognized as approved practitioners by Medicare. Previously, Marriage and Family Therapists and Mental Health Counselors were only allowed to submit claims to Medicare as auxiliary personnel incident to physicians or other Medicare-approved mental health providers. With the new regulations, these practitioners can now enroll in Medicare and bill independently. CMS anticipates that this change will result in an additional 400,000 mental health practitioners being available to treat Medicare beneficiaries.
Significantly, thanks to Congressional action, CMS has added a level of treatment not previously covered by Medicare: Intensive Outpatient Program (IOP). IOP can be conducted by hospital outpatient departments, community mental health clinics, Federally Qualified Health Centers, or Rural Health Clinics. Intensive outpatient services may also be provided by opioid treatment programs. Telehealth will remain a Medicare-covered service until December 31, 2024.
Effective January 1, 2024, Medicare will also cover a Social Determinants of Health Risk Assessment as part of the annual wellness visit. This assessment tool can assist in identifying Medicare beneficiaries who require mental health and/or substance use disorder treatment.
