On April 19, the American Counseling Association hosted a webinar discussing the Mental Health Access Improvement Act. This law, which was passed by Congress in December 2022 and goes into effect in January 1, 2024, allows licensed professional counselors (LPCs) and licensed marriage and family therapists (LMFTs) to be reimbursed by Medicare for providing mental health treatment and services to adults age 65 and older as well as some people under the age of 65 who are disabled or have permanent kidney failure.
Matthew Fullen, an associate professor of counselor education at Virginia Tech whose research focuses on the mental health of older adults, began the discussion by recalling the decadelong effort to pass the law. He noted the partnership between the ACA, the Medicare Mental Health Workforce Coalition, Arnold & Porter, and other professional and grassroots organizations in lobbying Congress to update Medicare’s mental health provider regulations and close the gap in federal law that historically excluded LPCs and LMFTs. The last time Medicare’s mental health provider regulations were updated was 1989.
The new law enables LPCs and LMFTs to expand their reach to new clients and in new health care settings, such as federally qualified health centers, rural health clinics, Medicare hospice interdisciplinary teams and Medicare integrated behavioral health and primary care programs.
“Counselors are now officially at the table in how Medicare thinks about mental health care,” said Fullen, past co-chair of the ACA Public Policy and Legislation Committee.
Under the new law, LPCs and LMFTs will be known as “non-physician practitioners,” which refers to any Medicare provider other than a physician (e.g., social worker, psychiatric nurse). To enroll in Medicare as a mental health care provider, counselors must have earned a master’s or doctorate degree that qualifies them to work as a licensed mental health counselor, professional counselor or clinical professional counselor in their state. They must have also completed two years of postgraduate supervised clinical experience in mental health counseling and have licensure in the state where they intend to provide services.
Monique Nolan, an attorney at Arnold & Porter with 20 years of health regulatory experience, told the audience that early this summer, the Centers for Medicare and Medicaid Services (CMS) will issue a proposed rule to address how the agency plans to enroll LPCs and LMFTs into the Medicare program, and how payment rates, which are adjusted every year, will be established. ACA will provide written public comments after the proposed rule is released.
“We expect that the agency will, as the months go on, begin to provide more information around implementation and the steps that you will need to go through to join the [Medicare] program as well as to generally orient you to Medicare,” Nolan added.
Kristine Blackwood, who serves as counsel at Arnold & Porter’s legislative and public policy practice, provided the audience with an overview of the Medicare program, which was signed into law in 1965. The program provides federal health care insurance for people aged 65 and older, eligible younger people with disabilities and individuals with end-stage renal disease.
“Traditional” Medicare is a fee-for-service health insurance program offered through the federal government. Traditional Medicare is divided into two parts: Part A provides hospital coverage and includes inpatient care in hospitals, skilled nursing facilities, hospice care and some home health care. Part B provides medical coverage and includes certain physician services, outpatient care, durable medical equipment and preventive services. Blackwood said LPCs and LMFTs will provide mental health treatment and services as nonphysician practitioners under the provisions for Part B.
Medicare Advantage, also known as Part C, allows people to get Medicare coverage from a private health plan that contracts with the federal government. This plan covers all the same services under Part A and Part B and provides care through physicians who are in-network, Blackwood said. Unlike the fee-for-service program, Part C may also provide coverage for vision, hearing and dental services. After the new law goes into effect on Jan. 1, 2024, LPCs and LMFTs can also be reimbursed for mental health treatment and services provided through Medicare Advantage, Blackwood noted.
“This is going to be a whole new market [to] access new clients,” she said. The new law will “open up a lot of opportunities for LPCs.”
LPCs may also benefit from the provisions in the Counseling Compact, which allow for reciprocal licensure in states that are a part of the compact, Blackwood said. ACA is keeping a close eye on the proposed rule to ensure that the CMS understands and will work to accommodate the compact.
We will not know what is in the proposed rule until it is released, but Nolan said that questions regarding diagnostic (psychological) testing, telehealth services and the use of current procedural technology codes may also be addressed.
Fullen acknowledged that the passage of this law was thanks to the persistence of ACA’s alliance with other professional partners and the advocacy of counseling professionals who sent emails, wrote letters and attended meetings with lawmakers to let their voice be heard.
“We see through this legislative victory [a] real contribution to equity and social justice in a way that provides more access to care for people who really need it,” Fullen said.
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Learn more
- Watch the webinar at ACA’s YouTube channel.
- Stay abreast of new developments in the law’s implementation through the CMS website.
- Learn more about this new law on ACA’s Medicare Mental Health Workforce Coalition web page.
- Find answers to frequently asked questions on the Mental Health Access Improvement Act here.
- Listen to two special episodes of The Voice of Counseling on this new law: “Celebrating the Passing of Medicare for Counselors With ACA’s Government Affairs Team” and “The Mental Health Access Improvement Act and What It Means for Counselors.”
- Participate in an upcoming CMS “open door forums,” which provide an opportunity for the public to engage in a live dialogue with CMS and ask questions they have about new policies.
- Chat with Medicare administrative contractors who will be available in the upcoming months to help providers enroll and answer questions.
- Visit the Government Affairs and Public Policy team’s web page or email the team at advocacy@counseling.org.
Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.