CMS Allows for the Coverage of Marriage and Family Therapists and Mental Health Counselors Services
For the first time, Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can enroll as Medicare providers under provisions established in the Consolidated Appropriations Act of 2023.[1] MFTs and MHCs can start the Medicare enrollment process prior to January 1, 2024, but billing privileges cannot be effective until that date.[2] It is estimated that 400,000 MFTs and MHCs will now be eligible to enroll as Medicare providers. [3]
Provider Eligibility
MFTs must meet the following requirements[4] to enroll with Medicare:
- Possess a master’s or doctorate degree which qualifies for licensure or certification as a MFT under the state law of the state in which the individual furnishes marriage and family therapist services;
- Is licensed or certified as a MFT by the state in which each individual furnished services[5];
- After obtaining such degree, has performed at least two years of clinical supervised experience in marriage and family therapy; and
- Meets other such requirements as specified by the Secretary.
MHCs must meet the following requirements[6] to enroll with Medicare:
- Possess a master’s or doctorate degree which qualifies for licensure or certification as a MHC, clinical professional counselor, or professional counselor under state law of the state in which the individual furnishes marriage and family therapist services;
- Is licensed or certified as a MHC, clinical professional counselor, or professional counselor by the state in which each individual furnished services;
- After obtaining such degree, has performed at least two years of clinical supervised experience in marriage and family therapy or mental health counseling; and
- Meet other such requirements as specified by the Secretary.
Clinical Supervision Requirements
Regarding supervision, if the MHC or MFT is licensed in a state that requires the clinical supervised experience to be fully licensed, no additional action to document supervision is necessary when enrolling with Medicare.[7] The MAC will validate the license and clinical supervised experience during the application processing period.[8] However, if the MFT or MHC is licensed in a state that does not require clinical supervised experience as part of licensure, the MFT or MHC will need to submit documentation with their application to the MAC that proves the two-year clinical supervised experience requirement is met.[9]
Covered Services
MFT and MHC services that will be covered under Medicare Part B are defined as “services for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital) which the marriage and family therapist is legally authorized to perform under state law (or the state regulatory mechanism provided by state law) of the state in which the services are furnished, as would otherwise be covered by a physician or as incident to a physician’s professional service.”[10]
CMS has also proposed that MFTs and MHCs be added to list of practitioners who can furnish telehealth services to Medicare beneficiaries.[11]
MFTS and MHCs must also be aware that if they choose not to enroll as a Medicare provider and submit claims for covered services to Medicare, they can no longer charge Medicare patients cash after January 1, 2024, unless they officially opt-out as a Medicare provider.[12] Once officially opted-out of Medicare, the MFT or MHC can enter into private contracts with Medicare patients wherein they agree to pay out-of-pocket and no one will bill Medicare for the services rendered.[13]
Application Details
Before applying to a Medicare Administrative Contractor (MAC) for enrollment, MFTs and MHCs will have to apply for a National Provider Number (NPI) unless they already have an NPI assigned through a prior Medicaid enrollment.[14] Medicare enrollments can be done electronically through the PECOS portal or a paper submission using CMS Forms 855I or 855B.[15] Applying through the PECOS system will have a faster processing time (average of 15 days) as compared to applying via mailing a CMS 855 form (average time 30 days).[16]
Providers must be enrolled with the MAC that governs the state that the MFT or MHC is licensed and providing services.[17] If the MFT or MHC practices in multiple states that are governed by different MACs, then the provider has to submit an enrollment to the MAC of each state.[18] MFTs and MHCs can be enrolled in Medicare as an individual provider and also as part of a group provider.[19] They can also enroll as an individual and as the owner of a group.[20]
Other Important Implications
- MFT and MHC services can be covered in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).[21] The Medicare Conditions for Certification and Conditions for Coverage for RHCs and FQHCs will allow for payment under Medicare Part B for mental health services provided by these providers at RHCs and FQHCs effective January 1, 2024.[22]
- MFT and MHC services will not be included in Skilled Nursing Facility consolidated billing so these services can be billed separately to Part B.[23]
- MFTs and MHCs are now included as part of the hospice interdisciplinary team. Effective January 1, 2024, the Medicare Hospice Conditions of Participation adds these providers to the hospice personnel and requires that at least one social worker, MFT, or MHC be included on the hospice interdisciplinary team.[24]
We will continue to update as MFT and MHC enrollments are processed, MACs begin to cover services, and the status of MFTs and MHCs providing telehealth services becomes more clear. Please reach out to Maynard Nexsen if you need help navigating any of the issues discussed in this article.
[1] Section 4121 of Division FF of the Consolidated Appropriations Act (CAA) (2023).
[2] https://www.cms.gov/files/document/marriage-and-family-therapists-and-mental-health-counselors-faq-09052023.pdf. (Question #7).
[3] https://telehealth.org/medicare-behavioral-health/
[4] CAA Section 4121(a)(2) (2023).
[5]Medicare recognizes MFT and MHC licenses obtained through the interstate license compact as valid for the purpose of meeting licensure requirements. https://www.cms.gov/files/document/marriage-and-family-therapists-and-mental-health-counselors-faq-09052023.pdf. (Question #12).
[6] CAA Section 4121(a)(2) (2023).
[7] https://www.cms.gov/files/document/marriage-and-family-therapists-and-mental-health-counselors-faq-09052023.pdf. (Question #32).
[8] Id.
[9] Id.
[10] CAA, Section 4121(a)(2) (2023).
[11] https://www.cms.gov/files/document/marriage-and-family-therapists-and-mental-health-counselors-faq-09052023.pdf. (Question #30).
[12] Id. at Question #36; See also https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/chain-ownership-system-pecos/manage-your-enrollment#opt-out
[13] Id.
[14] Id. at Question #4.
[15] Id. at Questions #8-10.
[16] Id. at Question #14.
[17] Id. at Question #11.
[18] Id.
[19] Id. at Question #23.
[20] Id. at Question #24.
[21] Id. At Question #26.
[22] CAA, Section 4121(b)(1) (2023).
[23] CAA, Section 4121(a)(4) (2023).
[24] CAA Section 4121(b)(2); See also https://www.cms.gov/files/document/marriage-and-family-therapists-and-mental-health-counselors-faq-09052023.pdf. (Question #28).
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