Article Published: 9/23/2022
The Centers for Medicare & Medicaid Services (CMS) recently released its 2023 Physician Fee Schedule proposed rule and solicited feedback from the public and impacted professions. The Physician Fee Schedule is an annual CMS determination of Medicare reimbursement rates for providers, facilities, and services, which CMS often uses as a vehicle to issue regulations that would expand access to certain services. NBCC supports the efforts CMS has taken to improve access to and the quality of mental and behavioral health care services through the 2022 CMS Behavioral Health Strategy, including the recently proposed rule.
NBCC strongly agrees with CMS’ assertion that reducing barriers and making greater use of licensed professional counselors (LPCs) is critical to CMS’ strategy of helping to reduce workforce shortages and ensuring Medicare patients are receiving the mental and behavioral health care they need. In addition, NBCC also believes that ensuring that mental health counselors can practice to the fullest extent possible by amending the direct supervision of a physician or non-physician practitioner (NPP) requirement under the “incident to” regulation is an essential step forward.
Through submitted comments, NBCC urged CMS to ensure that this provision makes it into the final Physician Fee Schedule rule to improve access to mental and behavioral health treatments for millions of Medicare beneficiaries.
The 2023 Physician Fee Schedule includes a proposal that would allow LPCs to provide services to Medicare beneficiaries in certain settings. Currently, mental health counselors can bill Medicare when their services are provided “incident to” the services of a physician and they are directly supervised by a physician. This applies to only a very small number of counselors who receive bundled Medicare payments and who are supervised directly by a physician in settings such as Federally Qualified Health Centers and Rural Health Clinics. The 2023 proposal would allow Medicare to reimburse mental health counselors to provide services “incident to” the services of a physician or other non-physician provider under general supervision, meaning that the supervising clinician would not be required to be onsite. This would be a significant change and expand access to counseling services by Medicare beneficiaries.
NBCC submitted comments in support of CMS’ proposal to expand the utilization of LPCs in the proposed rule, as the change will improve access to critical behavioral health services at a time when there is increased demand for services and workforce shortages in behavioral health. NBCC also requested that CMS clarify in the Physician Fee Schedule that mental health counselors are able to bill Medicaid for services, as a secondary insurance to Medicare, when treating dual-eligible individuals. Many mental health counselors have difficulty obtaining the required denial letter from Medicare to bill Medicaid as a secondary insurance.
Although we support the proposed rule, the only way to ensure mental health counselors can bill Medicare in all settings is passage of the Mental Health Access Improvement Act. Visit our Grassroots Action Center to contact your senators and representatives and tell them to cosponsor this important legislation!
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