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In connection with the federal Consolidated Appropriations Act of 2023, marriage & family therapists (“MFTs”) as well as licensed professional clinical counselors (“LPCCs”) are eligible to receive payment from the Medicare program for covered behavioral health services with dates of services commencing January 1, 2024. This change was intended to help address healthcare practitioner shortages and expand access to behavioral health services for Medicare beneficiaries.
MFTs and LPCCs may provide such services in private practice; additionally, the following providers have the option of integrating MFTs/LPCCs into their services:
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Community health centers and hospices may now use MFTs and LPCCs on their interdisciplinary teams;[1] and
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MFTs/LPCCs may provide payable Medicare services in rural health clinics and federally qualified health centers.[2]
In addition, MFTs and LPCCs may contract with Medicare Advantage Plans for payable services.
Health Behavioral Assessment & Intervention Services
MFTs and LPCCs may now be paid for performing health behavioral assessments and intervention services to address psychosocial behaviors associated with physical health conditions.
Medicare Enrollment Requirements
Medicare requires that the MFT or LPCC meet the following requirements to be eligible to enroll in Medicare:
- Possess a master’s or doctoral degree that qualifies the person for licensure under state law;
- Possess a state license as an MFT or LPCC; and
- Have performed at least two years or 3,000 hours of clinically supervised experience in marriage and family therapy or mental health counseling after obtaining the degree.
Clinically Supervised Experience
While California does require that a candidate for MFT licensure must undergo two years of clinically supervised experience, it is possible that a person could fulfill some of these requirements pre-degree, so practitioners must be able to document supervised experience in excess of that required for licensure to obtain Medicare enrollment.
In subregulatory guidance, CMS indicates that, in states like California where two years/3,000 hours of post-degree clinically supervised experience is not required, the practitioner must submit one of the following in connection with enrollment:
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A statement from the provider where the MFT/LPCC provided services verifying that the practitioner performed services at that setting for the required number of years/hours. The statement must be on letterhead and signed by the supervisor of the MFT/LPCC or the applicable department head or a current Medicare authorized official or delegated official.[3]
- A statement verifying that the MFT/LPCC meets the year or hour requirement from a licensing or credentialing body for the state or a national credentialing organization. This option does not appear to be available to Californians, where the Board of Behavioral Sciences is not making a process available for verification and where no such credentialing organization exists.
Opt-Out Requirements
MFTs and LPCCs who were already providing services to Medicare beneficiaries on a private pay basis and want to continue to provide these services and receive payments from the patient directly must now formally opt out of the Medicare program to continue to be paid privately for such services. See https://med.noridianmedicare.com/web/jeb/enrollment/opt-out. Under these agreements, the provider and the patient agree that neither will bill the Medicare program for the services provided. To opt out of the Medicare program, a practitioner must submit an “opt out affidavit” to the Medicare Administrative Contractor (currently Noridian) and enter into a private contract with the beneficiary.[4]
A provider that opts out of the Medicare program must do so for a minimum of two years; the Medicare opt out may not be terminated early except for those practitioners who have opted out for the very first time and that terminate the opt-out within 90 days of the initial opt-out.
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