CMS to Modernize Behavioral Health Coverage to Address Workforce Shortage, Proposes New Payment Policies

The Centers for Medicare & Medicaid Services (CMS) intends to better embrace a large swath of behavioral health practitioners in its payment structure. 

On Thursday, CMS unveiled a proposed rule that dictates the Medicare Physician Fee Schedule (PFS) for 2023. In it, CMS states it will change oversight and coordination rules “to ensure that behavioral health practitioners across the country can practice to the full extent of their license.”

The rule proposes four major supervision and coordination changes to improve behavioral health access for Medicare patients.


“Integrated coordinated, whole-person care — which addresses physical health, behavioral health, and social determinants of health — is crucial for people with Medicare, especially those with complex needs,” Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, said in an announcement. “If finalized, the proposals in this rule will advance equity, lead to better care, support healthier populations, and drive smarter spending of the Medicare dollar.”

First, the rule proposes to shift physician supervision requirements from “direct” to “general” for marriage and family therapists, licensed professional counselors, addiction counselors and certified peer recovery specialists.

“Practically speaking, this means that these behavioral health practitioners would be able to provide services without a doctor or nurse practitioner physically on-site, expanding access to behavioral health services like counseling and cognitive behavioral therapy in additional communities, particularly rural or underserved communities where care can be hard to find,” a blog post from CMS states.


Second, the rule proposes paying psychologists and social workers to help manage patient health in primary care teams.

Third, Medicare proposes a first-ever payment plan for team-based, comprehensive management and treatment of chronic pain.

Fourth, CMS is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access for Medicare recipients who are homeless or live in rural areas.

The rule also proposes increased payment rates to opioid treatment programs to cover the cost of counseling services and covering the costs to start opioid treatment drug buprenorphine over telehealth as it does with in-person visits.

These behavioral health reforms come alongside several other proposed changes including access to accountable care organizations (ACOs) and dental care.

Many of these efforts line up with the Pres. Joe Biden’s unity agenda, especially its priorities for the mental health crisis, the opioid epidemic and ending cancer “as we know it” through the Cancer Moonshot, the CMS announcement states. Biden introduced his unity agenda during his state of the union address.

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