The Senate Finance Committee is considering establishing Medicare reimbursements for mental health services from licensed marriage and family therapists (LMFTs) and licensed professional counselors.
On Thursday, the committee released draft legislation that would impact several regulations — mostly involving Medicare — related to the behavioral health workforce.
“There is an enormous need all across the country for mental and behavioral health care, but there aren’t nearly enough providers to meet that demand,” Chairman Sen. Ron Wyden (D-Ore.), said in a statement. “These proposals are about training new providers and finding opportunities to do more with the mental health workforce we already have.”
LMFTs and licensed professional counselors are not covered by Medicare’s outpatient mental health benefits, according to its website. This precludes Medicare beneficiaries from about 25% of the behavioral health workforce, based on data from the Health Resources & Services Administration.
About 18% of the U.S. population is on Medicare, the federal health plan for seniors and those with specific diseases.
The Senate Finance Committee is playing the lead role in the Senate in addressing mental health regulation reform. Mental health reform is part of the Biden administration’s unity agenda. Other major behavioral health legislation includes the Bipartisan Safer Communities Act, the gun reform and mental health legislation inspired by the massacre in Uvalde, Texas, in May.
The draft legislation is the third of its kind to come from the Senate Finance Committee. The first draft legislation focused on establishing and expanding the use of telehealth to treat Medicare and Medicaid members’ behavioral health. The second focused specifically on youth mental health.
While not part of the legislation, the committee said in its announcement of the legislation that it was committed to pursuing public-private partnerships that help address the mental health needs of Americans.
“Public-private partnerships are also going to be instrumental in solving this challenge by getting private contributions into the game and wringing more value out of taxpayer dollars,” Wyden said in the statement.
Wyden also signaled that additional draft legislation was forthcoming “related to crisis care and making mental health parity a reality in federal programs.”
Senate Finance Committee’s plan for the existing workforce
On top of adding LMFTs and counselors to Medicare, the draft legislation would also allow licensed clinical social workers (LCSWs) to bill Medicare for health behavior assessment and intervention (HBAI) services.
These services are meant to ensure that behavioral health issues do not impact physical health.
It would also allow psychologist trainees to provide mental health therapy services under general supervision rather than direct supervision, making it easier for trainees to see Medicare patients.
Medicare would also be required to provide education and outreach about the role of occupational therapists in the care of people with substance use disorders (SUD) and mental health disorders.
The plan for expanding the workforce
The draft legislation calls for additional funding for the training of new behavioral health professionals and expanded funding for providers that practice in areas identified as having a workforce shortage.
Specifically, it calls for the funding of 4,000 new Medicare Graduate Medical Education (GME) slots for psychiatry residencies. The U.S. is facing a present shortage of psychiatrists that is predicted to get much worse.
Psychiatrists would also get increased bonus Medicare payments if they practice in Health Professional Shortage Areas. Psychologists, clinical social workers, marriage and family therapists, mental health counselors and other non-physician practitioners would also be allowed to get bonus payments if they practice in shortage areas for the first time.
Other more indirect measures to expand the behavioral health workforce include the following:
— A new exemption to the Stark Law allowing hospitals to provide mental health to physicians
— Allowing states to get a grant and extra Medicaid funding if they participate in a demonstration program that would add more mental health
— Mandate the Secretary of the U.S. Health and Human Services Department to issue strategies for increasing education, recruitment and retention efforts for mental health and substance use providers in rural and underserved areas