Medicare Now Covering Services Provided by Marriage and Family Therapists and Mental Health Counselors

In December 2022, Congress finalized Section 4121 of Division FF of the Consolidated Appropriations Act of 2023 (the “Act”), creating two new Medicare provider types: Marriage and Family Therapist and Mental Health Counselor. This portion of the Act specifically addresses the current lack of access to mental health services in rural and underserved communities, as well as the gap in covered intensive outpatient programs, such as outpatient therapy provided by Marriage and Family Therapists and Mental Health Counselors.

Effective January 1, 2024, Marriage and Family Therapists and Mental Health Counselors are eligible to participate and enroll in Medicare Part B and receive payment for items and services furnished on or after this date. 

Some key aspects of these two new provider types are summarized below.

• What qualifies an individual to be a Medicare-enrolled Marriage and Family Therapist? The Act defines a Marriage and Family Therapist as an individual who: (1) has a master’s or doctorate degree which qualifies for licensure or certification as a marriage and family therapist under state law of the state where the individual provides such services; (2) is licensed or certified as a marriage and family therapist by the state in which services are furnished; (3) has had at least two years of clinical supervised experience in marriage and family therapy after obtaining the degree referenced above; and (4) meets other requirements as the Secretary of the U.S. Department of Health and Human Services deems appropriate. 
• What qualifies an individual to be a Medicare-enrolled Mental Health Counselor? The Act defines a Mental Health Counselor as an individual who: (1) has a master’s or doctorate degree which qualifies for licensure or certification as a mental health counselor, clinical professional counselor, or professional counselor under state law of the state where the individual provides such services; (2) is licensed or certified as a mental health counselor, clinical professional counselor, or professional counselor by the state in which services are furnished; (3) has had at least two years of clinical supervised experience in mental health counseling after obtaining the degree referenced above; and (4) meets other requirements as the Secretary of the U.S. Department of Health and Human Services deems appropriate.
• When can eligible providers start enrolling in Medicare? Marriage and Family Therapists and Mental Health Counselors can begin submitting their Medicare enrollment applications now. Claims with dates of service prior to January 1, 2024 will not be payable by Medicare.
• How does a Marriage and Family Therapist or Mental Health Counselor enroll in Medicare? Eligible individuals wishing to enroll in Medicare must complete and submit the Form CMS-855I (Medicare Enrollment Application for Physicians and Non-Physician Practitioners) as an initial enrollment. Individuals qualifying as a Marriage and Family Therapist or Mental Health Counselor should select the “Undefined Non-Physician Practitioner Specialty” category in section 2H of the CMS-855I application and specify Marriage and Family Therapist or Mental Health Counselor in the space provided. CMS has indicated that future updates to the CMS-855I paper application will include the Marriage and Family Therapist and Mental Health Counselor specialties. The current online application through PECOS has the Marriage and Family Therapist and Mental Health Counselor specialties available already. Individuals who provide services in more than one state may need to file separate CMS-855I applications for each state.

For questions about these new Medicare provider types or how to enroll in Medicare as an eligible provider, please contact any member of the Honigman Health Care Practice Group.