CMS Issues Final Rule Expanding Access to Behavioral Health Services

November 18, 2022


Jennifer Wessel, JD, MPH
Senior Policy Analyst and Data Privacy Officer

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On Nov. 1, the Centers for Medicare and Medicaid Services issued a final rule that aims to expand access to behavioral health services in rural and underserved communities where care may be hard to find.

Under the Medicare Physician Fee Schedule, a licensed professional counselor or licensed marriage and family therapist can only be paid for services performed as auxiliary to those of a billing physician or non-physician practitioner, who must directly supervise — i.e., be immediately available to furnish assistance and direction. The final rule amends this requirement to allow these services to be provided under more general supervision. Removing the requirement for direct supervision of auxiliary staff should enable more patients to receive care.

The rule cites a federal Health Resources and Services Administration analysis that projects shortages for a variety of behavioral health practitioners, including psychiatrists, mental health and substance use social workers, school counselors, and marriage and family therapists. The Arkansas Board of Examiners in Counseling and Marriage and Family Therapy lists 2,239 licensed professional counselors and 242 licensed marriage and family therapists with active licenses in the state.

The rule offers some supervisory flexibility to help reduce access challenges in Arkansas and create capacity for team-based primary care by leveraging a broader range of behavioral health professionals. In Arkansas, there are 57 Mental Health Care Health Professional Shortage Areas — a federal designation based primarily on the ratio of population to professionals, the percentage of the population that is low-income, and travel time to the nearest source of care. The Health Resources and Services Administration reports that only 34% of mental health care needs are met in Arkansas’s shortage areas.

Details on other parts of the final rule, including a 4.5% reduction in physician payments, are summarized in a U.S. Department of Health and Human Services news release. The final rule will become effective Jan. 1.

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