2 Ways a New Law Expands Medicare Coverage

On Dec. 23, Congress passed a $1.7 trillion package that keeps the federal government from shutting down while also handing out legislative goodies for the holidays.

These include, among other things, revisions to retirement law through the Secure 2.0 Act and to Medicare coverage through the Mental Health Access Improvement Act.

The latter legislation adds marriage and family therapists and mental health counselors to the list of health care practitioners who can accept payment from Medicare Part B health insurance. Part B is the component of Medicare that covers outpatient services, such as doctor visits.

Here’s a look at the coming changes to Medicare coverage, whom they’ll affect and when.

Marriage and family therapist services

The Mental Health Access Improvement Act defines marriage and family therapist services as authorized services provided for the diagnosis and outpatient treatment of mental illnesses “as would otherwise be covered if furnished by a physician or as an incident to a physician’s professional service.” These services are provided by someone who:

• Possesses a master’s degree or doctorate that qualifies that person for licensure or certification as a marriage and family therapist under state law in the state where services are provided
• Is licensed or certified as a marriage and family therapist by the state in which services are provided
• Has performed at least two years of clinical supervised experience in marriage and family therapy

The law also allows other requirements to be specified by the government agency overseeing Medicare.

But in short, someone who is properly licensed and trained to offer mental health services as a marriage and family therapist can now be considered a Medicare provider and their services will be covered the same as a physician’s services when the law takes effect.

Mental health counselor services

Similarly, outpatient mental health counselor services provided by someone properly trained and licensed by their state may be covered. A mental health counselor:

• Possesses a master’s degree or doctorate that qualifies that person for licensure or certification as a mental health counselor, clinical professional counselor or professional counselor under state law in the state where services are provided
• Is licensed or certified as a mental health counselor, clinical professional counselor or professional counselor by the state in which their services are provided
• Has performed at least two years of clinical supervised experience in mental health counseling

Again, the law allows other requirements to be specified by the overseeing government agency.

Who benefits from these changes?

This expanded coverage will apply to people with either traditional Medicare or Medicare Advantage plans. This is because Medicare Advantage plans must cover everything that traditional Medicare covers.

When do these changes take effect?

The Mental Health Access Improvement Act takes effect for eligible therapy and counseling services received on or after Jan. 1, 2024.