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Adam Swanson

Senior Policy Associate, National Council for Behavioral Health

New Legislation Expands Medicare Coverage for Behavioral Health Providers

June 4, 2014 | Medicare | Comments
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New legislation expands Medicare coverage for behavioral health services provided by marriage and family therapists and mental health counselors. Senator Al Franken (D-MN) included this important change in the Craig Thomas Rural Hospital and Provider Equity (R-HoPE) Act, a bill which amends several Medicare provisions in an effort to improve Americans’ access to mental health and other healthcare services in rural areas.

Under current law, Medicare only permits reimbursement for behavioral health services provided by selected types of providers such as clinical psychologists, psychiatrists, clinical social workers, and clinical nurse specialists. Yet according to SAMHSA’s 2013 Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues, 77 percent of U.S. counties have a severe shortage of mental health workers, including both prescribers and non-prescribers. This shortage is most common in counties with low per capita income and in rural areas. Named in memory of Wyoming Senator Craig Thomas, the bipartisan R-HoPE Act (S.2359) would combat the shortage by expanding the nationwide pool of eligible providers available to care for Medicare beneficiaries.

“The R-HoPE Act recognizes that rural health care providers have very different needs than their urban counterparts and that health care is not one-size-fits-all,” said Senator Pat Roberts (R-KS), co-chair of the Senate Rural Health Caucus and a cosponsor of the bill. The R-HoPE Act is also cosponsored by Sens. Tom Harkin (D-IA), John Barrasso (D-WY), Jerry Moran (R-KS) and Heidi Hietkamp (D-ND).

S.2359 is the fourth bill introduced in the current Congress that would extend Medicare reimbursement to marriage and family therapists and mental health counselors. Bipartisan standalone legislation has been introduced by Senators Ron Wyden (D-OR) and John Barrasso (R-WY) in the Senate, and Congressmen Chris Gibson (R-NY) and Mike Thompson (D-CA) in the House. The provision has also been included in a larger package of mental health reforms introduced by Congressman Ron Barber (D-AZ). The National Council strongly supports including marriage and family therapists’ and mental health counselors’ services as reimbursable under Medicare. We urge Congress to take action on this important issue.