CMS Approves New Treatment and Billing Rules for Mental Health Counselors

New Opportunity for Master Licensed Alcohol and Drug Counselors (MLADCs) and expansion of care! 

Effective January 1, 2024: 

Treatment and Billing by Mental Health Counselors (MHC) has been approved through the Centers for Medicare and Medicaid Services (CMS) 

With the publication of the new rules for CMS billing and services reimbursement, mental health counselors (MHC) can officially enroll in Medicare and begin to treat individuals with substance use disorders and mental health conditions. The term “mental health counselor” is defined broadly to include licensed and certified professional counselors, as well as addiction counselors and alcohol and drug counselors. Eligibility requirements specify that individuals: 

(1) have a master’s or doctorate degree in counseling, 

(2) are licensed or certified by the state in which they furnish services, and 

(3) have performed at least 2 years or 3000 hours of supervised clinical experience after obtaining their degree. 

For an brief overview of the updates for eligibility requirements for addiction professionals, please review https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/marriage-and-family-therapists-mental-health-counselors. A more comprehensive update for the rules can be found at https://www.govinfo.gov/content/pkg/FR-2023-11-22/pdf/2023-24293.pdf. 

While there are some limitations with billing for Medicare services based on level of care (specifically for IOP/PHP programs), this is a positive step towards recognizing and supporting the treatment of substance use disorders (SUD) in the State of New Hampshire. The approved billing services include: 

• Bundled substance use disorder (SUD) payments for: 
• SUD management and counseling 
• SUD services provided in an office setting, including: 
• Overall management 
• Care coordination 
• Individual and group psychotherapy 
• Substance use counseling