Legal Intelligencer article by Lamb McErlane Health Law attorneys Vasilios J. (Bill) Kalogredis and Artyom (Art) Sharbatyan.
The Mental Health Access Improvement Act (MHAIA) [S.828/H.R.432] is an important legislative act that seeks to provide much-needed relief to both counselors and clients. It was first introduced in the United States Congress in 2019 and gained support from mental health advocates and professionals. Congress passed it on December 23, 2022. The Act aims to increase access to mental health care by expanding the availability of telehealth services and providing reimbursement for licensed professionals such as Licensed Marriage and Family Therapists (MFTs) under Medicare. The Act amends the Medicare program to expand access to mental health services, particularly for those in underserved and rural areas. The Act also allows LPCs and MFTs to bill Medicare for their services, which they are not currently allowed to do.
The passage of MHAIA is critically important to both counselors and clients for several reasons. First and foremost, it seeks to address the significant barriers that individuals face when trying to access mental health care and will improve access to mental health services for millions of Americans, particularly those in rural and underserved areas. According to USAFACTS.org, 122 million Americans live in a mental health access shortage area. The Substance Abuse and Mental Health Services Administration (SAMHSA) published a report in 2019 which found that approximately sixty percent of United States counties do not have a single psychiatrist. Additionally, the report stated that ninety percent of mental health professional shortage areas are located in rural regions. This shortage of mental health professionals, particularly those in rural areas, confirms that many Americans do not have necessary access to mental health services. By expanding access to mental health services, MHAIA will help address this critical shortage and improve the overall mental health of Americans. Additionally, MHAIA positively impacts people struggling with mobility and transportation issues by expanding access to telehealth services, which will now allow patients to receive care from the comfort of their own homes. Telehealth services have become increasingly popular in recent years, as they allow patients to receive care without having to travel to a physical location. Telehealth services also provide a convenient option for those who work long hours or who have other obligations that make it difficult to attend in-person appointments.
Secondly, the passage of MHAIA is important for LPCs and MFTs, who are currently not allowed to bill Medicare for their services. The new legislation will provide coverage under Medicare for such services as psychotherapy, pharmacologic management, and other treatments deemed medically necessary. These services will be provided by licensed mental health professionals, including LPCs, MFTs, and clinical social workers. This is a crucial step in ensuring that mental health care is accessible to all, regardless of their financial situation. LPCs are trained professionals who provide counseling services to those struggling with mental health issues. However, they have historically been excluded from reimbursement under Medicare, which has made it difficult for many people to access their services. Under this bill LPSs and MFTs can enroll as providers in the Centers for Medicare & Medicaid Services (CMS) as Medicare providers. This means that as of January 1, 2024, LPCs and MFTs will be able to provide services to Medicare beneficiaries and bill Medicare Part B to get reimbursement for approved services. Currently, clients must pay out-of-pocket for these services. This change can broaden their ability to serve a large portion of the population. It will also help ensure that LPCs are able to continue providing their services, even if they are not able to charge as much as other mental health professionals, which will make it easier for those on a tight budget to access mental health care. Unlike other mental health professionals, Counselors have different titles in each state. And since many states do not use the term Licensed Professional Counselor or Mental Health Counselor, the specific title in each individual state will not prevent professionals from being eligible as long as they meet the general requirements for the Medicare system. Counselors who are licensed under a different title in their state should check with CMS to determine their eligibility. Counselors will not be able to be paid by Medicare for serving Medicare clients prior to January 2024, as this is when the provision for reimbursement of LPCs and MFTs under Medicare will take effect. It will take a year for CMS to allow LPCs and LMFTs to enroll in the program due to the time needed to develop regulations and implement the new policies. This delay may cause some frustration among mental health professionals, but it is important to note that the implementation process is necessary to ensure that the program runs smoothly and that individuals receive high-quality care. Nevertheless, counselors can begin preparing for enrollment by familiarizing themselves with the CMS enrollment process and ensuring that they meet the necessary qualifications. There are estimated to be 200,000 mental health professionals that may now be eligible to become Medicare Providers and will be able to be paid by Medicare for serving Medicare beneficiaries. The process for enrollment will involve submitting an application, providing documentation of qualifications, and meeting certain other requirements.
Thirdly, the passage of MHAIA will improve the overall quality of mental health care in the United States. By expanding access to mental health services, the Act will allow mental health professionals to diagnose and treat mental health disorders earlier, which can lead to better outcomes for patients. Mental health issues can have a significant impact on a person’s quality of life, and untreated mental health conditions can lead to a host of negative outcomes, including substance abuse, unemployment, and even suicide. By increasing access to mental health care, the MHAIA can help ensure that individuals receive the care they need to manage their mental health conditions. This can lead to better mental health outcomes, including increased productivity, and better overall health.
Another important benefit of the MHAIA is that it can help reduce the stigma around mental health. Stigma is a significant barrier to accessing mental health care, as many individuals may be reluctant to seek help due to the negative stereotypes surrounding mental illness. By expanding access to mental health care and providing reimbursement for LPCs, the MHAIA can help to reduce stigma and promote a more positive view of mental health.
Finally, the passage of MHAIA should have important economic benefits. Mental health disorders are a major source of disability and lost productivity in the United States, costing the economy billions of dollars each year. By expanding access to mental health services, MHAIA will help reduce the economic burden of mental health disorders, improving the overall health and well-being of Americans.
In conclusion, the passage of MHAIA is critically important for both counselors and clients. It expands access to mental health services, particularly for those in underserved and rural areas. It also allows LPCs to bill Medicare for their services, which can expand the pool of mental health professionals available to treat patients. Additionally, the passage of MHAIA should improve the overall quality of mental health care and have important economic benefits. While there may be some challenges in the implementation process, the MHAIA has the potential to improve mental health outcomes and reduce stigma surrounding mental health.
Vasilios J. (Bill) Kalogredis, Esq. has been exclusively advising physicians, dentists, and other health care professionals and their businesses as to contractual, regulatory and transactional matters for over 45 years. He is Chairman of Lamb McErlane PC’s Health Law Department. bkalogredis@lambmcerlane.com. 610-701-4402.
*Artyom (Art) Sharbatyan contributed to this article. Art has extensive real life practical experience in the healthcare field with particular concentration in dental practice groups. He represents healthcare providers in their business and legal needs at Lamb McErlane, PC’s Health Law Department. asharbatyan@lambmcerlane.com; 610-701-4416.
