CMS pitches tougher Medicare Advantage behavioral network requirements

CMS is proposing adding new requirements for Medicare Advantage plans to have adequate networks of outpatient behavioral health centers. 

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In a proposed rule published Nov. 6, the agency pitched requiring network adequacy standards for outpatient behavioral health providers, including marriage and family therapists, mental health counselors and addiction or drug and alcohol counselors. 

Medicare will reimburse marriage and family therapists, mental health counselors and addiction and drug or alcohol counselors beginning in 2024, and it will cover more types of intensive outpatient therapy. 

Under the proposed rule, Medicare Advantage plans would be eligible for 10% bonus payments if their outpatient behavioral health networks include telehealth options. 

Medicare Advantage beneficiaries sometimes have few options for behavioral health providers. A study published in Health Affairs in July found that two-thirds of psychiatry networks in Medicare Advantage were narrow, containing fewer than 25 percent of psychiatry providers in the plan’s area.  

The proposed rule is open for comment through Jan. 5. 

At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.

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Caring for the caregivers: How health systems are building benefits strategies with mental health at the core

Wednesday, August 12
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Presenters: Mark DeFee, LPC, Lyra HealthDeborah Visconi, Bergen New Bridge Medical CenterSuneel Kumar Parvathareddy, MD, Advocate/Atrium Health Wilkes Medical CenterEric Parmenter, PhD, MBA, CEBS, SPHR, Quantum HealthMary Beth Lardazabal, DO, DFAPA, Allina Health

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