6 new Medicare Advantage behavioral health regulations take effect

Medicare Advantage plans will be required to comply with new behavioral health network adequacy and wait time standards in 2024. 

CMS' 2024 Medicare Advantage rule took effect Jan. 1. In addition to improving behavioral health access for MA beneficiaries, the rule is designed to streamline prior authorizations and cut down on misleading advertising in the program. 

Here are six new behavioral health regulations to note: 

  1. Plans are now required to have adequate numbers of licensed clinical social workers and clinical psychologists in their network. Plans are eligible for bonus payments from CMS for having these providers available through telehealth. 
  2. CMS now includes behavioral health in its general access to service standards for MA plans. 
  3. MA plans will have to comply with new wait time requirements in 2024. Members must be able to access behavioral health appointments within 10 days, according to new CMS guidance. 
  4. In its 2024 rule, CMS clarified that plans cannot subject emergency behavioral health services to prior authorization. 
  5. MA plans must notify members when behavioral or primary care providers are dropped from networks midyear. 
  6. CMS will require plans to begin creating care coordination programs to manage behavioral, community and social services. 

The agency has pitched adding tougher behavioral network requirements for MA plans in 2025. 

Read the full final rule here. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars