CMS finalizes behavioral health network requirements for Medicare Advantage

CMS finalized new rules requiring Medicare Advantage plans to maintain adequate numbers of outpatient behavioral health providers in their networks. 

In a final rule published April 4, the agency laid out requirements for MA plans to include adequate numbers of outpatient providers, including marriage and family therapists and mental health counselors,  opioid treatment program providers, community mental health centers and addiction medicine specialists. 

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

New CMS regulations took effect at the beginning of 2024, allowing marriage and family therapists and licensed mental health counselors to bill Medicare for their services. 

An April report from CMS found fewer than 5 behavioral health providers participate in Medicare Advantage networks per 1,000 enrollees. 

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