Improving Access to Behavioral Health in Medicare: Significant Changes Ahead

As we continue to recover from the challenges posed by the COVID-19 pandemic, the importance of accessible mental health and substance use disorder treatment, collectively known as “behavioral health,” has become increasingly evident. Many older Americans and individuals with disabilities enrolled in Medicare have grappled with worsening depression, anxiety, and substance use issues. Recognizing the need for enhanced behavioral health care, the Centers for Medicare & Medicaid Services (CMS) has announced groundbreaking proposed policies aimed at making significant changes to improve access to behavioral health within the Medicare program.


Covering Gaps in Access to Behavioral Health:

CMS’ proposals aim to close the gap in Medicare’s coverage of behavioral health services. Historically, Medicare covered services like psychiatric hospitalization and outpatient therapy. However, for those requiring more intensive care than outpatient therapy but not requiring hospitalization, a gap existed. Now, CMS is proposing to pay for an intermediate level of care known as the “Intensive Outpatient Program” (IOP), expanding access to these services. CMS is also considering payments for intensive outpatient services provided by opioid treatment programs.

Moreover, CMS is working to improve access for underserved communities by changing the level of supervision required for certain behavioral health services. This change could expand access to counseling and cognitive behavioral therapy, particularly in rural or underserved areas.


Paying More Accurately for Behavioral Health Services:

To ensure fair compensation for behavioral health services, CMS is proposing changes to payment rates. This includes increased payment for crisis services provided outside of clinical settings, which is crucial for patients in crisis. Additionally, CMS plans to increase payment rates for substance use disorder treatment and psychotherapy services to reflect the true costs involved.

Furthermore, CMS recognizes that primary care providers play a significant role in providing behavioral health care. Proposed changes include additional payments for providers delivering primary and longitudinal care, ensuring patients receive appropriate treatment and referrals for behavioral health care.



The proposed changes set forth by CMS represent a significant step towards strengthening behavioral health care for Medicare beneficiaries. These changes have the potential to make a profound and sustained impact on the treatment of millions of Americans. However, to ensure the best possible path forward, thoughtful feedback is essential. The comment period for each rule ends on September 11, 2023, for the Physician Fee Schedule and the Outpatient Prospective Payment System. Your feedback can help shape the future of behavioral health care for everyone enrolled in Medicare.


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