Blog Viewer

Advancing High Quality Treatment for Opioid Use Disorders in Medicare Act and Mental Health Counselor Inclusion

By Joel Miller posted 04-27-2018 16:00


In addition to AMHCA’s legislative strategy on passing bills that will allow clinical mental health counselors (CMHCs) to receive fee-for-service reimbursement from Medicare, we have been pursuing a second strategy or parallel advocacy effort for CMHCs to receive reimbursement through new delivery mechanisms such as accountable care organizations (ACOs) and alternative payment  model (APMs) through the Medicare program.

Over the last few days, more than 30 Medicaid and Medicaid bills were the subject of the House Energy & Commerce Committee Health Subcommittee hearings focused on addressing the opioid crisis. As part of the bills considered, the following language has been identified pertaining to mental health counselors:

  • Medicare would implement a five (5) year opioid use disorder treatment demonstration where reimbursements would be paid to a “participating care team.”
  • Licensed mental health counselors and marriage and family therapists are listed as members of the team using statutory definitions drawn from our House (HR 3032) and Senate (S.1879) bills. Please see the language below, especially in bold.
  • The legislation lays out a monthly management fee for each participating care team starting on page 18.  The payments are pegged to the number of Medicare beneficiaries served by each team with list of payment adjusters on page 18.
  • Incentive payments are described at the top of page 19.


The language is similar to the ACO proposal that AMHCA pitched last year just before Finance Committee marked up the CHRONIC Care Act.  We are keeping all of our options open as we continue to press for passage of H.R. 3032 – our Medicare Provider Recognition Bill.


Specifically, here is the introductory language and sections on mental health counselors pulled out of the Alternative Payment Model bill:


‘‘(1) IN GENERAL.—Not later than January 1, 2021, the Secretary shall implement a 5-year demonstration program under this title (in this section referred to as the ‘Program’) to increase access of applicable beneficiaries to opioid use disorder treatment services, improve physical and mental health outcomes for such beneficiaries, and to the extent possible, reduce expenditures under this title. Under the Program, the Secretary shall make payments under subsection (f) to participating care teams (as defined in subsection (c)(1)(A)) for providing opioid use disorder treatment services to applicable beneficiaries participating under the Program. ‘‘(2) OPIOID USE DISORDER TREATMENT SERVICES. —For purposes of this section, the term ‘opioid use disorder treatment services’ means, with respect to an applicable beneficiary, such services as the Secretary shall specify that are furnished for the treatment of opioid use disorders in an outpatient setting and for which payment may otherwise be made under this title. Such services shall include— ‘‘(A) medication assisted treatment; ‘‘(B) treatment planning; ‘‘(C) appropriate outpatient psychiatric, psychological, or counseling services (or any combination of such services); ‘‘(D) appropriate social support services; and ‘‘(E) care management and care coordination of opioid use disorder services, as well as coordination with other physicians and providers treating the mental and physical conditions of such beneficiary.


‘‘(C) GROUP OF HEALTH CARE PROVIDERS PERMISSIVE INCLUSIONS.—For purposes of subparagraph (A), a group of health care practitioners described in such subparagraph may include—‘‘(i) an addiction specialist (as defined in paragraph (3)(B)); ‘‘(ii) marriage and family therapists, in accordance with such paragraph (3)(C); ‘‘(iii) mental health counselors, in accordance with such paragraph (3)(C); and ‘‘(iv) any other provider that the Secretary determines appropriate.


‘‘(C) MARRIAGE AND FAMILY THERAPISTS; MENTAL HEALTH COUNSELORS.— ‘‘(i) DEFINITIONS.—For purposes of paragraph (2)(C): ‘‘(I) The term ‘marriage and family therapist’ means an individual who—  ‘‘(aa) possesses a master’s or doctoral degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law; ‘‘(bb) after obtaining such degree has performed at least 2 years of clinical supervised experience in marriage and family therapy; and ‘‘(cc) in the case of an individual performing services in a State that provides for licensure or certification of marriage and family therapists, is licensed or certified as a marriage and family therapist in such State. ‘‘(II) The term ‘mental health counselor’ means an individual who— ‘‘(aa) possesses a master’s or doctor’s degree in mental health counseling or a related field; ‘‘(bb) after obtaining such a degree has performed at least 2  years of supervised mental health counselor practice; and ‘‘(cc) in the case of an individual performing services in a State that provides for licensure or certification of mental health counselors or professional counselors, is licensed or certified as a mental health counselor or professional counselor in such State.


We will closely follow the work of the Energy and Commerce Committee on this language.  There is no specific bill number at this time.  We will inform you of the bill number and more details in the next few days as the committee continues its deliberations.

The Energy and Commerce Committee Health Subcommittee will begin on April 25th to mark-up opioid-related bills.  We have monitoring 65 bills that could get rolled in a single legislative package in the House.

At this time it is unclear what the process is will be whether each individual bill will get an up or down vote, or whether blocks of bills will be considered.

Significantly for AMHCA, we understand that the Subcommittee will include a mandatory e-prescribing bill that is projected to save at least $7 billion over the next 10 years under the Federal Budget.  This is incredibly important, as our Medicare Provider Recognition Bills will cost somewhere between $500 million and $1 billion dollars toward the Federal Budget over the 10 years as offsets have not been built into the Congressional Budget’s office of H.R. 3032 or S. 1879. So the upshot is that the Energy and Commerce Committee will likely spend new money due to savings in another part of the package dealing with Medicare e-prescribing initiatives.

We will provide regular updates on our advocacy activities with the Energy and Commerce Committee.

#AdvocacyUpdates #Advocacy #Medicare #EnergyandCommerce #HR3032 #Advocacy



Recent Blogs List

  • Posted in: The Advocate Magazine

    New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) has found that socially isolated children ...

  • Posted in: The Advocate Magazine

    A report released by  Sapien Labs  indicates that smartphone use could be responsible for an ongoing decline in the mental ...

  • Posted in: The Advocate Magazine

    A UK-based research project, the largest of its kind on the subject, has suggested mindfulness training in schools might ...

  • Posted in: The Advocate Magazine

    The roughly two years since the beginning of the pandemic have seen a significant increase in teenage girls visiting emergency ...

  • Posted in: The Advocate Magazine

    Expertise based on experience matters. Young people who experience mental health challenges and treatment can provide unique ...