NBCC Addresses Mental Health Workforce Shortages

More than 45% of Americans live in areas with mental health service shortages, according to a 2022 study by the Kaiser Family Foundation. Unfortunately, fewer than half of adults with mental health conditions receive care. Additionally, more than 85% of individuals with substance use disorders do not receive treatment because of barriers such as stigma, lack of access, and cost.   

Congress has been advancing policy solutions to close this treatment gap for Americans needing behavioral health services. The NBCC Government Affairs Department has also been active on many levels to address the behavioral health workforce shortages. The following are some of NBCC’s efforts to remove this barrier to care.  

Expanding Access: Medicare Part B Recognition for Counselors 

In 2023, the Mental Health Access Improvement Act was enacted, allowing mental health counselors (MHCs) and marriage and family therapists (MFTs) to receive payment under the Medicare Part B program for providing covered mental health services to Medicare beneficiaries beginning Jan. 1, 2024. Counselors have now begun to bill Medicare for covered services rendered to beneficiaries over the age of 65 and people with disabilities who receive health care benefits from Medicare.  

According to the Centers for Medicare & Medicaid Services (CMS), this will potentially add many MHCs and MFTs who can independently treat people with Medicare and be paid for their services. In one clean stroke, the 2023 omnibus legislation significantly addressed the workforce shortage of behavioral health providers for older Americans with mental health conditions. This was years in the making, and NBCC played a pivotal role in passing this legislation.  

Engagement on Implementation of Medicare Coverage for Counselors: Webinar Series 

NBCC and the Medicare Mental Health Workforce Coalition (MMHWC) are currently focused on the implementation of the Medicare legislation. NBCC, in partnership with the MMHWC, sponsors and hosts webinars on the regulatory process associated with Medicare coverage of counselors and MFTs. So far, the team has produced seven webinars on varying topics to help counselors and MFTs prepare to serve Medicare recipient clients. Counselors who missed any of these webinars can view them and learn about future events on our website.  

Engagement With Officials From the Centers for Medicare & Medicaid Services (CMS) 

As part of NBCC’s efforts to ensure a smooth implementation of Medicare for counselors and to expand access to care and address workforce capacity issues, the Government Affairs team has engaged CMS on many levels. 

CMS is the federal agency that oversees the Medicare and Medicaid programs and is responsible for the implementation of Medicare. NBCC staff has regularly engaged with CMS officials over the last year to discuss the skills and expertise of counselors and acquire additional information on the implementation of the Medicare coverage of counselors.    

In 2023, CMS issued several regulations on the implementation of Medicare. NBCC provided comprehensive comments on these regulations to ensure appropriate implementation of counselor participation in Medicare and addressed provisions in several service systems such as Medicare outpatient hospital services and Medicare Advantage plans. The team will continue to work with CMS officials to represent and support counselors as they integrate into the Medicare program and increase access to care.

Occupational Series: Veterans Affairs (VA), the Indian Health Service (IHS), and the U.S. Navy

Another strategy to address workforce capacity has been through NBCC’s efforts to increase access to counselors for our nation’s veterans with mental health conditions through the Government Affairs team’s engagement with the VA.  

In 2023, the VA formally launched a unique Occupational Series for Mental Health Counselors (Series 0183). All federal jobs are categorized into job categories called “occupational series,” and NBCC strongly advocated for years for a separate occupational series designation for MHCs.  

The series will now allow counselors to have recognition and professional identity throughout the federal system, facilitating simplified hiring for counselors and expanding the VA workforce capacity for veterans with mental health conditions, cross-agency movement, and increased pay and promotion potential throughout the federal enterprise. VA human resources professionals throughout the agency and nationwide must now use the new occupational series for recruitment of new Licensed Professional Mental Health Counselors (LPMHCs). LPMHCs can search for employment positions under the new occupational series designation. 

NBCC has also been working with the Indian Health Service (IHS), the federal health program for American Indians and Alaska Natives (AI/AN) to provide the AI/AN population with increased access to mental health services through a new occupational series similar to the recently established VA program. The IHS does not currently recognize counselors as health care providers on par with social workers and psychologists. Among other problems, counselors are not eligible for funding through the IHS scholarship program, a key IHS provider recruitment tool. Integration of the occupational series will help to expand opportunities for counselors within the IHS and expand access to mental health care for IHS clients. 

In addition, NBCC staff also recently met with Navy Installations Command, which is in charge of hiring civilian mental health professionals for the Navy. The Navy is also starting the process of creating a job series for licensed mental health counselors to expand their behavioral health workforce. NBCC is proud to be a leader in these efforts and the Government Affairs team looks forward to additional implementation of the occupational series with other federal agencies.  

Minority Fellowship Program 

SAMHSA’s Minority Fellowship Program (MFP) has provided scholarships for mental health professionals for 50 years, and NBCC celebrates that counselors have now been included in the program for more than a decade. The MFP is a key program in governmental efforts to expand access to essential mental health services in traditionally underserved communities. The NBCC Foundation administers the federally funded MFP for counseling and addictions counseling and provides financial support to master’s and doctoral counseling students who commit to serving underserved communities. In this way, the program seeks to increase mental health availability and capacity for traditionally underserved populations. The program offers much more than just a monetary award, as Fellows receive many support services from the NBCC Foundation, including professional development, community engagement, and mentoring. 

Additional NBCC Congressional Actions and Workforce Recommendations 

NBCC continues to advocate for congressional committees to expand workforce capacity policies, including the following areas: