NBCC Provides Recommendations on Hospital Outpatient Payment System Rule Affecting Counselors

On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems (and Related Medicare Payment Programs).

Proposed Hospital Outpatient Prospective Payment System Rule 

This proposed rule would revise the Medicare Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare ambulatory surgical center (ASC) payment system for calendar year 2024 based on CMS’s experience with these systems. In the proposed rule, CMS described the changes to the amounts and factors used to determine the payment rates for Medicare services paid under HOPPS and those paid under the ASC payment system.

NBCC provided comments to CMS that focused on the following mental health areas contained in the rule:

• Community Mental Health Centers Conditions of Participation: The rule supported the recognition that mental health counselors (MHCs) and marriage and family therapists (MFTs) provide services in community mental health centers (CMHCs) because that is a current practice setting for these practitioners. NBCC supported that action and we asked that MFTs and MHCs be specifically identified in the regulation as potential members of the CMHC interdisciplinary team, placing us on equal footing with clinical social workers. We also asked to be added to the list of practitioners that may provide group psychotherapy similar to the other practitioners who may lawfully provide these services.
• Exclusion of MHC/MFT Services From HOPPS Payment: We requested that CMS include statements that MHC and MFT services are not included within HOPPS payments except when part of a bundled rate. This will help clarify Medicare payments for MHCs and MFTs. 
• Partial Hospitalization/Intensive Outpatient Services: We also asked for the regulations concerning Medicare programs for partial hospitalization programs and intensive outpatient services to be modernized to fully recognize the services of MHCs and MFTs in this setting. 

For more information on the Hospital Outpatient Payment System rules, please contact the NBCC Government Affairs Department at govtaffairs@nbcc.org.