CHA News

Medicare Coverage for Behavioral Health Expanded

What’s happening: The Department of Health Care Services (DHCS) announced that Medicare will cover visits with mental health counselors, addiction counselors, and marriage and family therapists, effective since Jan. 1. 

What else to know: The Centers for Medicare & Medicaid Services (CMS) will conduct both routine and focused program audits of Medicare Advantage (MA) organizations in 2024 to assess compliance with new requirements. 

MA plans will be: 

  • Evaluated by CMS for network adequacy of clinical social workers and clinical psychologists 
  • Required to establish care coordination programs 
  • Required to contract with providers that ensure continuity of care and integration of behavioral services 
  • Prohibited from requesting prior authorization for emergency behavioral health services 

MA plans must also notify enrollees when their behavioral health and primary care physician are no longer in-network and apply wait time standards for behavioral health and primary care services.  

For more information, refer to the DHCS fact sheet.