MMHCA Statement on Medicare Inclusion Act
Many of you have heard the news that the Omnibus Bill which passed Congress on December 23, 2022 provides for counselors to bill under Medicare. While this is certainly good news, MMHCA has serious concerns about the limitations this legislation places on counselors’ scope of practice and where counselors can provide services under Medicare.
Services allowed to be provided by counselors under this legislation are limited to the diagnosis and treatment of mental and emotional disorders. (See Attachment pp. 3723 to 3729.). Our scope of practice in Michigan law is much broader than this. For example, counselors working in integrated care often bill for health and behavior assessment and intervention (HCPCS 96150 through 96161) for patients who do not have a mental illness diagnosis but who need counseling to cope with challenging physical diagnoses and treatments. MMHCA has worked very hard with Co-Sponsor Senator Debbie Stabenow’s office to insure that language which allows counselors to practice integrated care using these codes was included.
As a result of MMHCA’s initiatives, in September the Senate Finance Committee included in its discussion draft the language allowing counselors to provide integrated care services using the above referenced codes. Unfortunately, this language was not included in the Omnibus Bill. As a result, only psychologists are allowed under Medicare to use these codes even though counselors use these codes with other insurances and are qualified by their training and scope of practice to do this work.
Inclusion of this language would have allowed counselors to work with people who are struggling with a physical diagnosis but do not have a mental illness diagnosis. In this type of integrated care work, the physician makes the health-related diagnosis and the counselor provides the health and behavior assessments and intervention using the above-referenced codes. Outside of Medicare, counselors are able to do this work. But they will not be able to help their Medicare clients in this way who are struggling with challenging physical diagnoses and treatments. This is harmful to our clients. It is also harmful to the future of counseling in that it limits what counselors can do when working with integrated care for Medicare patients. In Michigan we have experienced too many efforts to limit our scope of practice which have been rectified with the passage of our 2019 law, and we are concerned that the language in the Omnibus Bill imposes new limits on our scope of practice. We have learned over the years how important it is for counselors to define the profession of counseling themselves rather than allowing others to do so.
Not being able to practice our full scope of practice also has the potential of limiting where counselors can work. While the passage of the Omnibus Bill eases some of the restrictions on the practice of counseling it also imposes new restrictions. For example, with the limitation on our scope described above, counselors would not be the most preferred providers to work in integrated care settings just as they have not been preferred providers to work in some community mental health agencies because they could not bill Medicare. The legislation which has passed also prohibits counselors from working with hospital inpatients. This limitation was not in the language as introduced, and we are working to learn why it was added before this legislation passed.
MMHCA is committed to supporting counselors in practicing their full scope of practice and in being able to be employed in all appropriate settings. We will continue to work to correct the problems we see with the legislation that has just passed. This legislation is goes into effect in 2024, and it is our goal to correct these problems before that.