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Tags Posts tagged with "Medicare"

Medicare

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RCPA and the National Council for Mental Wellbeing have worked together to resolve the recent concern with Medicare enrollment rejections for Marriage and Family Therapists as well as Mental Health Counselors. There have been many cases where the applications were rejected because applications did not include documentation or verification of the required 3,000 hours of supervision or the 2 years’ experience. RCPA met with the Centers for Medicare and Medicaid Services (CMS) on several occasions, outlining that the applications that meet the Medicare enrollment criteria have met this standard as part of the PA State License.

Initially, CMS cited that it was a requirement to provide the documentation. After communicating with CMS leadership, however, CMS responded that RCPA was correct and clarified that if a provider is licensed and the hours are a requirement for the licensure, said provider does not require the verification.

If your agency has received a rejected application, please contact RCPA Policy Director Jim Sharp, who will connect your agency to the proper department that will address the denial.

SUD Addiction Counselors Eligible for Medicare Enrollment

There have been several members who have attempted to enroll their SUD counselors who have met the enrollment qualification being told by CMS that the enrollment does not include these SUD professionals.

RCPA has confirmed with CMS leadership that if the provider is licensed as an addiction counselor or alcohol and drug counselor (ADC) by the state in which the services are performed, they can also enroll as an MHC as long as all other requirements are met.

MHCs are defined as individuals who:

  • Possess a master’s or doctor’s degree, which qualifies for licensure or certification as an MHC, clinical professional counselor, or professional counselor under the state law of the state in which such individual furnishes the services defined as mental health counselor services;
  • After obtaining such a degree, have performed at least 2 years or 3,000 hours of post-master’s degree clinical supervised experience in mental health counseling in an appropriate setting, such as a hospital, SNF, private practice, or clinic; and
  • Is licensed or certified as an MHC, clinical professional counselor, professional counselor, addiction counselor, or alcohol and drug counselor (ADC) by the state in which the services are performed.

RCPA is recommending that this language accompany any future enrollment applications to CMS for SUD Addictions Counselors enrollment documentation.

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Image by Dirk Wouters from Pixabay

The Centers for Medicare and Medicaid Services (CMS) is conducting a study to help them improve your experience with Medicare program and billing resources. Share your thoughts with them by taking this survey today. Responses are confidential, and the survey should take about 15 minutes to complete.

CMS thanks you for your time and valuable feedback.

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The Medicare Payment Advisory Commission (MedPAC) has published the 2023 Data Book Health Care Spending and the Medicare Program, which provides information on national health care and Medicare spending as well as Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care in the Medicare program, and Medicare beneficiary and other payer liability. It also examines provider settings — such as hospitals and post-acute care — and presents data on Medicare spending and beneficiaries’ access to care in the setting (measured by the number of beneficiaries using the service, number of providers, volume of services, length of stay, or through direct surveys). Specifically of interest is information on dual-eligible beneficiaries, including individuals with disabilities, and information on alternative payment models.

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Caregiver supporting sick elderly man in the wheelchair during stay in the hospice

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), announced the new Guiding an Improved Dementia Experience (GUIDE) Model. The purpose and goal of this model is to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services.

Through the GUIDE Model, CMS will test an alternative payment for participants who deliver key supportive services to people with dementia, including comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. Under the model, people with dementia and their caregivers will have access to a care navigator, who will help them access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations.

The GUIDE model supports President Biden’s Executive Order that directed HHS to develop a new health care payment and service delivery model focused on dementia care that would include family caregiver supports.

There is a web page that has been created specific to this care model that provides additional information, including a link to a webinar that will provide an overview of this care model scheduled for August 10, 2023:

CMS will release the application for GUIDE, a voluntary, nationwide model, in the fall of 2023. Prior to the application release, interested organizations are encouraged to submit Letters of Intent to CMS by September 15, 2023. The model will run for eight years beginning July 1, 2024.

If you are interested in receiving additional information, updates or have questions about the GUIDE model, please send an email to the GUIDE Model team’s inbox.

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