The Centers for Medicare and Medicaid Services (CMS) posted an FAQ on Mental Health Counselors (MHC) and Marriage and Family Therapists (MFT) on the CY 2024 Physician Fee Schedule (PFS) proposed rule related to the existing enrollment process on September 13, 2023. The FAQs outline proposed qualifications and enrollment steps these professionals would need to take to get enrolled in Medicare so they can bill Medicare for services.

Question 28 in the FAQ includes MFT and MHC in hospice: Can MFTs and MHCs serve as members of the hospice interdisciplinary team? Yes, the hospice interdisciplinary team is required to include at least one social worker, MFT or MHC. In LeadingAge’s comments to CMS on the PFS, we noted our concerns with recent CMS staff clarifications regarding this provision on the August 30 Open Door Forum (ODF) call. CMS personnel, in response to a question about this MFT and MHC in hospice, implied that hospices would be required to employ or contract with all three discipline types (social worker, MFT, and MHC).

Based on the way the statutory provision is written, as well as communication with Congressional offices, that was not the intent of the legislative language which was passed last year and is not a reasonable interpretation for implementation and enforcement purposes.

LeadingAge asked that CMS finalize the rule with clear language stating that hospices may use MFTs and MHCs as appropriate but underscore that it is not a requirement to make them available, even when counseling services are in the plan of care. LeadingAge will continue to advocate with CMS and the Administration on this critical distinction.