ASAM Requests Legislative Clarifications in U.S. House Ways and Means Committee Legislation to Expand Access to Mental Health and SUD Care Under Medicare

On September 28^th, ASAM wrote to the Chair Richard Neal and Ranking Member Kevin Brady of the U.S. House Ways and Means Committee, regarding the Committee’s recent markup of worker and family support and health legislation aimed to expand access to mental health and substance use disorder (SUD) care under Medicare. ASAM requested several, specific clarifications to be made to ensure that Medicare beneficiaries with a primary diagnosis of SUD or with no co-occurring mental health condition can access critical SUD services under Medicare. 

These include ensuring that: 1) Medicare covers intensive outpatient and partial hospitalization programs (IOPs and PHPs) for those with a primary SUD diagnosis or with no co-occurring mental health diagnosis, and that Medicare covers IOP and PHP services in free-standing SUD treatment facilities, 2) Medicare coverage of mental health counselors include qualified, licensed or certified SUD counselors, including at inpatient and skilled nursing facility settings, 3) the legislation’s outreach and education efforts are expanded to include the office-based bundled payments under the Medicare Physician Fee Schedule for SUD treatment (G2086-G2088), and 4) the HHS Secretary is required to provide guidance – under the Public Health Service Act, Internal Revenue Code, and Employee Retirement Income Security Act – on the generally accepted standards of care for SUD treatment, which includes The ASAM Criteria.

Read the letter here.