In a landmark proposal, the Centers for Medicare & Medicaid Services (CMS) has outlined sweeping changes to Medicare Advantage (MA) programs that promise to reshape behavioral health access for millions of beneficiaries. The comprehensive reforms target long-standing barriers to mental health care and embrace technological innovation. They are embodied in this proposed rule.
In a formal statement to CMS, the National Board for Certified Counselors (NBCC) expressed support for the reforms contained in the proposed regulation and highlighted the implications for counselors and their practices. Learn more about NBCC’s comments on key provisions.
Breaking Down Barriers to Mental Health Care
At the heart of the proposal is a dramatic reduction in cost-sharing for behavioral health services. The proposed rule represents one of the largest expansions of behavioral health access in MA history. The new structure slashes client costs for mental health services from the current 30%–50% range to only 20% coinsurance, matching Traditional Medicare rates. Other key provisions include:
Streamlining Prior Authorization
Mental health providers have long struggled with burdensome prior authorization requirements. The new rule implements stronger oversight to curb excessive requirements, with CMS mandating clearer coverage criteria and enhanced transparency in plan policies. These changes aim to reduce administrative overhead and speed up access to critical mental health services.
Technology Meets Accountability
In a forward-thinking move, CMS is establishing the first comprehensive guidelines for artificial intelligence (AI) use in health care decision-making. The regulations ensure AI systems maintain equitable access and prevent discrimination, reflecting the growing role of automation in health care delivery while protecting client interests.
Simplified Plan Comparison
Finding the right MA plan is about to become easier. The proposal integrates provider directory information directly into the Medicare Plan Finder, creating a one-stop shop for beneficiaries to compare plans and provider networks. This long-awaited improvement addresses years of beneficiary feedback about the challenges of navigating multiple platforms to make informed health care choices.
Key Takeaways for Counselors:
- lower patient cost-sharing for mental health services
- improved access to services for clients
- reduced administrative burden through streamlined prior authorization
- new AI guidelines ensuring fair coverage decisions
- improved visibility in the Medicare Plan Finder
These reforms signal CMS’s strong commitment to expanding mental health access while modernizing MA operations. As the health care landscape continues to evolve, NBCC believes these changes position behavioral health services for greater accessibility and efficiency in the years ahead.
What's Next?
The proposed MA changes are scheduled to take effect Jan. 1, 2026, pending final approval. NBCC will monitor the final rule-making process for any changes to key provisions based on comments from NBCC and other stakeholders. The final rule is expected to be issued in April.
