Important RHC Behavioral Health Provisions Proposed in President’s FY 2023 Budget

Sarah Hohman, Deputy Director of Government Affairs


In late March, the White House released President Biden’s proposed budget for Fiscal Year 2023 which will begin on October 1, 2022. It is very important to understand that this budget is only a proposal and will need to be enacted by Congress. However, the Biden Administration has included provisions specific to behavioral health services within RHCs, an important demonstration of the Administration’s priorities!

Rural Health Clinic Behavioral Health Initiative
The budget includes $10 million for a new RHC Behavioral Health Initiative. If approved by Congress, this would be the first federal grant program specifically for RHCs, building upon the success of the RHC Vaccine Confidence program in a prevalent issue area for rural communities! The initiative intends to achieve the following:

“To allow clinics in rural areas where there are no existing behavioral health providers to fund the salary of a

behavioral health provider, address provider burnout, and expand the availability of services such as mental health screenings, counseling, and therapy.”

Modernize Medicare Mental Health Benefits
Additionally, the budget includes a proposal recommending that Congress recognize Licensed Professional Counselors (LPCs) and Marriage and Family Therapists (MFTs) as mental health professionals in both fee-for-service Medicare as well as in the RHC setting. The proposal would:

“establish a Medicare benefit category for Licensed Professional Counselors and Marriage and Family Therapists that authorizes direct billing and payment under Medicare for these practitioners , remove limits on the scope of services for which Clinical Social Workers, Licensed Professional Counselors, and Marriage and Family Therapists can be paid by Medicare; allow these practitioners to bill Medicare directly for their mental health services for covered Part A qualifying Skilled Nursing Facility stays; establish Medicare payment under Part B for services provided under an Assertive Community Treatment delivery system; allow payment to Rural Health Clinics and Federally Qualified Health Centers for Licensed Professional Counselors and Marriage and Family Therapists providing mental health services; and enable Medicare coverage of evidence-based digital applications and platforms that facilitate the delivery of mental health services.”

Efforts to cover MFTs and LPCs as eligible Medicare providers have been ongoing for decades with bipartisan support, and its inclusion in the proposed budget encourages NARHC that 2022 may be the year we achieve this important change. Together, these policies could increase the pool of mental health providers that can provide crucial care within RHCs, while providing financial tools to recruit and retain these providers.

Since the release of the budget, NARHC sent letters to both the House HHS/Labor Appropriations Subcommittee and the Senate Committee on Finance in advance of their hearings on the budget, emphasizing our support of these critical initiatives. However, it will likely not be until the winter (or even next spring) before we know if Congress will indeed adopt these policies for RHCs. For instance, it wasn’t until March of 2022 that Congress finally passed the omnibus bill to fund the federal government for FY 22 after passing a series of continuing resolutions to keep the government open and funded since October of 2021. We anticipate a similar timeline for FY 23.

We encourage all RHCs to contact your Senators and Representatives to provide grassroots support for these behavioral health initiatives.

Sarah Hohman
National Association of Rural Health Clinics