DEPARTMENT  OF  HEALTH  &  HUMAN SERVICES  
Centers for Medicare & Medicaid Services  
7500  Security  Boulevard,  Mail  Stop  S2-26-12  
Baltimore, Maryland   21244-1850  
CENTERS FOR MEDICARE & MEDICAID SERVICES 
  CENTER FOR MEDICAID & CHIP SERVICES 
 
 
CMCS  Informational  Bulletin  
 
DATE:   December 14, 2023  
 
FROM:   Daniel  Tsai,  Deputy  Administrator  and  Director   
  Center for Medicaid and  CHIP Services  
 
SUBJECT:   Guidance to State Medicaid Agencies on  Dually Eligible Beneficiaries  
Receiving Medicare Part  B Marriage and Family Therapist Services,  
Mental Health Counselor Services, and Intensive Outpatient Services  
Effective January 1, 2024 
 
The Center for Medicaid and CHIP Services (CMCS) is issuing this CMCS Informational 
Bulletin (CIB) to  advise state Medicaid agencies that  starting on January 1, 2024, Medicare will  
begin covering and making payment for  the services of  marriage and  family therapists  (MFT)  
and mental health counselors  (MHC), and intensive outpatient program  (IOP) services  as  
authorized by Sections 4121 and 4124, respectively, of the Consolidated Appropriations  Act,  
2023 (CAA, 2023)  (P.L.  117-328, enacted  on  December  29, 2022). These provisions were  
implemented  as part of  the Calendar  Year (CY)  2024 Physician Fee Schedule final rule (Centers  
for Medicare & Medicaid  Services (CMS)-1784-F, Revisions to Payment Policies under the  
Medicare Physician Fee  Schedule, Quality Payment Program and Other Revisions to Part B for  
CY 2024) and the  CY 2024 Hospital Outpatient Prospective Payment System (OPPS) and 
Ambulatory Surgical Center (ASC) final rule  (CMS-1786-F), issued on November 2, 2023.  
 
For dually eligible beneficiaries  (those  enrolled in both Medicare  and Medicaid) who receive  
Medicaid coverage of services furnished by MFTs or MHCs, or  IOP services furnished by 
hospital outpatient  departments, community mental health centers  (CMHC), rural health clinics  
(RHC), federally qualified health centers (FQHC), or opioid treatment programs (OTP), 
beginning on January 1, 2024, Medicare will become the primary payer for these services  
provided by Medicare-enrolled  practitioners or providers. CMS  expects  that most facilities that 
will begin furnishing Medicare-covered IOP services in CY 2024 will already be enrolled as  
providers under Medicare. However, not all  MFTs and MHCs  will have completed  the Medicare 
enrollment process  and be able to bill Medicare  for MFT or MHC services  by this date. In an 
effort to prevent any disruption in treatment for dually eligible beneficiaries, CMS is providing 
background information on the enrollment of MHCs, MFTs, and providers  of  IOP services and is 
providing clarification on options available for coordination of benefits/third party liability under  
Medicaid.  
 
Background  
 
Typically, State Medicaid  agencies may not pay claims if it is likely that a  third party (such as  
Medicare) is liable for the claim, as Medicaid is generally the payer of last  resort. For dually 
eligible beneficiaries, Medicare is generally liable for claims for Medicare-covered services,   Page 2  CMCS  Informational Bulletin  
 
including MFT  services,  MHC  services, and  IOP  services  furnished on or  after January 1, 2024, 
and thus  State Medicaid  agencies  are  required to cost-avoid claims for such services, or seek  
reimbursement from the  practitioner or provider. Currently, MFTs and MHCs provide  services  
that can be covered as an  optional  state plan benefit such as services of other licensed  
practitioners  under the Medicaid state plan.  IOP services are generally covered through the  
optional rehabilitative  services benefit under the Medicaid state plan.   
 
MFTs and MHCs could begin submitting their Medicare enrollment applications after the CY  
2024 PFS final rule was issued on November 2, 2023. The effective date of  a MFTs  or  MHCs 
enrollment may be up to 30 days prior to the submission of the enrollment application to 
Medicare, but no earlier than January 1, 2024, which is the date the new benefits authorized by 
the CAA, 2023 take effect. Newly Medicare-enrolled MFTs and MHCs will not be granted an 
effective date  earlier than January 1, 2024, and claims with dates of service  prior to January 1, 
2024, will not be payable  by Medicare. Further, facilities that are newly enrolling in Medicare to  
furnish  IOP services will not receive Medicare payment for  IOP services for dates of service 
prior to January 1, 2024.  
 
Medicaid-enrolled MFTs and MHCs, and IOP service providers interested in becoming 
Medicare-enrolled  should follow the enrollment instructions found here. State Medicaid agencies  
---
may confirm a MFT or  MHCs Medicare enrollment status and effective date of enrollment  in 
Medicare using the Provider Enrollment Chain and Ownership System (PECOS) or PECOS  
extract files.   
 
In order for State Medicaid agencies to promote  continuity of care for dually eligible  
beneficiaries during this transition period, CMS is  clarifying ways Medicaid can pay for services  
delivered by providers who are not yet enrolled in Medicare while upholding their  
responsibilities to be the payer of last resort. However, States are encouraged  to reach out to their  
Medicaid-enrolled MFTs and  MHCs, and to IOP  service providers to advise them to enroll as  
quickly as possible in Medicare.  
 
Coordination of Benefits and  Third-Party  Liability Options for States  
 
While CMS  anticipates  that some MFTs, MHCs, and IOP service providers will become  
Medicare-enrolled on or  around January 1, 2024, many others will not be Medicare-enrolled by 
that date. MFTs, MHCs, and IOP  service providers cannot submit claims to Medicare or receive 
payment or even a denial of payment from Medicare unless they are enrolled in Medicare. Newly  
Medicare-enrolled MFTs, MHCs, and IOP service providers  can get  a retrospective billing date  
for up to 30 days prior to the effective date of  their Medicare enrollment, but no earlier than 
January 1, 2024.  
 
States must pay claims for  IOP services and services provided by MFTs and  MHCs delivered to 
dually eligible beneficiaries by Medicaid-enrolled providers who are not yet enrolled or choose 
not to enroll  in Medicare, to the extent that the services are covered in the state plan.  To prevent  
any disruption in IOP services and services provided by MFTs and MHCs for dually eligible  
beneficiaries, states have a few  options during the  interim until Medicare approves the  
practitioners  or providers enrollment:  
  Page 3    CMCS  Informational Bulletin  
 
1) The state may choose  to continue to pay MFTs, MHCs, and IOP  service  providers for  
claims for dually eligible individuals for a period in early 2024. A state may do so by not  
imposing systems edits to automatically reject claims at the start of 2024.  Alternatively,  a 
state may do so by suspending claims for dually eligible beneficiaries  from  MFTs, MHCs,  
and IOP service providers  until it is able to manually confirm the MFT,  MHC, or the  IOP  
service providers Medicare enrollment. Once the state verifies Medicare as a liable third  
party (that is, once the state verifies that the provider is enrolled in Medicare), the state  
must seek reimbursement within 60 days from the end of the  month in which it learns of  the 
providers enrollment with Medicare.  
 
Once a MFT, MHC, or  IOP  service provider becomes Medicare-enrolled, Medicaid must  
recoup (chase) all Medicaid payments from the MFT, MHC, or  IOP  service provider back 
to the effective date of the MFTs, MHCs, or  IOP  providers Medicare provider  
enrollment, and advise the provider to bill Medicare to receive payment for these services.   
 
2)A state may advise MFTs, MHCs, and IOP  service providers they can hold claims and 
bill Medicare once the provider becomes Medicare-enrolled. This process  will allow  
Medicare to review the claim and then cross the claim to Medicaid for payment  
automatically.   
 
Managed Care  
 
If  services provided by  MFTs and  MHCs, or  IOP  services are covered under  the Medicaid state 
plan and delivered through a managed care delivery system that includes dually eligible  
enrollees, states must ensure that their managed care organizations, prepaid inpatient health 
plans, or prepaid ambulatory health plans (referred to  as managed  care plans) are notified in a 
timely manner of which claims processing option described above they should employ and 
should evaluate if the selected option impacts capitation rate development  as appropriate.  States  
must also  ensure that their  managed  care plans can process timely and accurate claims payments  
to avoid any disruption or delay for  enrollees in accessing these services.   
 
States  are reminded  that Medicaid managed care  plans may have additional obligations to ensure  
parity in the coverage of  mental health and substance use disorder benefits compared to 
medical/surgical benefits, consistent with 42 CFR part 438, subpart K  and 438.3(n).  
 
Conclusion  
 
As  CMS  implements  the provisions  of the CAA, 2023, our top priority is ensuring that people  
have better  access to treatment.  States  are encouraged  to consider the best ways to achieve that  
goal, especially as Medicare participation evolves  over time. As always, CMS is happy to 
provide technical assistance to states on the information outlined in this bulletin.  
 
For specific questions related to third party liability, you may contact Ginger Boscas, Deputy 
Director within the Division of Health Homes, PACE, and Coordination of Benefits/Third Party 
Liability at Ginger.Boscas@cms.hhs.gov.