CMS 2025 Final Rule: New Behavioral Health Requirements for MA Plans - Veda Skip to content

CMS 2025 Final Rule: New Behavioral Health Requirements for MA Plans

Mental Health Awareness Month and Summary of New CMS Final Rule

Fitting for Mental Health Awareness Month, the Centers for Medicare & Medicaid Services (CMS) recently released its 2025 Final Rule that, among other things, aims to improve access to behavioral health providers for Medicare Advantage members.

Ready to learn about the CMS 2025 Final Rule and Veda’s strategic approach to its behavioral health network requirements?

The CMS 2025 Final Rule significantly expands the behavioral health network requirements for Medicare Advantage (MA) health plans. As reported by Fierce Healthcare, all Medicare Advantage plans will likely see increased administrative burdens due to the behavioral health network expansion requirements.

Not only is Veda a proven and trusted partner for achieving compliance with CMS requirements, Veda’s solutions are unrivaled in their ability to help health plans verify, expand, improve, and map their behavioral health networks.

Here are the behavioral health requirements covered in the Contract Year 2025 Medicare Advantage and Part D Final Rule and Veda’s approach:

New “Outpatient Behavioral Health” Category Added to Network Adequacy Evaluations 

Building upon CMS’s recent addition of a new benefit category for mental health counselors (MHCs) and marriage and family therapists (MFTs)—and recognizing that many MHCs and MFTs practice in outpatient behavioral health facilities—CMS has expanded its network adequacy requirements to include a new category called “Outpatient Behavioral Health.”

Wide Range of Specialists Included in “Outpatient Behavioral Health” Category

More specialties and outpatient care classifications were added to solve behavioral health provider shortages. The specialists in the new “Outpatient Behavioral Health” category include MHCs, MFTs, Opioid Treatment Program providers, Community Mental Health Centers, addiction medicine physicians, nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs).

Skill Sets of Certain Behavioral Providers Must Be Verified 

“Outpatient Behavioral Health” Facility Added to Time & Distance Standards and Telehealth Specialty Requirements

CMS now includes the “Outpatient Behavioral Health” facility specialty in the list of specialty types that will receive a 10% credit toward meeting time and distance standards. Additionally, MA plan’s networks must include at least one telehealth provider within the Outpatient Behavioral Health specialty.

Veda is Equipped to Meet The Needs Introduced By The 2025 CMS Rule Changes

Veda excels at helping health plans and systems connect members with behavioral health services, treatment facilities, and telehealth providers. The 2025 MA rule changes are an opportunity for health plans and health systems to explore how Veda can help them expand, improve, and map their behavioral health networks and verify the claims data for behavioral health providers.

Veda’s solutions can help connect members to quality behavioral health services more quickly, efficiently, and at less cost than the traditional methods relied on in the past. Armed with the most accurate provider data available, Veda’s solutions contribute to positive member experiences while helping people find the right care for their behavioral health needs.



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