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Marriage and Family Therapists and Mental Health Counselors in Hospice Care

The Centers for Medicare and Medicaid Services (CMS) has updated the Medicare Benefit Policy Manual to include services by marriage and family therapists (MFTs) and mental health counselors (MHCs) in hospice care. This expansion aims to enhance the psychosocial services available to hospice patients and their families. While hospices are not required to hire MFTs and MHCs, those that do must adhere to specific requirements.

To help hospice providers navigate the updated benefit, Axxess created a one-page reference guide to promote a better understanding of MFTs and MHCs and their role in hospice care.

Zaundra Ellis, Vice President of Hospice Professional Services at Axxess, created the guide and details what providers can expect when incorporating MFT and MHC services in patient care.

Enhancing the Patient Experience

Ellis shares that the primary reason CMS expanded the benefit to include MFTs and MHCs is to provide the patient and their families with specialized counseling that a hospice social worker may not be equipped to take on. She says that patients with family issues that arise at the end of life and patients battling mental health issues are those who would benefit from specialized care.

“While the social worker certainly has the training and should have the skills to provide counseling services related to family issues and maybe even related to mental health, having those specialists in there may be better for the patient and family who are experiencing family issues or mental health [issues],” Ellis said.

The addition of MFTs and MHCs also helps alleviate ongoing staffing shortages and lightens the load of over-worked social workers.

“If [social workers] have 50 patients on their caseload and they’ve got two families experiencing wild dynamics and three patients who are being affected by mental illness, they’re going to struggle to make sure everybody’s cared for,” Ellis said.

Ellis advises that despite tough financial times, hospice operators should weigh their options and hire counselors and therapists to benefit their organization.

“Find these counselors, these therapists, talk to them and then bring them on as PRN employees, so that when the occasion arises, you have them and you can use them,” Ellis recommended.

Training and Effective Communication

Ellis shares that it’s important for therapists and counselors to have a solid understanding of the hospice benefit to see success in the role.

“You really want to make sure that they understand the core benefit, how the interdisciplinary team functions, how they work together and that their role is to complement the interdisciplinary care the patient is getting,” Ellis said.

She notes that training platforms like Axxess Training and Certification+ can provide organizations with the tools needed to educate those unfamiliar with the hospice benefit.

Ellis also outlines the importance of effective communication when bringing on MFTs and MHCs, highlighting that not only do therapists need to understand the role of the hospice benefit and how the interdisciplinary group (IDG) functions, but members of the IDG also need to understand the role of the therapist.

“We need to make sure that our teams – our existing teams – understand the importance of having these counselors and how they complement the care we’re providing,” Ellis said. “They’re not coming in to replace anybody.”

She recommends organizations look to messaging tools so therapists and counselors are notified of patient changes in a timely manner, especially if they work as part-time employees for the organization. She also encourages organizations to invite MFTs and MHCs to at least one IDG meeting each month to stay on track.

W-2 Employee Status

Focusing on the collaborative nature of hospice care, Ellis notes that MFTs and MHCs must be W-2 employees and can be full-time, part-time or PRN based on the needs of the organization. In order to receive and meet benefit standards and provide adequate care, they cannot be contractors.

“Psychosocial services are part of the core services provided to patients,” Ellis said. “The regulations are very clear that those core services have to be provided by an employee of the hospice, with the exception of the physician. They can be contracted.”

To download Ellis’ guide on hospice MFTs and MHCs, click here.

Axxess Hospice, a cloud-based hospice software, includes simple tools such as a robust messaging center to facilitate easy communication between users.


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