ADAPT Act Expands Medicare Mental Health Coverage: Trainees Can Bill Under 'General Supervision,' Starting Next Year

The newly proposed Accelerating the Development of Advanced Psychology Trainees Act (ADAPT Act) is looking to tackle the mental health access problem by changing who Medicare pays for. Essentially, this bill opens the door for advanced psychology trainees—think doctoral interns and post-doctoral residents—to bill Medicare for services, even before they have their full license. This is a big deal for both patients and the mental health workforce.

The Super-Supervisor Loophole: General Supervision

The core change is found in Section 2, which expands Medicare coverage for services provided by these trainees. Currently, Medicare often requires a licensed professional to be right there, physically present, during the service. The ADAPT Act changes this by allowing these services to be covered under “general supervision.”

What does “general supervision” mean in the real world? It means the licensed clinical psychologist is still responsible for the care and overall direction, but they do not have to be physically in the room or even in the building while the trainee is working with the patient. For a busy person needing therapy, this could mean faster access to care, especially in rural or underserved areas where a fully licensed psychologist can’t be everywhere at once. The bill specifies that this coverage kicks in one year after the Act passes, giving the Department of Health and Human Services (HHS) time to create a specific billing code (a “GC modifier code”) to track these services.

Who Are These Trainees, and What’s the Catch?

The bill is very specific about who qualifies: it’s doctoral interns finishing their required, year-long supervised training, and post-doctoral residents who already have their doctorate but are completing the final supervised hours needed for state licensure. These are people who are highly trained and on the cusp of becoming fully independent professionals.

However, the shift to “general supervision” (instead of direct, in-person supervision) is where the rubber meets the road. While this change is crucial for expanding the workforce—allowing trainees to gain experience and serve more patients—it raises questions about quality control. For Medicare beneficiaries, especially those with complex mental health needs, the level of oversight matters. If a supervising psychologist is overseeing several trainees remotely, the immediate safety net of having a licensed professional nearby is gone. The quality of care will heavily depend on how strictly HHS defines the operational standards of “general direction and control.”

Pushing Mental Health Access to Medicaid and CHIP

Beyond Medicare, Section 3 of the ADAPT Act focuses on getting states to adopt similar policies for Medicaid (Title XIX) and CHIP (Title XXI). The Secretary of HHS is required to issue guidance within one year to states, showing them the “best legal ways” to cover services provided by these advanced trainees. This guidance will include technical assistance, billing codes, and examples of states that have successfully used waivers to make this happen.

For working families relying on Medicaid or CHIP, this provision is potentially huge. By eliminating state-level roadblocks, the bill aims to standardize and expand access to mental health services for low-income populations. If states take this guidance seriously, it could significantly boost the number of available mental health providers in community clinics and hospitals that serve these populations, making it easier for a parent or a shift worker to finally get an appointment without a six-month wait.