Reflections on 2024 and What Lies Ahead in 2025 for Behavioral Health Professionals

The behavioral health industry navigated significant challenges in 2024, prompting a look back at the year's major disruptions and a preview of critical updates for 2025.

2024 Challenges

Change Healthcare Crisis

In February, a major disruption affected claim processing across the nation. "Our industry had to pivot immediately in order to get 1/3 of our country's claims processed," with ongoing remittance issues persisting throughout the year.

21st Century Cures Act Implementation

July's enforcement created enrollment confusion. Many providers discovered they weren't properly enrolled with Medicaid despite earlier confirmations, resulting in payer warning letters. For a detailed breakdown of what this means for your practice, see our post on checking your practice's Medicaid info.

Optum Supervision Rule Changes

Optum eliminated group approval for supervised billing claims and altered submission requirements, necessitating software updates across the industry.

Consolidation Concerns

"It's getting harder to run a private practice, and investors and healthcare systems are buying up clinics left and right because owners are tired," reflecting broader market pressures. Workforce shortages and burnout are contributing factors that are pushing many practice owners toward the exit.

2025 Payer Updates

Minnesota Medicaid Programs (PMAPs)

• UnitedHealthcare Community Plan: Terminating 12/31/2024
• HealthPartners: Closed to new enrollees (limited exceptions)
• Blue Plus: Expanding to Ramsey and Scott Counties
• Medica: Available in expanded counties
• UCare: Restricted enrollment except Hennepin County

Keep up with the latest Medicaid payer policy updates as these changes continue to evolve into 2025.

Medicare Developments

LMFTs, LPCCs, and master's-level LPs gained Medicare eligibility in 2024. Critical clarifications emerged regarding supervision and Medicare provider enrollment requirements.

Key point: "Behavioral health supervision claims are not allowed. Providers who aren't fully licensed and enrolled with or Opted Out of Medicare may not see Medicare or Medicare Advantage clients."

Other Payer Changes

• Mayo Medica Plan: Claims processing transitions to Optum
• Surest: Large corporations (Google, Microsoft, UPS) shifting to Optum-administered plans
• Tricare: BlueCross BlueShield assumes administration via TriWest Healthcare Alliance
• UCare ARMHS: Increased authorization thresholds for specific service codes

Medicaid Requirements

Medicaid now functions as the "Payer of Record," requiring practices to verify:

• Proper Medicaid enrollment
• Correct address information
• Matching taxonomy codes across NPPES and claims systems
• Proper provider affiliation with groups

This makes provider credentialing and enrollment more critical than ever — mismatches between your Medicaid records and commercial payer data can halt claim payments entirely.

Minnesota Debt Fairness Act Implications

New regulations restrict collection practices:

• Healthcare providers cannot refuse medically necessary care due to debt
• Collections policies must be posted and accessible
• Credit reporting restrictions apply to collection agencies
• Payment plans must account for patient financial circumstances
• Billing errors require notification and review before collection

Recommendation: Implement cards-on-file systems and formal write-off and collections policies. Understanding collections and write-offs is increasingly important given these new restrictions.

Contracting Timeline Impact

Medicaid's new "Payer of Record" status has extended commercial contract updates by 30–45 days. Practices must update Medicaid first, then submit changes to commercial payer contracts.

Looking Ahead

The consolidation trend in behavioral health is real, but independent practice owners have tools and partners to fight back against it. In 2025, the focus should be on reducing administrative burden, staying current on payer changes, and advocating for the future of private practice. BreezyBilling and sister company Phoenix Credentialing are committed to supporting providers through these challenges. Subscribe to our Trade Winds newsletter to stay ahead of payer and regulatory changes as they happen.