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Congress Passes NDAA Recommending Independent TRICARE Practice for Counselors
On December 22, 2010, Congress passed legislation that directs the Secretary of Defense to implement regulations authorizing counselors to practice independently under TRICARE by June 20, 2011. This language is a significant accomplishment for the counseling profession and the culmination of many years of hard work by NBCC, AMHCA and ACA.
The language was included in the National Defense Authorization Act (NDAA), which authorizes appropriations for fiscal year 2011 for the Department of Defense's military activities. On December 17, 2010, the House passed H.R. 6523, which was the product of negotiations between the House and Senate Armed Services Committees. The Senate passed an amended version of H.R. 6523 on December 22, which the House approved by unanimous consent on the same day. The bill has been sent to the President for his signature.
Section 724 of H.R. 6523, entitled Licensed Mental Health Counselors and the TRICARE Program, states in full:
Not later than June 20, 2011, the Secretary of Defense shall prescribe the regulations required by section 717 of the National Defense Authorization Act for Fiscal Year 2008 (Public Law 110-181; 10 U.S.C. 1073 note).
Section 724 is similar to past House language, but significantly different than Senate legislation. The provision does not establish any criteria in law for practicing independently: it does not reference a degree from a CACREP program or passage of the NCMHCE as recommended by the Institute of Medicine (IOM). Rather, the language directs the Defense Department to establish the criteria for independent practice.
As previously reported, Congress commissioned a study by the IOM of counselor participation in TRICARE. The study recommended specific criteria for independent practice, including a CACREP degree and passage of the NCMHCE. NBCC, AMHCA and ACA successfully convinced Congress to leave the criteria out of this law because it ties the hands of the Defense Department and the omission allows for greater flexibility in counselor participation in the future.
Once signed by the President, the new law will set a deadline of June 20, 2011, for new regulations authorizing counselors to practice independently. NBCC, AMHCA and ACA will be trying to work with the Defense Department to ensure the regulations are inclusive of all qualified professional counselors.
If you have any questions about the passage of the NDAA or the language referencing counselors in the NDAA, please do not hesitate to contact advocacy@nbcc.org.
Iowa Senator Charles Grassley is on the Senate committee writing Medicare law
Template Letter to Senator Grassley
Ask the Senator to cosponsor S. 671, the “Seniors Mental Health Access Improvement Act,” to show support for improving Medicare beneficiaries’ access to outpatient mental health services.
We want Senator Grassley to know the legislation needs to include a provision establishing Medicare coverage of licensed mental health counselors.
Please use the time between now and Labor Day to let Finance Committee Ranking Member, Senator Chuck Grassley, know that LMHCs/LPCs should be included in any health care reform legislation for the following reasons:
690 licensed mental health counselors/ licensed professional counselors (known as licensed mental health counselors in Iowa) practice in Iowa.
S. 671 also known as H.R. 1693 has been included in the House Tri-Committee’s health care reform bill, H.R. 3200, in Section 1308. It has passed the House before as part of the CHAMP Act. We’d like for Senator Grassley to support S. 671 as well as ask for its inclusion in the Senate Finance Committee’s health reform bill.
S. 671 has been scored by CBO as costing $500 million over 10 years and $200 million over 5 years.
S.671’s language for Medicare reimbursement of LMHCs/LPCs must be included in the Senate Finance Committee’s health reform bill to…..
1) Expand Access to Outpatient Mental Health Providers- Federal govt. statistics emanating from the Health Resources and Services Administration of the Department of Health and Human Services show approximately 77 million older adults live in 3,000 mental health professional shortage areas and fully 50 percent of America’s rural counties lack practicing psychiatrists, psychologists, and social workers. Many of these mental health care shortage areas do have practicing LMHCs/LPCs whose services are currently not reimbursed under Medicare. Most of Iowa consists of mental health care shortage areas!
2) Reduce Medicare Inefficiency- Medicare spends 80 percent of its mental health costs on the more expensive inpatient mental health care versus only 20 percent of its mental health costs on the less costly outpatient mental health (CMS). In 2002, Medicare spent $9,660 per inpatient mental health claimant as opposed to $549 per outpatient mental health claimant (Mental Health United States – 2004, Numbers & Trends of Persons with Mental Health and Substance Abuse Disorders in Payment for Their Services in the Public and Private Health Sectors, Chapter 16, pages 149 thru 180).
3) Honor LMHC/LPC Education and Training Comparable to LCSWs- Licensed clinical social workers (LCSWs) with education hours (minimum of 48-60 hours of graduate school) and training comparable to LMHCs/LPCs are currently reimbursed for outpatient mental health services at 75 percent of the allowable rate under Medicare. Iowa LMHCs, like LCSWs, have a minimum of a Master’s degree, passage of a clinical examination, a minimum of 2 years of supervision or equivalent in full time supervised work experience in mental health counseling following completion of all graduation requirements, concurrent with 1,000 hours of mental health counseling conducted with clients face-to-face, and 100 hours of individual supervision by a licensed mental health counselor. LMHCs/LPCs have licensure in 49 states and the District of Columbia.
Please take a moment to do one or more of the following:
1. Call Senator Grassley’s office in Washington, D.C. and ask to talk to the aide who handles Medicare issues. Whether you talk to this person, or are asked by the receptionist to leave a message, describe why Medicare should cover licensed professional counselors, and ask the Senator to cosponsor S. 671, the “Seniors Mental Health Access Improvement Act,” to show support for improving Medicare beneficiaries’ access to outpatient mental health services. Be sure to leave your name and postal address so that the Senator can get back to you.
2. Send Senator Grassley an e-mail or letter conveying the same information. The following link will take you to a direct email page http://grassley.senate.gov/contact.cfm
3. Call one of Senator Grassley’s offices in the state near you, and set up a time when you can visit with one of the Senator’s staff members to discuss Medicare coverage of counselors.
Senator Grassley’s Washington, D.C. office can be reached at 202-224-3744, and his district office phone numbers are as follows:
Cedar Rapids (319) 363-6832
Council Bluffs (712) 322-7103
Davenport (563) 322-4331
Des Moines (515) 288-1145
Sioux City (712) 233-1860
Waterloo (319) 232-6657
Senator Grassley's offices and upcoming appearances
California is Final State to License Mental Health Counselors
Alexandria, VA – October 12, 2009 – With today’s signing of California Senate Bill 788 by Governor Arnold Schwarzenegger, mental health counselors are now licensed as master’s degreed mental health professionals in all 50 states and the District of Columbia.
"Achieving licensure in every state is a tremendous victory, both for mental health counselors and for those seeking their services," said AMHCA president Linda Barclay, PhD, LPCC/S, LICDC, NCC.
AMHCA recognizes the efforts of the California Coalition for Counseling Licensure (CCCL), which worked actively for licensure of mental health counselors, to be known in California as licensed professional clinical counselors (LPCCs). AMHCA assisted the CCCL in its lobbying efforts, producing letters in support of SB 788 to Assembly and Senate Business and Professions Committee chairs and members.
"AMHCA deeply appreciates the hard work of CCCL in this historic achievement," said Mark Hamilton, PhD, AMHCA executive director and CEO.
Governor Schwarzenegger will appoint two LPCCs to the Board of Behavioral Sciences, which is already comprised of two licensed clinical social workers, a licensed educational psychologist, and two licensed marriage and family therapists. SB 788 defines "professional clinical counseling" as being focused exclusively on the application of counseling interventions and psychotherapeutic techniques for the purposes of improving mental health. Under SB 788, the LPCC profession does not include the assessment or treatment of couples or families unless the LPCC has completed additional training and education beyond the minimum education and training required for LPCC licensure.
The law will go into effect on January 1, 2010. At that point, the Board of Behavioral Sciences will have the responsibility for developing the rules and regulations to implement the bill and it will prepare to accept LPCC applications.
Applications for grandparenting and reciprocity will be available on January 1, 2011, through the Board of Behavioral Sciences. Applications for regular licensure will be available on January 1, 2012, for those not eligible for grandparenting or reciprocity.
American Mental Health Counselors Association. (10/12/09). Retrieved from: www.amhca.org.
Senate Health Reform Package Falters, Failing to Include Medicare Recognition of LMHCs
This past Wednesday Senate Majority Leader, Harry Reid (D-NV), unveiled the Senate’s health care reform package. He pronounced the bill as being one to expand health care coverage to millions of Americans. As currently written, the Senate’s health care reform bill continues to deny mental health access to millions of Medicare beneficiaries. The bill unveiled by Senator Reid lacks Medicare eligibility of licensed mental health counselors (LMHCs).
For months, AMHCA, in conjunction with other organizations representing the interests of mental health counselors and marriage and family therapists, has pushed for inclusion of Senator Lincoln’s Medicare reimbursement bill, S. 671, in the Senate’s health care reform package. AMHCA’s cries to include Medicare reimbursement in the Senate health care reform bill are falling on deaf ears, as every U.S. Senator’s office has been appraised of S. 671 and the great need for it enactment, but S. 671’s Medicare reimbursement of LMHCs cannot be found anywhere in the Senate’s health care reform bill.
It’s not too late for your U.S. Senators to include S. 671 in the final Senate health care reform bill. With over 77 million Americans residing in areas characterized as mental health shortage areas and a great share of well-educated and highly trained LMHCs residing in underserved areas, there is no reason to deny LMHCs recognition under Medicare. The House rose to the occasion two weeks ago, including Medicare recognition of LMHCs in Section 1308 of its health reform bill, H.R. 3962, the Affordable Health Care for America Act. Economically, it would be an exercise of fiscal prudence to make LMHCs eligible as outpatient Medicare mental health providers. The Congressional Budget Office’s recent scoring of Medicare recognition of LMHCs came to $400 million over 10 years. Medicare presently spends mental health dollars inefficiently, with 80 percent of its mental health costs going to higher cost inpatient health care and only 20 percent being directed at lower cost, preventive outpatient care, like psychotherapy. Increased access to outpatient mental health providers can reign in the higher costs stemming from inpatient mental health care and chronic physical illness, each arising from lack of outpatient mental health care services.
AMCHA urges its members to call their U.S. Senators and ask that they sign onto S. 671 as a cosponsor and additionally ask for S. 671’s inclusion in the Senate health care reform bill. Over 100,000 highly trained mental health clinicians stand ready and able to deliver outpatient mental health services to Medicare beneficiaries. Please call the Capitol Switchboard at (202)-224-3121 and ask to be connected to your U.S. Senators’ offices. Let your Senators know you stand ready, willing, and more than competent to provide much needed mental health services to Medicare’s beneficiaries. Let them know enhanced access to mental health care in conjunction with a reduction in overall health care expenditures CAN BE and MUST BE achieved via incorporation of S. 671 into the Senate’s health reform package.
American Mental Health Counselors Association. (11/20/09). Retrieved from: www.amhca.org.
ARCHIVE: Iowa Public Radio Debate - Feb 1, 2010
IMHCA President Cindy R. Boyle and the Executive Director of Federation of Iowa Insurers, Paula Dierenfeld, debate current mental health legislation. Specifically, legislation being examined during this legislative session which would require broader insurance coverage for mental health issues including drug or alcohol addiction. Listen to an audio archive of the discussion
Check out the April IMHCA newsletter for more info on IMHCA's current legislative efforts.
