Ohio Mental Health Counselors Association

Matters of Interest

New Legislation to Cover Mental Health Counseling Under Medicare (SAMPLE LETTER TO SENATORS)

Co-Sponsors Needed--Contact Your Senators

On March 14, 2013, Senators Ron Wyden (D-OR) and John Barrasso (R-WY) reintroduced Medicare legislation covering the services of mental health counselors (MHCs) and marriage and family therapists (MFTs) under part B of the Medicare program. The time to promote Medicare recognition of MHCs and MFTs is now. Urge your U.S. Senators to support S.562, which would authorize MHCs and MFTs to be paid by Medicare for outpatient mental health services to beneficiaries. (To view the bill text and sponsor introductory comments in the Congressional Record, please click on the link below and go to page S1853.)
http://www.gpo.gov/fdsys/pkg/CREC-2013-03-14/pdf/CREC-2013-03-14-pt1-PgS1853-3.pdf#page=1

Action Requested
OMHCA members are urged to email their two U.S. Senators and urge them to co-sponsor S.562, sponsored by Senators Ron Wyden and John Barrasso. Respondents can find their Senators' e-mail address on their office websites.
Download a sample e-mail message to Senate offices:
Sample letter .doc version

Background and Justification
About 50 percent of rural counties have no practicing psychiatrists or psychologists. MHCs and MFTs are often the only mental health providers in many communities, yet they are not now recognized as covered providers within the Medicare program. These therapists have equivalent or greater training, education and practice rights as currently eligible provider groups that can bill for mental health services through Medicare.

Other government agencies already recognize these professions for independent practice, including The National Health Service Corps, the Dept. of Veterans' Affairs, and TRICARE. Medicare needs to utilize the skills of these providers to ensure that beneficiaries have access to these services.

Lack of Access in Rural and Underserved Areas—Approximately 77 million older adults live in 3,000 mental health professional shortage areas. Fully 50 percent of rural counties in America have no practicing psychiatrists, psychologists, or social workers. However, many of these mental health professional shortage areas have MHCs whose services are underutilized due to lack of Medicare coverage.
Medicare Inefficiency—Currently, Medicare is a very inefficient purchaser of mental health services. Inpatient psychiatric hospital utilization by elderly Medicare recipients is extraordinarily high when compared to psychiatric hospitalization rates for patients covered by Medicaid, VA, TRICARE, and private health insurance. One-third of these expensive inpatient placements are caused by clinical depression and addiction disorders that can be treated for much lower costs when detected early through the outpatient mental health services of MHCs.
Underserved Minority Populations—The United State Surgeon General noted in a report entitled "Mental Health: Culture, Race, and Ethnicity" that "striking disparities in access, quality, and availability of mental health services exist for racial and ethnic minority Americans." A critical result of this disparity is that minority communities bear a disproportionately high burden of disability from untreated or inadequately treated mental disorders.
Medicare provider eligibility for MHCs and MFTs is long overdue—These two professions represent over 40 percent of today's licensed mental health practitioners. Unfortunately, Medicare has not been modernized to recognize their essential contribution in today's health delivery system. Congressional scoring rules obscure the dollars saved by utilizing their services to treat mental health conditions before they exacerbate into more serious mental and physical disorders.

SAMPLE LETTER TO SENATORS

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*Fact Sheet: Allowing Licensed Professional Clinical Counselors
to Initiate the Ohio Mental Health Hold

TRICARE UPDATE:

ACA UPDATE: DoD Clarifies TRICARE Rule in Response to ACA Request, as Sequester Hits Program

The Department of Defense (DoD) has clarified aspects of its interim final rule (IFR) establishing certification criteria for licensed mental health counselors participating in the TRICARE program, in response to a request submitted by ACA. In a letter to ACA Executive Director Richard Yep, Assistant Deputy Director Mary Kaye Justis confirmed that counselors who meet the education, examination, and supervision requirements in effect during the transition period (from now through December 31, 2014) will continue to be recognized as independently practicing mental health counselors after the transition period ends. ACA asked DoD to clarify this issue because several of our members were being told that they would not be recognized after the transition period ended. DoD’s letter expressed appreciation for ACA bringing this issue to their attention, and stated “We have discussed this issue with the TRICARE Regional Offices to ensure accurate implementation of the IFR by the Managed Care Support Contractors who interface with applicants.”

During the transition period, the IFR allows certification of counselors with a degree from a regionally (but not CACREP) accredited program, completion of 2 years/3,000 hours of post-master’s supervised experience, and passage of the National Clinical Mental Health Counseling Exam (NCMHCE). When the transition period ends, on January 1, 2015, the certification criteria will require that counseling degrees be from CACREP accredited programs. (CACREP is an acronym for the Council on Accreditation of Counseling and Related Educational Programs, one of the two national accreditation entities. The other national accreditation body for counseling graduate programs is the Council on Rehabilitation Education, or CORE.)

In its letter, DoD stated that counselors wishing to become certified as mental health counselors within TRICARE under the transition period requirements must complete those requirements before the transition period ends. However, “…while these certification requirements must be completed prior to January 1, 2015, the IFR permits an applicant to become a CMHC [certified mental health counselor] after the transition period if all of the certification requirements were completed before the end of the transition period.” [emphasis in original]

ACA has confirmed with DoD staff that while completing the requirements must happen before January 1, 2015, counselors can become certified after that date. ACA has asked DoD to consider both extending the transition period, and to allow counselors to complete the supervision and examination requirements after January 1, 2015, as long as they have met the degree requirement (which does not require CACREP accreditation) during the transition period. The supervision and examination requirements in effect beginning in 2015 are the same as are required of counselors with regionally accredited degrees during the transition period.

According to DoD staff, the agency will issue a final rule on counselor certification, which may include changes to the requirements. There is no word yet on when the final rule will be released.

In other news, TRICARE will be impacted by the sequestration taking place across most federal programs and agencies. TRICARE staff and civilian personnel may be furloughed for one day a week, constituting a 20% pay cut. Contracts, however, should not be affected. It is unclear at this point if, or how, TRICARE reimbursement rates will be affected by sequestration.

For more information on TRICARE issues, contact Scott Barstow with ACA at sbarstow@counseling.org.