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Matters of Interest

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Dear Ruthann Anderson,
Medicare Legislation Action Alert
New bills have been introduced in the House and Senate to extend Medicare provider status to mental health counselors and marriage and family therapists. On July 22, 2015 Senators John Barrasso (R-WY) and Debbie Stabenow (D-MI) introduced the “Seniors Mental Health Access Improvement Act” (S. 1830) and on June 12, 2015 Representatives Chris Gibson (R-NY) and Mike Thompson (D-CA) introduced the House version as (HR. 2759). The identical bills would allow Medicare beneficiaries access to mental health counselor services and marriage and family therapists (MFTs) through Medicare. By providing these mental health professionals the opportunity to participate in the Medicare program, the bills expand the number of mental health providers available to beneficiaries.

Describing the need for the legislation, AMHCA notes that in the United States 20 percent of individuals aged 55 and older experience some type of mental health problem. According to the Health Resources and Services Administration, there are approximately 4,000 Mental Health Professionals Shortage Areas in the United States, and half of all counties in the U.S. have no practicing psychiatrists, psychologists or clinical social workers. Seniors in rural communities are the most adversely affected by these shortage areas. The time to promote Medicare recognition of mental health counselors and MFTs is now. Urge your two Senators and Representative to co-sponsor this vital legislation that would authorize MHCs and MFTs to be paid by Medicare for outpatient mental health services to beneficiaries.

Action Requested
AMHCA members are urged to email their two U.S. Senators and one Representative to urge them to co-sponsor S. 1830/HR. 2759. AMHCA members may find their Senators and Representative’s email address on their office websites. See these suggested email messages to Senate and House offices.

Background and Justification
About 50 percent of rural counties have no practicing psychiatrists or psychologists. Mental Health Counselors and MFTs are often the only mental health providers in many communities, and 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 necessary services.
  • Lack of Access in Rural and Underserved Areas--Approximately 20 percent of individuals aged 55 and older experience some type of mental health problem. According to the Health Resources and Services Administration, there are approximately 4,000 Mental Health Professionals Shortage Areas in the United States, and half of all counties in the U.S. have no practicing psychiatrists, psychologists or clinical social workers. However, many of these mental health professional shortage areas have mental health counselors 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 mental health counselors 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.
Please direct inquiries to James K. Finley, AMHCA Associate Executive Director: jfinley@amhca.org

If you wish to stop receiving email from us, you can simply remove yourself by visiting: http://www.amhca.org/members/EmailOptPreferences
The American Mental Health Counselors Association (AMHCA) works to enhance the profession of mental health counseling through advocacy, education, licensure, and professional development.
AMHCA, 801 N. Fairfax Street, Alexandria, VA, 22314, 703-548-6002, www.amhca.org

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PRESS RELEASE

For Immediate Release: November 19, 2014
Contact: Whitney Meyerhoeffer
800-326-2642
wmeyerhoeffer@amhca.org
www.amhca.org


AMHCA Praises NBCC Action on CACREP

Alexandria, VA – The American Mental Health Counselors Association (AMHCA) is pleased the National Board for Certified Counselors (NBCC) has recently announced critically important changes in its educational requirements for professional counseling certification. Effective January 1, 2022, NBCC will require a master’s degree or higher from a CACREP-accredited counseling program to be recognized for the National Certified Counselor (NCC) certification. Beginning in 2022, this policy change will require all students to graduate from a program accredited by CACREP or face ineligibility to apply for the NCC, a key professional certification indicating recognition within the profession. View the NBCC announcement.
     NBCC’s action, which provides a grandfather clause for professionals who graduated before the end of 2021, ensures universities and students have sufficient time to obtain CACREP-accredited status. Since 2012, AMHCA has been at the forefront in calling for all schools of professional counseling to obtain CACREP accreditation, and the Association is highly supportive of this action by NBCC to reinforce this next step to full professional recognition. Like NBCC, AMHCA has also expressed full support for the recognition of professionals that have obtained their educational training before 2022. AMHCA plans to continue to advocate forcefully at the state and federal level for those professionals, including NCCs, who came earlier into the field and who continue to offer a wealth of training and experience to their profession.
     AMHCA represents and advocates for the needs of all Clinical Mental Health Counselors (CMHCs), including members that have graduated from programs that were not CACREP-accredited. Stephen A. Giunta, Ph.D., President of the American Mental Health Counselors Association praised the NBCC action on CACREP standards and noted their policy would permanently qualify non-CACREP professionals for practice. He added that a seven year window for counseling programs to make the change to CACREP is more than sufficient time. “Too often, members of the profession encounter barriers posed by federal program standards or from the wide variation in state standards for counselor recognition. Action is necessary now to advance standardized training across states and the profession,” said Dr. Giunta. “We also believe better unified state and federal professional standards will enable the advance of licensure portability, a problem that has long stymied critical mobility within our ranks, Giunta noted. Giunta also called on other organizations representing the profession and its training programs to join AMHCA and NBCC in supporting the adoption of CACREP standards for all programs of counselor education.

The American Mental Health Counselors Association (AMHCA) works to enhance the profession of mental health counseling through advocacy, education, licensure, and professional development.

AMHCA, 801 N. Fairfax Street, Alexandria, VA, 22314, 703-548-6002, www.amhca.org

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Many Licensed Professional Counselors will benefit under the Final Rule published today by the Department of Defense (DoD). The Final Rules apply to the TRICARE Certified Mental Health Counselors (TCMHC) category. Several provisions included were those advocated for by the American Counseling Association over the last several years.

 The Final Rule will finally allow LPCs meeting specific criteria to operate as independent practitioners under TRICARE.  This has been a key component in ACA’s efforts to demonstrate parity among those providing mental health services. In addition, TRICARE is extending the transition period for meeting education, examination, and supervised clinical practice criteria to January 1, 2017. Without this extension, the window for eligibility would have ended in just over five months on December 31. With the extension, our members will have had five full years to meet the criteria which include: 

 1. Possession of a master’s degree or higher from a mental health counseling program accredited by the Council for Accreditation of Counseling & Related Education Programs (CACREP) and passage of the National Counselor Examination for Licensure and Certification (NCE); OR, 

 2. Possession of a master’s degree or higher in counseling from a regionally accredited institution and passage of the National Clinical Mental Health Counseling Examination (NCMHCE). 
“DoD made the right choice in allowing LPCs to become independent practitioners in TRICARE, and with the extension of the time in which to meet the criteria,” said Robert L. Smith, ACA President.

 Another provision of the Final Rule will allow those in the Supervised Mental Health Counselor (SMHC) category to continue beyond the current December 31, 2014 deadline.  The SMHC works via physician supervision and referral. Those counselors in this category were going to lose that status and no longer be able to practice within TRICARE. These practitioners will now have an indefinite extension.

“We were very pleased that DoD made the wise decision to continue the SMHC category of provider. This move is congruent with many state licensure laws and helps to ensure that more LPCs will be able to practice under TRICARE,” said Richard Yep, ACA Chief Executive Officer.
 Many of the changes in the Final Rule encompassed the recommendations which were advocated by ACA.   “Our goal was to work diligently to ensure that the final rule was less exclusionary, and therefore would allow our members to provide help to service members and their families,” said Art Terrazas, ACA Director of Government Affairs. 

More details on the Final Rule will be coming soon but rest assured that ACA will continue to work for all LPCs to ensure they find a place within TRICARE. Please stay tuned to ACA communications channels for more updates. Read the final rule  here [ https://www.federalregister.gov/articles/2014/07/17/2014-16702/tricare-certified-mental-health-counselors ]  .

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4 Million Uninsured People With Mental Illness Will Be Denied Health Insurance Because Their Home States Refuse to Participate in the ACA Medicaid Expansion Program

Nearly 75 Percent of These 4 Million Uninsured People With Mental Health Conditions Reside in 11 Southern States That Opted Out of the New Program

Alexandria, Va. – February 26, 2014 – AMHCA's new, groundbreaking study shows that nearly 4 million people with mental illnesses who are uninsured reside in the 25 states that have refused to participate in the Medicaid Expansion program under the Affordable Care Act (ACA). Many of these individuals have severe mental health conditions and currently have no health insurance coverage through any public or private plan, but will be denied the opportunity to obtain coverage for treatment since those states have refused to participate. States declining Medicaid Expansion represent 55 percent of all uninsured people with major mental health disorders who are eligible for coverage in the new health insurance access initiative.

Download the comprehensive study, "Dashed Hopes, Broken Promises, More Despair: How the Lack of State Participation in the Medicaid Expansion Will Punish Americans With Mental Illness"

Other key findings from the AMHCA report include:

·         6.7 million uninsured people with a mental illness are currently eligible for coverage under the Medicaid Expansion that went into effect on Jan. 1, 2014. But the majority of these individuals with mental health conditions will be left out in the coverage cold due to their state’s antagonism toward the Medicaid Expansion health insurance initiative.
·         Nearly 75% (2.7 million adults) of all uninsured persons with a mental health condition or substance use disorder who are eligible for coverage in the non-expansion states (3.7 million), reside in these 11 Southern states that have rejected the Medicaid Expansion: Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas and Virginia.
·         More than 1.1 million uninsured people who have serious mental health and substance abuse conditions live in just two states – Texas (625,000) and Florida (535,000). These more than 1.1 million individuals are eligible for coverage under the new Medicaid Expansion program, but won't receive it. Since officials in Texas and Florida (and other 23 states) have said they will not participate in the initiative, they are leaving their most vulnerable citizens without health insurance, even though the federal government will pay for it (at 100% for the first three years of the program and slowly tapering off to 90% in 2020 and thereafter). The funds for this are already included in the federal budget.

"If the 25 states do not participate in the new Medicaid Expansion program, uninsured citizens with mental illness who experience the misfortune of residing in those states will see their hopes of a healthier and better life dashed when they learn during the enrollment process that they will not be able obtain health insurance," said Judith Bertenthal-Smith, AMHCA president.

The U.S. Supreme Court ruled in 2012 that the new Medicaid Expansion program is an optional program; states can opt into or out of it at any time without incurring penalties. But states that perpetually opt out of Medicaid Expansion will hurt people with mental illness.

"The burden of mental illness in the U.S. is incredibly high due to increasing numbers of uninsured people with mental health conditions. The lack of health insurance coverage keeps people with mental illness from obtaining needed services and treatments—and follow-up care—that lead to achieving long-term recovery and improving their quality of life," said Joel E. Miller, executive director and CEO of AMHCA and author of the "Dashed Hopes" report. "Health insurance is the passkey to good, timely health care services, and state policymakers in 25 states are locking people out of the system."

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ACTION ALERT: Medicare Recognition of Mental Health Counselors 12/17/13

AMHCA has long sought bipartisan support for its Medicare provider status legislation in the U.S. House of Representatives and on December 5, 2013, HR.3662 was introduced by our new sponsors Rep. Chris Gibson (R–NY) and Rep. Mike Thompson (D–CA). The House bill contains language identical to that used in the Senate version, S.562 (Wyden/Barrasso), which amends Medicare to add the outpatient services of licensed mental health counselors (“LMHCs”) and licensed marriage and family therapists (“LMFTs”) under part B of the Medicare program.

Action Requested:
Now is the time to contact your House member to show their support HR. 3662 and request they cosponsor the bill. Here is the information on contacting your Representative and a sample e-mail message for a Representative.
Download sample text in Word
Download sample text as PDF


Background: Inquiries, contact James K. Finley, AMHCA associate executive director, at 703-548-6002 ext.105 or jfinley@amhca.org

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AMHCA Hails Release of Final Mental Health Parity Regulations
By Joel E. Miller, AMHCA Executive Director & CEO

matters of interest November 11, 2013 – On Friday, Nov. 8, a landmark event for mental health coverage and benefits occurred: The federal government issued a long-awaited "final rule" dictating that mental health benefits offered by health plans be covered equal to general health benefits. The final rule provides the specific clarity needed to move forward in implementing mental health parity.

The federal law generally prevents group health plans and health insurance issuers that provide mental health and substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical coverage. Read more about:

A New Call To Arms: Restoring Our Returning Troops
to Physical—and Mental—Wholeness

By Joel E. Miller, AMHCA Executive Director & CEO

matters of interest November 11, 2013 – America's military veterans, and the men and women who have recently returned home from wars in Iraq and Afghanistan, need much more than Veteran's Day tributes and lip service about how much a grateful nation appreciates their sacrifice. Our members of Congress need to issue a new collective and dramatic "call to arms" to help reintegrate veterans with mental health conditions into their families, their communities, and the workplace.

In this case, money really does talk. Making the investment in the lives of returning soldiers with mental health conditions can make a real difference. We need to increase service capacity through use of community-based care that is evidence-based, use new technologies and use the workforce that is available.

Clinical Mental Health Counselors are ready to serve in this capacity to address the mental health needs of returning veterans. Read more about:

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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.

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.

 


 

 

 

 

 

 

 

 

 

 

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