5-19-10
AMHCA announces introduction of legislation to cover LPCs under Tricare.
Dear AMHCA Region Directors:
I am writing to update you on some legislation that has been introduced. The legislative language arising from S. 3371, the TRICARE Mental Health Care Access Act, will exclude some counselors from participating under TRICARE without a “supervision and referral” requirement, while the House bill language in H.R. 3839, will be more general, simply just adding LMHCs to the list of TRICARE independent providers. I want your membership to know I, along with my colleagues, will be making every effort to ensure more counselors have an opportunity to practice under TRICARE without supervision and referral restrictions. Much of the process in attempting to reach a more “ideal” bill will have to take place behind the scenes.
As TRICARE currently stands, LMHCs can see TRICARE beneficiaries if they’re referred or supervised by a primary care physician. After a year long study by a panel comprised of some of the nation’s leading psychiatrists, mental health counselors, psychologists, and social workers, the IOM issued a recommendation that LMHCs be able to practice independently under TRICARE. The IOM recommendation came with several qualifications; they are the following:
1) LMHCs’ have a Master’s or higher-level degree in counseling from a program in mental health counseling or clinical mental health counseling that is accredited by CACREP.2) A state license in mental health counseling that is “clinical” or the higher or highest level available in states that have tiered licensing schemes. 3) Passage of the National Clinical Mental Health Counseling Examination (NCMHCE) 4) A well-defined scope of practice for practitioners.
Several Senators, including an Independent, a Democrat, and a Republican, have introduced S. 3371. The Senate Armed Services Committee has historically not supported a TRICARE LMHC independent practice bill. This time around the committee staff for both the Minority and Majority side of the Senate are willing to introduce such a bill if the IOM recommendations, including the 4) bullet points cited above, are included in the language.
I am the first to acknowledge a lot of counselors don’t satisfy all 4) of the points cited above. That being said, we have no opportunity for a Senate bill if we don’t embrace the Senate’s language, taken from the IOM report verbatim, in a Senate stand-alone bill. (A bill is called stand-alone when introduced singularly by one Senator as a little bill; the bill will likely be folded into a bigger bill, the National Defense Authorization Act, the funding mechanism for the Department of Defense in the coming year). I wish to suggest that we get behind these Senators willing to introduce a bill for independent LMHC TRICARE practice and be supportive of their efforts, while strategizing to make tweaks to the bill, thus raise it closer to a more “ideal” bill that includes more counselors, during the conference period between the House (more general, all encompassing bill of H.R. 3839) and the Senate (more restrictive bill with IOM bullet point suggestions verbatim). I think with a Senate and House bill having been introduced and moving, we’ll have more of an opportunity to make suggestions to the bill (ie grandfathering provisions, saying CACREP core curriculum, maybe creating an exemption for counselors who practice in federally recognized mental health shortage areas, etc). I also remind you that the Department of Defense will be charged with the rulemaking-implementation process for any language that passes out of Congress. Usually, it’s the implementing agency that gets “into the weeds” about grandfathering clauses, practice exceptions, etc. and not the legislative counsel for the committees who compose the statutory legislative language.
I caution us to not put the cart before the horse and thus lose both the cart and the horse. I don’t want well-intentioned counselors who wish to write their U.S. Senator and ask that the bill be amended to provide for their independent practice to create a situation in which Senators feel ungrateful for their support of counselors and consequently, throw up their hands and surrender from carrying the bill forward. We only have so many friends in Congress who want to take up this issue! I also worry about creating a civil war between counselors. This has been done with TRICARE legislation in the past (it resulted in no legislation being passed and a long study taking place). We don’t want this outcome. Inevitably, there will be counselors who support the legislation and others who are less supportive.
I am trying to lobby for elevation of the mental health counseling profession. Ideally, I want to do what’s best for the profession as a whole. In the coming weeks, once a bill is introduced, I will be sending out legislative alerts. My alerts will be celebrative and use a positive tone. I’ll be commending legislators for accepting the IOM report and moving it forward in legislation. What I don’t want to see, and I cannot afford to see is counselor members who are well-intentioned derailing advances that have been made. I will be sharing this information with state AMHCA leaders too. As leaders you have websites and newsletters in which federal policy is discussed, please check and make sure that your members know the full gist of what AMHCA is trying to pursue with the TRICARE legislation. Please have members wanting to complain to legislators talk to me or you first before initiating letter writing campaigns, etc (got one such call about this the other day, so people are already thinking about it) to Senators bold enough to introduce this legislation. Also, I must admit I am working for consensus among the other organizations lobbying on behalf of the counseling community. We’re working to present a united message on this. Whatever you may hear about other organizations, do know that AMHCA is for 1) getting a Senate bill and 2) will embrace Senators Lieberman, McCaskill, and Collins’s introduction of the more restrictive IOM language Senate bill, and 3) AMHCA will work in conference and behind doors with legislators to try to reach a more “ideal” TRICARE bill, more similar to the House bill, which currently would cover all LMHCs. Be patient; be thoughtful. If you have questions, or your members have questions, before they post something publicly, before reacting to an email chain, or before calling or writing a legislator to criticize him/her for introducing a less than perfect bill, PLEASE CALL ME OR HAVE THEM CALL ME!
Thank you. I appreciate your leadership.
Julie A. Clements, J.D. Director of Legislative Affairs American Mental Health Counselors Association The only organization working exclusively for mental health counselors 801 N. Fairfax St., Suite 304 Alexandria, VA 22314 Phone: 800-326-2642 x 105 Fax: 703-548-4775 Website: www.amhca.org E-mail:
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3-18-10
Medicare Eligibility of LMHCs Excluded in Final Health Reform Bill
Alexandria, VA – March 18, 2010 – Today the House Reconciliation Bill language, to be coupled with the original Senate bill, was unveiled, sealing the contents of a long-awaited health care reform package. Much to the chagrin of many in the mental health community, the language does not include Medicare coverage of counselors. In an effort to diminish the overall cost of the package, numerous important provisions were excluded.
AMHCA and its colleagues got closer than ever to getting into this package Medicare eligibility of LMHCs. Your lobbying efforts as members of the profession are not futile. Phone calls, emails, and district office visits to legislators have put LMHCs within reach of achieving Medicare eligibility. AMHCA commends its members' unparalleled advocacy efforts.
AMHCA will continue to pursue Medicare eligibility of LMHCs. For now, continue to ask your legislators to sign-on as cosponsors to the Medicare LMHC bills in the House and Senate, H.R. 1693 and S. 671. Mental health access will be expanded because of you. AMHCA will be searching for other legislative vehicles to carry this necessary preventive health provision.
Contact Julie A. Clements, J.D., AMHCA Director of Legislative Affairs, at
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or 1-800-326-2642 if you have further inquiries.
2-18-10
Synopsis of IOM Panel LMHC TRICARE Recommendations
On Friday, February 12, 2010, the Institutes of Medicine (IOM) released its final report titled Provision of Mental Health Counseling Services under Tricare. The IOM made the following recommendations, with the first one being to eliminate the supervision and referral requirement currently defining LMHCs’ practice under TRICARE, and the second one being directed to all cadres of licensed mental health professionals currently practicing under TRICARE.
Below are the recommendations and attached is an IOM report brief summary. The report itself is not yet law. However, recommendations arising from IOM panels commissioned by Congress and the Department of Defense usually receive deference by Congress and the Department of Defense, thus inspiring changes to existing laws which will parallel the IOM studies’ recommendations to Congress and the Department of Defense. To link to the full report, click on the following link: http://www.nap.edu/catalog.php?record_id=12813#toc.
Recommendations
1) Independent practice of LMHCs in TRICARE in the circumstances in which their education, licensure, and clinical experience have helped prepare them to diagnose, and where appropriate, treat conditions in the beneficiary population. These circumstances include:
-A master’s or higher level degree in counseling from a program in mental health counseling or clinical mental health counseling that is accredited by the Council for Accreditation of Counseling and Related Educational Programs.
-A state license in mental health counseling at the "clinical" or the higher or highest level available in states that have tiered licensing schemes (community counseling programs won’t suffice)
-Passage of the National Clinical Mental Health Counseling Examination (passage of the NCE alone won’t suffice)
-A well-defined scope of practice for practitioners.
*The Committee found that LMHCs who do not meet these proposed requirements may still practice within the system of TRICARE but will be supervised with the opportunity to acquire greater levels of independent practice as their experience and demonstrated competence increase.
2. A comprehensive quality management system for all mental health professionals, with this system including:
-Well-defined scopes of practice and clinical privileging of all TRICARE mental health providers consistent with their professional education, training, and experience.
-Promotion of evidence-based practices for treatment of conditions and monitoring of results.
-Focused training in the particular mental and related general medical conditions that are present in the TRICARE beneficiary population, and in military cultural competence.
-A systematic process for continued professional education and training to ensure continuing improvement in the clinical evidence base and accommodation of the changing needs of the TRICARE population.
-Development and application of quality measures to assess the performance of providers.
-Systematic monitoring of the process and outcomes of care at all levels of the health care system and application of effective quality improvement strategies.
* The IOM panel determined that the coursework required by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) helps prepare counselors to serve as independent practitioners. It also found the National Clinical Mental Health Counselor Examination (the NCMHCE) best tests the experiences and competencies of mental health counselors to practice independently.
*The TRICARE IOM panel could not find any evidence distinguishing LMHCs from other cadres of licensed mental health professionals in their ability to serve in an independent capacity or provide high quality care. The panel’s research pointed to the need for a quality management system to ensure that all mental health professionals serving TRICARE beneficiaries provide care so TRICARE beneficiaries receive the “proper diagnosis and treatment for disorders.”
***Please call AMHCA Director of Legislative Affairs, Julie A. Clements, J.D., if you have any particular questions about the report’s content and applicability. The above brief is meant to provide you with some of the nuances in the IOM recommendations.***
Health Care Reform on Life Support:
Continue to Lobby U.S. Senators
for LMHC Medicare Eligibility in Final Reform Bill
Alexandria, VA – January 22, 2010 – In the wake of Scott Brown’s ascendancy to the late Edward M. Kennedy’s Massachusetts Senate seat, Senate supporters of health care reform lack the 60 seats necessary to surmount a filibuster by health care reform opponents. To remain viable, health care reform will assume a new shape. AMHCA and its legislative coalition members continue to push for inclusion of LMHC Medicare eligibility in any final health reform package. LMHC Medicare eligibility has the support of numerous House members, House committee leadership, and House leadership.
Over the past few weeks, discussions between House and Senate staffers have revealed increased support among U.S. Senators for LMHC Medicare eligibility. AMHCA is grateful for its members’ overwhelming outreach to U.S. Senators. As a product of your lobbying efforts, a growing number of Senators are placing LMHC Medicare eligibility on their health care reform radar screens. AMHCA asks its members to continue to lobby their U.S. Senators for LMHC Medicare eligibility.
Today, the federal government reports there are 77 million Americans lacking access to mental health care. Many of these Americans are Medicare beneficiaries unable to access current Medicare outpatient mental health providers. Let your U.S. Senators know you stand ready, willing, and more than able to deliver outpatient “medically necessary” mental health care to these Medicare beneficiaries.
Ask that your U.S. Senators support The Seniors Mental Health Access Act of 2009 and its inclusion in any final health care reform bill sent to President Obama for a signature. Please call the Capitol Switchboard at (202)-224-3121 and ask to be connected to your U.S. Senators’ offices. Make sure your U.S. Senators know LMHC eligibility is necessary to the achievement of Medicare cost savings and enhanced mental health access.
Contact Julie A. Clements, J.D., AMHCA Director of Legislative Affairs, at
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or 1-800-326-2642 if you have further inquiries.incidence of disability. Furthermore, according to the U.S. Surgeon General, disparity in access to mental health care is causing "racial and ethnic minority communities to bear a disproportionately high burden of disability from untreated" mental disorders.
Make Medicare a More Efficient Purchaser: Relative to patients who receive coverage from other federal programs or private health insurance, Medicare-eligible seniors are higher utilizers of inpatient psychiatric hospital services.
All of these problems have a single cause: senior citizens and minority Americans can’t obtain access to mental health care. Do something about this problem by establishing Medicare reimbursement for LPCs. Vote for S. 671 and HR 1693 if you get the opportunity.
