If you aren’t in private practice yet, you may not be aware of the Medicare credentialing situation. For many years, Medicare has not allowed Licensed Professional Counselors and Licensed Marriage and Family Therapists to be credentialed. I just learned about S.1830 which can change that. Please take action and email your Senators and Representatives asking them to co-sponsor this bill.

Below you will find information about the bill and some information posted to our Facebook page which you can use to email your Senators and Representatives.

Facebook Post

Therapist Private Practice received this post on our Facebook page today. I hope the woman who posted does not mind me re-posting it. I would like to give her credit but I don’t want to post her name without permission. However, you can find the post through this link. I used the post, along with a few words of my own, to contact my Senators and Representatives asking them to co-sponsor this bill.

Please help us shed light on this! I’d love to discuss this further. It’s so important to mental health in America

Good afternoon, thought this may be of interest.

A letter to Senators and Representatives.

I urge you to co-sponsor S. 1830/HR. 2759.

I am the President of the NM Mental Health Counselors Association and on behalf of all Counselors – this is imperative.

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 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.

Affect of Medicare Credentialing Issues

I’ve only been in private practice for a few years yet I have many stories of clients who have been affected by Medicare’s failure to recognize counselors and marriage and family therapists as capable of independent practice. I can’t tell you much because of confidentiality but I will tell you a couple of situations by changing any identifying information.

Recently I had a client who I was seeing for a while turn 65. I knew when the client turned 65 that it was going to be a problem. The client didn’t understand when I tried to explain. I think the client misunderstood the difference between Medicare, which I cannot take and Medicaid, which I can take. When the client turned 65, I had the unpleasant task of telling the client I couldn’t take Medicare insurance.

Luckily, I have a LCSW in my office who I could refer to. The client didn’t want to go to someone new but was willing to do it because the client could not afford to pay even a small fee. Let’s be honest, it’s like starting over when a client gets a new therapist. I believe rapport is most important for affecting change. I already had a good rapport with this client.

I helped the client with the transition by having a closing session (pro-bono because it was after the client’s birthday) and by going to the client’s first appointment but I’m sure there are lots of counselors who wouldn’t be able to do that because there isn’t a LCSW in their office.

Before I referred this client, my office manager contacted Medicare and explained the situation. I thought they would contract with me for this case, considering there were good reasons to not disrupt this client’s care by changing providers. But we were pretty much told to not bother because it would never happen. I knew I would just end up delaying the change and make it more difficult for the client. And I wouldn’t get paid while I was trying to fight it.

I don’t want to downplay that this is about the client not me, but this was very difficult for me too. This was a client who really needed help. I felt like I was referring the client just because I couldn’t get paid which just seems wrong. I’m not someone who makes it all about the money. At the same time, I am running a business and I have to consider payment because I have bills to pay like anyone else.

Plus, I felt this client would be in therapy for a while because of the nature of the client’s issues. I didn’t want to keep seeing the client for a long time and end up feeling resentful. That wouldn’t be in the client’s best interest either. I was stuck between a rock and a hard place.

I’ve had other situations come up as well. I’ve had people tell the staff they had Medicaid, only to be halfway through the intake to learn they had Medicare. It is so awkward to tell an intake that you can’t take their insurance when they thought you could. And I understand why they don’t get the difference. I never understood it until I started working in private practice. We even had a psychiatrist, who was new to private practice, refer a Medicare client to me. He didn’t understand the difference either.

Seniors Mental Health Access Improvement Act of 2015

S.1830

The following section is text from Congress.gov which can be found at https://www.congress.gov/bill/114th-congress/senate-bill/1830/text .

To amend title XVIII of the Social Security Act to provide for the coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program, and for other purposes.

IN THE SENATE OF THE UNITED STATES
July 22, 2015

Mr. Barrasso (for himself and Ms. Stabenow) introduced the following bill; which was read twice and referred to the Committee on Finance


A BILL

To amend title XVIII of the Social Security Act to provide for the coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

This Act may be cited as the “Seniors Mental Health Access Improvement Act of 2015”.

SECTION 1. SHORT TITLE.

SEC. 2. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL HEALTH COUNSELOR SERVICES UNDER PART B OF THE MEDICARE PROGRAM.

 (a) Coverage Of Services.—

(1) IN GENERAL.—Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—

(A) in subparagraph (EE), by striking “and” after the semicolon at the end;

(B) in subparagraph (FF), by inserting “and” after the semicolon at the end; and

(C) by adding at the end the following new subparagraph:

“(GG) marriage and family therapist services (as defined in subsection (iii)(1)) and mental health counselor services (as defined in subsection (iii)(3));”.

(2) DEFINITIONS.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:

“Marriage And Family Therapist Services; Marriage And Family Therapist; Mental Health Counselor Services; Mental Health Counselor

“(iii) (1.) The term ‘marriage and family therapist services’ means services performed by a marriage and family therapist (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses, which the marriage and family therapist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as an incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.

“(2) The term ‘marriage and family therapist’ means an individual who—

“(A) possesses a master’s or doctoral degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law;

“(B) after obtaining such degree has performed at least 2 years of clinical supervised experience in marriage and family therapy; and

“(C) in the case of an individual performing services in a State that provides for licensure or certification of marriage and family therapists, is licensed or certified as a marriage and family therapist in such State.

“(3) The term ‘mental health counselor services’ means services performed by a mental health counselor (as defined in paragraph (4)) for the diagnosis and treatment of mental illnesses which the mental health counselor is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.

“(4) The term ‘mental health counselor’ means an individual who—

“(A) possesses a master’s or doctor’s degree in mental health counseling or a related field;

“(B) after obtaining such a degree has performed at least 2 years of supervised mental health counselor practice; and

“(C) in the case of an individual performing services in a State that provides for licensure or certification of mental health counselors or professional counselors, is licensed or certified as a mental health counselor or professional counselor in such State.”.

(3) PROVISION FOR PAYMENT UNDER PART B.—Section 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)) is amended by adding at the end the following new clause:

“(v) marriage and family therapist services (as defined in section 1861(iii)(1)) and mental health counselor services (as defined in section 1861(iii)(3));”.

(4) AMOUNT OF PAYMENT.—Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395 l(a)(1)) is amended –

(A) by striking “and (Z)” and inserting “(Z)”; and

(B) by inserting before the semicolon at the end the following: “, and (AA) with respect to marriage and family therapist services and mental health counselor services under section 1861(s)(2)(GG), the amounts paid shall be 80 percent of the lesser of the actual charge for the services or 75 percent of the amount determined for payment of a psychologist under subparagraph (L)”.

(5) EXCLUSION OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL HEALTH COUNSELOR SERVICES FROM SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting “marriage and family therapist services (as defined in section 1861(iii)(1)), mental health counselor services (as defined in section 1861(iii)(3)),” after “qualified psychologist services,”.

(6) INCLUSION OF MARRIAGE AND FAMILY THERAPISTS AND MENTAL HEALTH COUNSELORS AS PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clauses:

“(vii) A marriage and family therapist (as defined in section 1861(iii)(2)).

“(viii) A mental health counselor (as defined in section 1861(iii)(4)).”

(b) Coverage Of Certain Mental Health Services Provided In Certain Settings.

(1) RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS.—Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking “or by a clinical social worker (as defined in subsection (hh)(1))” and inserting “, by a clinical social worker (as defined in subsection (hh)(1)), by a marriage and family therapist (as defined in subsection (iii)(2)), or by a mental health counselor (as defined in subsection (iii)(4))”.

(2) HOSPICE PROGRAMS.—Section 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by inserting “, marriage and family therapist, or mental health counselor” after “social worker”.

(c) Authorization Of Marriage And Family Therapists And Mental Health Counselors To Develop Discharge Plans For Post-Hospital Services.—Section 1861(ee)(2)(G) of the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended by inserting “, including a marriage and family therapist and a mental health counselor who meets qualification standards established by the Secretary” before the period at the end.

(d) Effective Date.—The amendments made by this section shall apply with respect to services furnished on or after January 1, 2016. (S.1830, 2015)

I hope you will take a few minutes to copy and paste this information in an email to your Congressmen and women. Adding a few words of your own could help them understand how important this issue is to you.

Works Cited

S.1830 – Seniors Mental Health Access Improvement Act of 2015 114th Congress (2015-2016). (2015, July 22). Retrieved August 5, 2015, from https://www.congress.gov/bill/114th-congress/senate-bill/1830/text