Updated: 12/10/10

American Mental Health Counselors Association
801 N. Fairfax Street, Ste. 304
Alexandria, VA 22314

Federal Legislative Issues Updates:
AMHCA/ACA/NBCC Update: Senate Introduces
“TRICARE Mental Health Care Access Act,” S. 3371

Alexandria, VA – May 18, 2010 – The counseling profession took a significant step forward with the introduction of Senate legislation (S. 3371) that will make it easier for TRICARE beneficiaries to see a professional mental health counselor. TRICARE is the health care system for servicemembers and their dependents, and licensed professional counselors are the only mental health professionals still required by law to see beneficiaries following physician referral and under physician supervision.

Senators Joseph Lieberman (I-CT), Claire McCaskill (D-MO) and Susan Collins (R-ME) jointly introduced S. 3371 to allow licensed professional counselors to independently treat and diagnose TRICARE beneficiaries. The American Mental Health Counselors Association, the American Counseling Association and the National Board for Certified Counselors applaud the senators for sponsoring this legislation, as it is a much-needed step forward in giving TRICARE beneficiaries better access to highly skilled outpatient mental health professionals. Our three organizations are working closely together to gain the enactment of legislative language providing counselors independent practice rights as part of this year’s National Defense Authorization Act (NDAA).

Introduction of S. 3371 comes on the heels of a recently released Institute of Medicine (IOM) report that recommends independent practice of mental health counselors in TRICARE. The Institute of Medicine’s report, titled "Provision of Mental Health Counseling Services under TRICARE," was conducted pursuant to a request by Congress contained in the National Defense Authorization Act for Fiscal Year 2008. The IOM panel recommended granting independent practice authority for counselors who have:
  1. A master’s (or higher) degree in mental health counseling from a program accredited by the Council for Accreditation of Counseling and Related Education Programs (CACREP);
  2. Obtained state licensure in mental health counseling at the "clinical" or highest level available;
  3. Passed the National Clinical Mental Health Counselor Examination (NCMHCE); and
  4. Have a well-defined scope of practice sufficient to permit a counselor to see TRICARE beneficiaries absent primary care physician supervision and referral.

Representatives Tom Rooney (R-FL) and Mike McMahon (D-NY) introduced a similar bill, H.R. 3839, last October. The Rooney-McMahon legislation would let any counselor participating in the TRICARE program practice independently, just like clinical social workers and marriage and family therapists have done for years. The legislation is currently being cosponsored by Reps. Bordallo (GU), Courtney (CT), Israel (NY), Jones (NC), Kilpatrick (MI), McMorris Rodgers (WA), Rodriguez (TX) and Shuster (PA).

AMHCA, ACA, and NBCC are working with members of the House and Senate Armed Services Committees to gain adoption of legislative language based on H.R. 3839 and S. 3371 as part of the defense authorization legislation being considered over the coming weeks. We urge counselors to contact their representatives to ask them to cosponsor H.R. 3839, and to contact senators to ask for cosponsorship of S. 3371. The more cosponsors we have on the legislation, the greater our chances of establishing independent practice authority for as many counselors as possible within the TRICARE system.

If you have any questions, please contact AMHCA via email at jclements@amhca.org or via telephone at (800)-326-2642 ext. 105.

Thank you for your support.

Julie A. Clements, J.D.
Director of Legislative Affairs
American Mental Health Counselors Association


Contact Congress to Urge Support
for LMHC Medicare Reimbursement Bills

The time for enhanced recognition of LMHCs is now. Urge your federal legislators to support S.671 and H.R. 1693, legislation that, if enacted, will allow you as a Licensed Mental Health Counselors (LMHC) to be reimbursed at 75 percent of the Medicare allowable rate for the outpatient services you provide to seniors.

Today, health care comprises almost 20 percent of the United States=E 2s gross domestic product (GDP). In the next few weeks, legislators on the Senate Finance and House Ways and Means Committees will come together to decide how to restructure this significant chunk of U.S. GDP.
  • Notify your legislators, via e-mail letters or phone calls to their DC and state district offices, of the need for LMHC Medicare reimbursement.
  • Explain how Medicare reimbursement of outpatient psychotherapy services will benefit Medicare eligible seniors and the mental health care needs of society in general.
Legislators are attuned to the fact that changes to the health care system will impact everyone. Please let them know how Medicare reimbursement will affect you and the senior population in your locale. Go to www.senate.gov to find contact information for your U.S. Senators and to www.house.gov to find contact information for your U.S. Representatives. Download a list of members of the key committees voting on this legislation. Please stress to your legislators who sit on these committees our need for t heir possible cosponsorship and, at a minimum, their support of S. 671/H.R. 1693.

Why should your federal legislators support
LMHC Medicare Reimbursement bills, S. 671 and H.R. 1693?

Lack of Access to Mental Health Services – Fully 50 percent of rural counties in America have no practicing mental health providers that are currently covered under Medicare. However, many of these mental health shortage areas have well-educated and experienced LMHCs who desire to deliver outpatient mental health services to the senior population but are obstructed by Medicare’s current lack of reimbursement.

Medicare Inefficiency – Medicare has proven to be a very inefficient purchaser of mental health services, choosing to fund a disproportionate share of more costly inpatient mental health services, rather than less costly, preventive outpatient mental health services. An American Psychiatric Journal study on private health insurance recipients’ mental health care purchases evidences that increased availability of outpatient treatment for mild to moderate mental health disorders, like depression and anxiety, can result in as much as a 30 percent decrease in mental health costs expended by private insurers and their insured population.

Underserved Minority Populations – In a report by the United States Surgeon General entitled "Mental Health: Culture, Race, and Ethnicity," it was noted that "striking disparities in access, quality, and availability of mental health servi ces exist for racial and ethnic minority Americans." Minority communities bear a disproportionately high burden of disability from untreated or inadequately treated mental disorders. Many minority communities have a shortage of mental health providers, like clinical psychologists and clinical social workers, whose services are covered by Medicare.

Education and Training Comparable to Covered Social Workers – Today, LCSWs with education hours and training hours comparable to LMHCs receive reimbursement under Medicare for outpatient services they provide to Medicare insured clients. LMHCs, like clinical social workers, have a minimum of a Master’s degree, thousands of hours of counseling experience and direct client contact, and passage of a clinical examination.

Please contact AMHCA’s Director of Legislative Affairs, Julie A. Clements, J.D., at (703)-548-6002 X 105 or via email at jclements@amhca.org, if you have further inquiries.


DRAFT LETTER TO CONGRESS (copy & paste text into your word processing software))


The Honorable_______
____House/Senate Office Building
Washington, DC 20510

RE: Please Co-Sponsor S. 671/H.R. 1693:
The Seniors Mental Health Access Improvement Act of 2009.

Dear Senator/Representative:

I am writing to strongly urge you to co-sponsor S. 671/H.R. 1693, The Seniors Mental Health Access Improvement Act, which would establish Medicare coverage for l icensed professional mental health counselors. With the exception of a recent federal law that finally equalized outpatient co-payments for mental health and medical/surgical services, the baseline Medicare mental health benefit has not been updated in almost 20 years. This inaction has consequences.

Improve Access in Rural Areas and Among Underserved Minority Populations:
Approximately 77 million older adults live in 3,000 mental health professional shortage areas. Yet over 50% of rural counties have no practicing psychologists, psychiatrists or social workers. It is shocking to note that fully two thirds of rural residents with mental illness symptoms receive no treatment at all. As a direct result of this lack of access, older Americans with chronic medical conditions and major depression (nearly 2 million senior citizens nationwide) have significantly higher rates of disability than those with either condition alone.

Similarly, in a report entitled "Mental Health: Culture, Race and Ethnicity," the United State Surgeon General noted 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.

Making Medicare a Better Purchaser of Mental Health Care:
Inpatient psychiatric hospital utilization by elderly Medicare recipients is extraordinarily high—particularly when compared t o psychiatric hospitalization rates for patients covered by Medicaid, VA, TRICARE and private health insurance. To the extent that fully one third of these expensive inpatient placements are caused by clinical depression and addiction disorders, it is strikingly clear that additional community-based mental health services provided by licensed professional mental health counselors will reduce unneeded hospitalizations.

The bottom line is: lack of access to mental health care is increasing both the burden of disability on our senior citizens and minority communities as well as the financial burden on the Medicare program. Take action today. Co-sponsor H.R. 1693/ S. 671.




  Copyright 2007, Ohio Mental Health Counselor's Association.