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Legislative Update
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Looking Back at the 111th Congress, and Ahead at the Fight for Medicare Coverage

By Julie A. Clements, JD
Director, Legislative Affairs

  • A Summary of AMHCA’s Legislative Agenda in the 111th Congress

Mental health counselors should take pride in the legislative victories they have achieved in 2010. The profession has been one to exclusively experience several legislative victories. For example, as of the beginning of October 2010, mental health counselors can be hired to work in the Veterans Health Administration. This past spring, the Institute of Medicine concluded a study producing a recommendation that mental health counselors be permitted to independently treat TRICARE patients. Certainly, these victories come as the consequence of hard-fought battles among government agencies, Congress, and the American people. 

But what of the other legislation that has exhausted the resources of those lobbying for the mental health counseling profession? AMHCA members should know AMHCA’s legislative resources are not limited to lobbying solely for bills that exclusively impact mental health counselors. In conjunction with legislative coalitions that comprise other professionals representing mental health providers— such as clinical social workers, psychiatrists, and social workers — AMHCA has signed on to support the following legislative priorities in the 111th Congress.  

Many of these priorities indirectly benefit the mental health counseling profession through the direct benefit of the clients that you, as the mental health counselor, treat.

  • Medicare eligibility of all licensed mental health counselors.
  • Independent practice for mental health counselors serving TRICARE beneficiaries.
  • Elimination of insurance-company discrimination against those with pre-existing conditions.
  • A ban on insurance companies’ use of annual or lifetime dollar limits to health insurance plans.
  • Elimination of cost-sharing for preventive care.
  • Establishment of a national network of centers of excellence for the study of depressive disorders.
  • Requiring the benefit plans of the insurance exchanges created by the health-reform bill to identify mental health and substance-abuse care as part of the essential benefits package.
  • Increased funding for research on postpartum disorders and depression.
  • Advocating for the removal of interstate compacts, known as “health care choice compacts,” in the health-reform bill.
  • Ending the two-year waiting period for the disabled to acquire access to Medicare.
  • Increase of $100 million for the mental health block-grant.
  • Extension of the mental-health parity requirement to all qualified health-insurance plans, regardless of size.
  • Medicare reimbursement of therapeutic foster-care services for children.
  • Depression screenings for adults and adolescents.
  • Early childhood autism screenings.
  • Insurance coverage of suicide screening in adults.
  • Expansion of Medicaid benefits for individuals earning up to 150 percent of the federal poverty level.
  • Mandating Children’s Health Insurance Program plans to include mental healthcare and substance-abuse services.
  • Support for the establishment of a mental health/behavioral health education and training grant program.
  • Expanding Medicare Part D’s drug coverage to include six clinically sensitive mental health medications.

True, not all of the legislation that AMHCA supported in the 111th Congress received a threshold of support conducive to being passed and signed into law by the president. However, much of the legislation to which AMHCA lent its legislative resources made its way into the final healthcare reform bill. 

Rest assured that items that did not make their way into the final health-reform bill — chiefly Medicare eligibility of LMHCs — will continue to define AMHCA’s legislative goals in the 112th Congress. The new Congress convenes Jan. 3, 2011, and runs through Jan. 3, 2013.

  • AMHCA Renews Push for LMHC Medicare Eligibility in 112th Congress

Medicare eligibility of licensed mental health counselors is among the many pieces of legislation that initially made it into a version of the health-reform bill, but not the final version. Following the congressional mid-term elections, AMHCA has renewed its push for legislation in both the House and Senate that will enlarge the Medicare Part B provider pool to include LMHCs. The results of the mid-term elections made clear that AMHCA needs two new bill sponsors, one in the Senate, one in the House.

With the defeat of Sen. Blanche L. Lincoln (D–Ark.), the sponsor of S. 671, the Seniors Mental Health Access Improvement Act, AMHCA is in need of a new Democrat to champion S. 671. AMHCA has particularly been trying to promote S. 671 to members of the Senate Finance Committee. Thus far, no Finance Committee member has expressed an interest in the bill. On the House side, the Democrats’ loss of the majority, coupled with the retirement of the sponsor of H.R. 1693 (companion bill to S. 671), Rep. Bart Gordon (D–Tenn.), has propelled AMHCA to seek legislative support from a Republican member. In particular, AMHCA is seeking a Republican who sits on one of the two House committees with Medicare jurisdiction. 

In recent weeks, AMHCA has been meeting with Republican members who sit on the Ways and Means Committee or the Energy and Commerce Committee, the two House committees with subject-matter jurisdiction over Medicare legislation. Thus far, no members with whom AMHCA has met, on either the House or Senate side, have expressed an interest in taking up sponsorship of S. 671 and H.R. 1693.

Following passage of the mammoth health-reform bill, many legislators are not keen to sign on to or champion more health-related bills. Though the cost of AMHCA’s Medicare LMHC bill is very slight — what many lobbyists call “budget dust” — pressure from the American people to curb government spending has many members, both Democrat and Republican, reconsidering what legislation they will support. Any bill with a cost attached to it received an unprecedented amount of scrutiny by legislators in the lame-duck 111th Congress, as it will in the 112th Congress. 

Every year Congress is required to make updates to Medicare. Most notably, Congress is regularly required to adjust the payment formula for medical doctors accepting assignment from Medicare. Congressional staffers have made it clear that this year’s Medicare “fixes” will not include a Christmas tree of new provisions. Mental health counselors should rest assured that though AMHCA could not get S. 671/H.R. 1693 into a Medicare “fix” bill taken by Congress during the lame-duck session, AMHCA will push for attachment of S. 671/H.R. 1693 to other bills taken up at the start of the 112th Congress.

As AMHCA lobbies a new Congress to expand Medicare’s pool of outpatient mental health providers to include LMHCs, it seeks your help communicating to members of the House and Senate the need for Medicare reimbursement of LMHCs. You can do this by writing to your two U.S. Senators and one U.S. Representative, explaining the need in your community for Medicare eligibility of LMHCs. 

A template letter can be found on the AMHCA website under the “Affect Public Policy” page. Feel free to draw ideas from the template letter. Be sure that your letter identifies the unique circumstances of why your clients need you to be a Medicare-eligible provider. We all must join in the Medicare fight together if we’re to garner Medicare reimbursement for LMHCs.