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Legislative Update
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Medicare Chiefs Needed; TRICARE Implementation Under Way

By Julie A. Clements, JD
Director, Legislative Affairs

Calling All Medicare Chiefs!

With the seating of the 112th Congress in January, AMHCA has renewed its push for Medicare eligibility of mental health counselors. AMHCA has been meeting with legislator after legislator in the U.S. House of Representatives, seeking to find a Republican member who will take the lead on what was H.R. 1693, the Medicare eligibility bill filed by Rep. Gordon (D–Tenn.) in the 111th Congress. Ideally, AMHCA would like a chief sponsor who sits on a House committee with jurisdiction over Medicare. AMHCA continues to meet with all GOP members seated on the House Ways and Means Committee and the Committee on Energy and Commerce.

Following the re-election defeat of Sen. Blanche L. Lincoln (D–Ark.), S. 671’s bill chief, AMHCA began making direct pitches to Senate Finance Committee members who had previously cosponsored S. 671 or supported its inclusion in a general rural health bill. These members include Senators Ron Wyden (D-–Ore.), Kent Conrad (D–N.D.), and Jeff Bingaman (D–N.M.). 

Senator Wyden has stepped forward, agreeing to reintroduce the Seniors Mental Health Access Improvement Act, formerly S. 671. AMHCA asks its Oregon membership to thank Sen. Wyden for his commitment to being chief sponsor of the LMHC–LMFT Medicare eligibility bill, and it asks members across the country to write to their U.S. Senators and ask them to sign on as cosponsors to Sen. Wyden’s legislation.

Implementation of LMHC Independent TRICARE Practice Under Way

Rep. Thomas J. Rooney (R–Fla.), AMHCA’s 2010 honorary chair of National Mental Health Counseling Week, reintroduced The Counselor Accessibility Reform and Expansion Act for Soldiers (CARES) Act, H.R. 208, as his first piece of legislation in the 112th Congress. A member of the Armed Services Committee, Rep. Rooney is committed to giving the servicemembers “the most efficient mental health services we can provide.” Rep. Larry Kissell (D–N.C.), an original CARES Act cosponsor, has re-signed on as cosponsor of H.R. 208.

The CARES Act is important to mental health counselors, since if enacted, it would allow all LMHCs immediate access to TRICARE beneficiaries. This follows recent enactment of the National Defense Authorization Act, which included language authorizing the Secretary of Defense to devise rules by June 20, 2011, for carrying out LMHC independent practice. 

The latest language in Section 724 of the NDAA, signed into law by President Obama on Jan. 7, permits the Secretary of Defense to implement independent practice for LMHCs as he sees fit. Previous legislative language would have limited the pool of LMHCs eligible to independently serve TRICARE beneficiaries. 

The Secretary may try to draft rules providing for the elimination of physician supervision and referral requirements for all LMHCs, as language in the CARES Act provides. Or he may adopt recommendations from the 2010 Institute of Medicine TRICARE study, which would eliminate the supervision and referral requirements for some LMHCs.

The ball is now in DoD’s court to come up with a rule by June 20, 2011, outlining how LMHC independent practice is to be achieved.