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Legislative Update
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Congress Grapples With Health Funding Issues

By James K. Finley *
Director of Public Policy

Medicare Debate Offers Vehicle for LMHCs

Vice-President Joe Biden is leading deficit-reduction negotiations that are expected to result in legislation that would make sweeping changes in long-term spending such as Medicare, and perhaps in taxes. Such a large and ultimately bipartisan agreement offers a must-pass bill that may become a vehicle for small Medicare spending changes, including extending Medicare independent provider status to LMHCs.

With this end in mind, AMHCA is seeking passage of Medicare legislation for LMHCs. In March, Sens. Ron Wyden (D–Ore.) and John Barrasso (R–Wyo.) introduced S. 604, the Seniors Mental Health Access Improvement Act, which establishes coverage of LMHCs and licensed marriage and family therapists. 

AMHCA and a coalition of professional organizations are working closely with Senators Wyden and Barrasso and potential House sponsors to build momentum for inclusion of this provision in larger Medicare legislation when it is considered later this year. The House version is still being readied for introduction, but AMHCA is urging its members to ask their Senators to cosponsor this important legislation. 

Please call, write, or email your U.S. Senators to ask them to cosponsor S. 604. 

The more cosponsors we have for the bill, the easier it will be to win inclusion in larger Medicare legislation when an agreement is reached. 

Senators may be called at the U.S. Capitol switchboard: 202/224–3121. Please ask:

1)     to be connected to the office of one of your Senators; 
2)     to speak with the health legislative assistant; and 
3)     request that his or her boss co-sponsor S. 604.

Alternatively, find your two Senators’ name on an Internet search engine, go to their website, and use the “Contact” link, typically on their main page, to send an email urging cosponsorship of the bill. Tell your Senators that this bill will improve Medicare beneficiaries’ access to outpatient mental healthcare in a cost-effective manner, by establishing coverage of highly qualified LMHCs.

If Congress defers action on Medicare in this summer’s deficit-reduction agreement, it must still pass Medicare legislation later this year to prevent a scheduled 20 percent pay cut for participating physicians. Therefore, we expect to remain active on this issue throughout the year.

Deadline Missed for TRICARE LMHC Independent Practice Rule

The National Defense Authorization Act for fiscal year 2011, signed in January 2011, directed the Department of Defense (DoD) to adopt regulations allowing licensed mental health counselors (LMHCs) to practice independently under the TRICARE program. The Act gave DoD until June 20th to issue rules implementing the requirement, but DoD has now missed the deadline, making it impossible to implement the directive. Estimates of when the rules will be released range from six to 18 months from now.

AMHCA has led LMHCs in encouraging the DoD to adopt regulations implementing the rule, which will make it easier for beneficiaries to gain access to needed care. However, we have also called on DoD to adopt more inclusive regulations that will recognize a wider array of qualified LMHCs than a recently adopted standard set in a separate VA administrative procedure.

AMHCA will continue to work with the DoD to ensure the regulations are more inclusive than the VA LMHC eligibility standard, and AMHCA is closely monitoring the agency’s activity on this matter.

VA Is Slow to Hire LMHCs

AMHCA is hearing a few scattered reports of increased VA hiring, but progress is slow and the agency has taken little action to promote the option among its local facilities. We will continue advocating for expanded VA hiring of LMHCs within the agency. We also continue to support the VA expanding its September 2010 federal rule limiting qualified counselors to graduates of CACREP-accredited schools. 

Currently, the VA recognizes only graduates of CACREP-accredited institutions with master’s or doctoral degrees. Graduates of counseling programs that were not CACREP-accredited, even counselors with independent licensure and years of clinical experience, are not recognized for independent practice under the VA standard. The standard was first recommended by an Institute of Medicine advisory panel early last year.

AMHCA Joins Comments on ACO Regs

AMHCA has joined with other national mental health and substance-use disorder organizations in commenting on important proposed regulations concerning the development of Accountable Care Organizations implementing the federal healthcare reform law. 

AMHCA joined the comments in an effort to ensure that mental health and substance abuse disorders are appropriately addressed in the reform models that emerge under the new law. Of particular interest to AMHCA members is the focus in the comments on the inclusion in ACOs of small, independent practices. 
For a copy of our coalition comments, please email Jim Finley <>.

For more information, contact Jim Finley by email at

* Jim Finley became AMHCA’s new director for public policy in mid-May. He brings to his new role many years of experience advocating for federal mental health coverage, including most recently representing the National Association of Social Workers.