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Legislative Update
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AMHCA's Policy Agenda Moves Forward in Difficult Environment

By James K. Finley
Director of Public Policy

AMHCA remains engaged on a number of important issues this fall while Congress remains severely divided and often paralyzed by fundamental political and ideological differences. Although congressional deadlock threatens to delay progress on matters of great concern to our members, we continue to educate decision-makers about our members’ needs and to make significant progress on our policy agenda. Following is an update on our major concerns.


Past-due TRICARE rules that will implement clinical mental health counselor (CMHC) independent provider status are still under internal review within the Administration. We understand that draft rules have been forwarded up through administrative channels and are awaiting final clearance from the Office of Management and Budget. The rules are required under a law enacted earlier this year that was sought by AMHCA and its coalition partners. 

TRICARE staff will not predict when the rules will be released, although they have indicated the proposal is moving up the chain of command. AMHCA staff anticipates the rules will be influenced by recent CMHC provider requirements issued by the Department of Veterans Affairs and the U.S. Army.


The Department of Veterans Affairs (VA) is advertising a few more positions open to CMHCs although the number of openings remains very small. Last month our coalition learned that the Office of Personnel Management would not issue job standards defining CMHCs as a discreet professional group from other behavioral health professions. 

Although separate CMHC job standards were promised by the VA in September 2010 when its rule was released, OPM recently declined to issue the standards, explaining that doing so would require more administrative time than it has available. 

AMHCA and its coalition partners are meeting with VA and Capitol Hill staff to assess what actions might be taken to reverse the OPM decision. In the meantime, both the VA and U.S. Army are authorized to recruit and hire CMHCs, using the positions standards of the related mental health professions. AMHCA policy leaders recently urged reversal of the OPM decision.

Medicare Legislation

AMHCA’s Medicare provider status legislation has now been introduced in both the House and Senate [S 604; Senators Ronald Lee Wyden (DOre.) and John Barrasso (RWyo.) / HR 2954; Rep. Barbara Lee (DCal.)]. A new House bill was introduced in late September and is known informally as the Tri-Caucus Bill. Our Medicare language was included in this “omnibus” bill, with many different provisions that address the health coverage needs of underserved populations. 

Medicare spending is currently being discussed by the congressional super committee on deficit reduction, but it is highly uncertain whether any recommendations for Medicare changes will be made by the committee. The divisive atmosphere in Congress has greatly limited legislators’ interest and ability to make changes or improvements in the program. 

One major challenge confronting Congress is the need to replace the existing Medicare payment formula for all independent Part B providers. Physicians and other independent outpatient practitioners face a 30 percent across-the-board payment cut for services occurring after January 1, 2012. 

This Medicare formula crisis offers a legislative vehicle for Medicare provisions, such as CMHC provider status legislation, but in the current budget climate, prospects for inclusion appear quite poor. Nevertheless, AMHCA and its coalition partners are pressing the Hill on our concerns, knowing our efforts will build momentum to pass our bill once the legislative environment has improved.