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Legislative Update
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Congress Approves Minimal Medicare Extenders Bill

By James K. Finley
AMHCA Director of Public Policy

Congress recently completed action on one of the few must-pass bills of the year, legislation extending Medicare physician-payment rates, unemployment insurance, and a temporary cut in the payroll-tax deduction. The legislation was a critical vehicle for Medicare amendments this year because further Medicare legislation will not be considered again until the end of the year when the latest physician payment fix will expire.

Medicare Provider Status and Psychotherapy Rates

Since the 112th Congress began in 2011, AMHCA has worked tirelessly with its coalition partners to advocate that Medicare provider-status language for LMHCs and licensed marriage and family therapists (LMFTs) be included in the latest Medicare physician-fee legislation, but we were not successful. Unfortunately, the final bill was kept very bare bones and excluded all new Medicare spending items. Even several Medicare provisions were allowed to terminate under the bill. 

One of the now-expired Medicare provisions had supported 2011 payment rates for psychotherapy services. Failure to extend the psychotherapy rate provision will cause an immediate 5 percent decrease in all Medicare psychotherapy rates for covered practitioners. 

This new cut in Medicare payments for psychotherapy services will also be extended to the many private insurance plans that base their rates on Medicare’s fee schedule. If private insurers extend their fee schedule cuts to all covered psychotherapy services, the cut could impact the claims of clinical mental health counselor services. 

The now-final Medicare extender law is again short term, running until the end of this year. Congress will be forced to reconsider Medicare rates for physician services immediately after the November election. This lame-duck Medicare extender bill is now AMHCA’s next target for inclusion of our provider status provisions. AMHCA members interested in learning more background on the physician fee dilemma should view this FAQ


AMHCA submitted comments by the deadline in late February on interim TRICARE rules concerning provider participation for certified mental health counselors (CMHC). The association also encouraged members to submit their individual comments following a suggested model.

The DoD/TRICARE office administering the program is now writing policies that will interpret the mental health counselor rules for TRICARE intermediaries. The TRICARE Intermediary cannot process new CMHC provider applications until new administrative procedures are released. AMHCA’s comments will provide rule-makers an avenue to make improvements or clarifications in the interim rules. AMHCA commented on a number of areas, including:

  • Criteria for clinical mental health degrees, including education and training standards;
  • Support for clinical mental health counseling as the specialty professional skill and training necessary for independent practice;
  • Relaxation of standards that unnecessarily restrict pre-licensure clinical supervision to be provided only by mental health counselors; and
  • Expansion of the grandfather period to a total of seven years rather than three as proposed in the rule. 

The comment period for the interim rule ended on Feb. 27. Further updates will be forthcoming. 

Health Reform Implementation Developments

AMHCA recently joined more than 40 national health groups in an amicus brief to the U.S. Supreme Court concerning the case of Florida et al v. United States Department of Health and Human Services. AMHCA’s coalition brief narrowly addressed the question of support for the 2014 Medicaid expansions under the Affordable Care Act (ACA). The amicus argued that 26 states made a very damaging argument with far-reaching implications for the ACA’s expansion of Medicaid eligibility as well as a host of other federal programs based on the Constitution’s “Spending Clause.” 

The spending clause allows Congress to offer states money, with conditions, to encourage participation in joint federal-state efforts to address societal concerns such as education, child welfare, highway safety, property rights, and discrimination based on race, gender, or disability. The brief argued that if a state disagrees with the conditions that accompany the federal money, it can decline the money. If the Court finds the ACA’s Medicaid expansion unconstitutional, then an array of cooperative federal-state spending programs could also become subject to constitutional challenge. A ruling is expected in June. 

AMHCA also recently joined with other national mental health groups in comments to the Department of Health and Human Services (HHS) concerning the ACA’s essential health benefit package. The coalition’s comments argued that a clear federal minimum standard is necessary to maintain a strong federal role in the essential health benefits that states will implement under the ACA. 

Our comments also addressed the need to implement and enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) along with the ACA. The coalition argued for adequate oversight of plans to eliminate healthcare inequities and disparities addressed by the ACA. The comments strongly supported an HHS decision to extend the ACA’s MHPAEA requirements to the individual market, bringing parity benefits to many millions more Americans when implemented.