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Legislative Update
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Special Feature on Healthcare Reform


With the presidential election behind us, what are its implications for the mental health counseling profession and for AMHCA’s professional advocacy? 

The Advocate puts those questions to three of its leaders: 

  • Karen Langer, LMHC, AMHCA president, 2012–2013;
  • James K. Finley, AMHCA’s associate executive director and director of public policy; and
  • Dan Holdinghaus, chair of AMHCA’s Public Policy and Legislation Committee as well as executive director of AMHCA’s Missouri chapter, the Missouri Mental Health Counselors Association (MMHCA).


KAREN LANGER, LMHC, AMHCA President, 2012–2013

The Advocate: What do you see as AMHCA members’ primary needs?

AMHCA President Karen Langer: To feel connected, and to feel that they have the information and support they need to be effective with clients. 

This means not only up-to-date information on practice issues and continuing education, but also information on rules, regulations, and the issues that can negatively impact their client work and their livelihood. We strive to help members recognize strategic changes in their practice environment and empower them with adaptive tools for the changes ahead.

The Advocate: What will the association do differently in the new year to meet those needs?

AMHCA President Karen Langer: We are emphasizing communication. We are recognizing that our members don’t necessarily know all that is being done on their behalf. The board and the AMHCA staff know what information is available on the website and the issues that arise daily, but the general member may not regularly visit the website or take the time to read the information in The Advocate, or even pay attention to AMHCA’s email notifications. We all have a lot going on, and it’s easy to stay focused on the practice, the local issues, and the bottom line. 

The Advocate: You’ve been a major proponent of AMHCA adopting social networking and improved communication technology. What do you see as AMHCA’s next steps into online communications, training, and advocacy?

AMHCA President Karen Langer: The first step is to make sure we are utilizing the tools we do have. With our Facebook and Twitter feeds, we need to make sure we keep the flow of information timely. One part of that is using these as teasers to let everyone know what we are up to and what the issues are, but also making sure members can get full information “behind the wall.” 

That’s part of how we provide value in being an AMHCA member, giving our members information that’s not available free to nonmembers. In addition, we need to become better at using our regional Groupsite to get the word out to leaders and as a way to combine resources when needed. 

We also need to improve how the association website is organized so that it’s easier for members who login to find legislative and regulatory information. 

We recently offered a webinar on the impact of healthcare reform. Another idea is to create a webinar or video on the “how to’s” of advocacy for counselor educators to use with their students as well as with our membership. Many AMHCA members are frankly insecure and uncomfortable with politics and the advocacy process.

The Advocate: What do you see as the biggest advocacy challenges confronting the profession today?

AMHCA President Karen Langer: It’s that we have yet to come to grips with who we are as a profession. 

Though we are actually a very young profession, we finally have licensure in all states. However, each licensure law is separate, which makes it difficult to advocate when there is no consistent standard. Regardless of what standards the organization endorses, we risk alienating some groups or states.

Further, the divergent regulations make it difficult to make a case for being included in the discussions at the highest level. During last summer’s conference in Orlando, and when I was in Missouri this fall for their conference, we had very good discussions about who we are as a profession. 

The Advocate: How will AMHCA grow its membership to meet the profession’s advocacy challenges?

AMHCA President Karen Langer: To grow our membership and be able to have a stronger advocacy voice, we need to use the tools at our disposal. 

We need to be better at getting the word out that this is a critical time for our profession, and the only way to ensure that we have a voice is to encourage the 90 percent of counselors who are not actively participating in the association to step up. 

The Advocate: How will AMHCA work to unify the profession?

AMHCA President Karen Langer: We will continue to work for clinical mental health counselors and the needs of our clients while keeping our eye on the big picture. We do have a committee looking at how we might advocate for consistent licensing standards to help with portability and other issues. This committee is reviewing what other professions have done in this regard to see if we can borrow from their successes. 

JAMES FINLEY, AMHCA Associate Executive Director and Director of Public Policy

The Advocate: With the election behind us, how do you see the congressional environment changing in the new year? Is continued gridlock likely? Will resistance to Obamacare diminish?

AMHCA Associate Executive Director and Director of Public Policy James Finley: Call me crazy, but I think the environment will improve in 2013. Republicans are indeed chastened by their election performance, and I expect will be more willing work with Democrats on a few select issues and with the White House. 

For AMHCA, I think Obamacare—the Affordable Care Act, or ACA—as well as Medicare will be major areas where GOP members will seek cooperative legislation. Everyone understands now that Medicare will not be converted into a voucher or privatized, but both sides recognize the need for incremental reforms on both the spending and delivery sides. For the ACA, I expect House Republicans to relent a bit and shift into a monitoring mode. While I still expect some harsh hearings and occasional talk of repeal, everyone recognizes that implementing the ACA will occur and that it is shifting to the states. 

I think Congress will focus more on identifying small changes in the ACA that both sides agree are necessary and would improve the program. For mental health counselors, this provides an opportunity to emphasize how our services fit within a restructured and quality focused delivery system. I hope our members can build understanding that mental health counseling is part of the solution to addressing both healthcare delivery and spending problems. 

The Advocate: Medicare spending was a major issue during the election and in recent negotiations on the fiscal cliff. How is AMHCA’s provider status legislation impacted by the budget debate on Medicare? Did the election outcome change these dynamics?

AMHCA Associate Executive Director and Director of Public Policy James Finley: Congress will remain deeply divided on Medi-care’s direction, but there are still issues that must be addressed where they may seek agreement. Many of our members don’t know our provider status amendment has been scored by the Congressional Budget Office as increasing Medicare spending. That means we face an uphill battle for a new Medicare spending provision while Congress is struggling to reduce total expenditures. This is hard! So we must greatly increase our profession’s voice on Capitol Hill. 

I expect two big Medicare problems will become bipartisan in the New Year: physician payment reform and finding new methods to make Medicare a more efficient purchaser of care. Forming more efficient provider networks under Medicare will be more popular on both sides because of its potential to reduce spending. For AMHCA, this means we’ve got to advocate that addressing the mental health needs of Medicare patients will improve health outcomes and lower costs overall, while stressing that participation of mental health counselors in the reformed system is essential. 

The Advocate: Did we lose any congressional advocates for the profession in this election cycle? Is anyone emerging who looks promising?

AMHCA Associate Executive Director and Director of Public Policy James Finley: We did better this election cycle at holding onto our key supporters, with one major exception—Rep. Pete Stark (D–Calif.), who lost his race. Rep. Stark was the highest ranking member of the House Health Subcommittee on Ways and Means, which authorizes Medicare. He was a principal supporter of our inclusion under Medicare, and in 2011 he won our Legislator of Year Award. We cannot easily replace the value of his support in such a key position. 

In the Senate, Sen. Patty Murray (D–Wash.) will be rotating off as chair of the Senate Veterans Affairs Committee, but will remain on the Committee. She is very supportive of improving mental health services in the VA, and has been willing to work with us on our VA recognition issues. 

On the plus side, the new senior Democrat on the House Committee on Veterans Affairs will be Rep. Mike Michaud (D–Maine). He is an excellent supporter of ours on VA hiring issues, and we are eager to work with him in his more influential capacity. 

DAN HOLDINGHAUS, Chair, AMHCA's Public Policy and Legislation Committee; Executive Director, Missouri Mental Health Counselors Association (MMHCA)

The Advocate: What are the priorities of AMHCA’s Public Policy Committee in the new year?

Public Policy and Legislation Committee Chair Dan Holdinghaus: Inclusion of mental health counselors in the Medicare program remains our top priority, and we’ve got to pull out all the stops with our membership on this issue. We expect Congress will conduct a heated debate over potential changes in Medicare, as part of its ongoing discussion of budgetary issues. We will look for openings to include mental health counselors as providers.

Along with this effort we will monitor the implementation of the Affordable Care Act (ACA) to make sure we are included as key pro-viders of mental and behavioral healthcare. We are also very disappointed the VA has hired so few of our people. We are0 already searching on Capitol Hill for support of new legislation that would redirect VA hiring practice.  

The Advocate: Mental health counselors have made important advances recently toward full federal recognition in the VA and DoD, but federal policy is incomplete. What’s next in these agency efforts?

Public Policy and Legislation Committee Chair Dan Holdinghaus: We continue to encourage mental health counselors across the country to seek independent provider status under TRICARE. There is a window of opportunity now for our people to be recognized using a temporary set of qualifying criteria that are more inclusive. This year we’ll continue our push to expand the TRICARE grandfather standards so even more mental health counselors can eventually participate. 

Elsewhere within the DoD, we need to complete the adoption of independent practice status for our people in the Army and with other service branches that have yet to recognize our independence. At the VA we will continue to advocate for broader hiring standards so that more of our people can fill their mental health staff positions. Unfortunately, the VA is highly resistant to broadening its requirements for qualified mental health counselors, and we’ll have to push this hard for at least several more years. 

The Advocate: You’re also a state chapter executive in Missouri. What will AMHCA state chapters confront on Obamacare and Medicaid that could impact the mental health counseling profession, and how should chapters respond?

Public Policy and Legislation Committee Chair Dan Holdinghaus: We maintain close contact with AMHCA state chapters through our network of State Coordinators for Legislative Activity (SCLAs). We will provide them with information and action alerts to relay to their chapter membership. 

We are also encouraging all of our state chapters to carefully monitor their state’s plan for implementation of their health care exchanges and Medicaid plans. We will seek their feedback on the inclusion of mental health counselors in their state plans and share that information with other state leaders. We will try to provide them with information on model programs in healthcare reform to help inform and empower membership advocacy in the states.