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Legislative Update
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AMHCA’s 2013 Strategy for Advancing the Profession; and Details on Mental Health Benefits Under Obamacare

By James K. Finley, Associate Executive Director, 
and Director of Public Policy

The long-dreaded budget sequester has gone into effect on March 1, triggering a series of often dramatic cuts in most federal programs. 

Some programs—including Medicare, Medicaid, and Veterans Affairs—are exempt or partially protected from automatic cuts, but most federal programs are vulnerable and will experience substantial cuts during the month of March. 

The most likely sequester cuts that will impact mental health 

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services will be in research funding for the National Institute of Mental Health (NIMH) and in service programs under the Substance Abuse and Mental Health Services Administration (SAMHSA). The White House estimates that cuts to the Mental Health Block Grant program will eliminate services to 373,000 adults and children. 

The sequester was regarded as a virtual fait accompli when just 10 days before it was to go into effect, no serious negotiations were under way between the White House and Congress to avert the cuts. 

Seeking Provider Status Under Medicare

In spite of the political drama over the sequester, Congress is making plans for the year, and Medicare physician fee legislation is shaping up as a bipartisan priority. As in past years, AMHCA’s small bill granting provider status to mental health counselors must ride along with larger Medicare spending legislation that is typically considered about once a year. AMHCA and its coalition partners are targeting an upcoming Medicare physician fee bill as the catch-all vehicle for our bill this year. 

Since this is a new Congress, we must start anew by getting our bill reintroduced in both the Senate and the House of Representatives. AMHCA and our coalition have been in touch with last year’s lead Senate sponsors, and we once again have strong bipartisan support in that body. We expect a Senate bill will be introduced later in March. Securing introduction of a House version of the bill, however, has proven much more problematic. AMHCA’s coalition can easily secure a House Democratic co-sponsor, but we have no willing House Republican to take the role of lead co-sponsor. 

We are meeting with many potential House Republican sponsors, but we anticipate securing a GOP sponsor will re-main a major hurdle. Our coalition believes that without a Republican co-sponsor, a House bill would be dead on arrival, so we have asked our House Democratic supporters to hold back introduction. 

Can you help? We ask all AMHCA members with good contacts among GOP House members to contact our office to work with us on promoting the House bill. 

TRICARE Certification for Independent Practice

AMHCA still receives a trickle of requests from members seeking help obtaining TRICARE certification for independent practice. The good news is we have heard from many mental health counselors who have received certified provider status. However, key deficiencies in TRICARE’s December 2011 rules remain. 

During much of 2012, TRICARE administrators worked on revised program rules; however, there has been no recent activity from the agency. AMHCA is seeking a more inclusive grandfather provision that will enable all demonstrably well-qualified practitioners to participate in the program. Specifically, we seek an inclusive grandfather that will open a time-limited alternative to the CACREP accreditation requirement. 

Beginning in February, AMHCA joined its coalition partners in meeting with potential Senate supporters to assess whether new grandfather rules will be forthcoming or whether we should seek congressional intervention. We are currently exploring strategies for congressional intervention should improved rules not be forthcoming in TRICARE rules. 

Putting Pressure on the VA to Hire More Mental Health Counselors

AMHCA is also upping pressure on the Department of Veterans Affairs to hire more mental health counselors. Though we continue to meet regularly with top VA leadership to advocate for increased hiring within the profession, we encounter great resistance. 

In late February we restarted rounds of House and Senate VA committee members to seek traineeship funding for mental health counselors. Such traineeships are an important starting point to employing more mental health counselors in the VA system. We are also urging congressional offices to examine the very slow pace of mental health counselor hiring, including considering how barriers to mental health counselor hiring compound broader congressional concerns about the pace of VA hiring of mental health professionals. 

Lastly, we are asking congressional offices to support bill language that would add a grandfather provision to mental health counselor position requirements. Such a provision would allow more mental health counselors to qualify for VA employment. 

AMHCA Identifies “Grandfather Language” as a Best Strategy

For both TRICARE and the VA, AMHCA leaders have set a high priority on securing more inclusive grandfather language in the agencies’ professional standards. AMHCA recognizes the need for national (CACREP) accreditation standards of our training programs, but we also urge adoption of an inclusive grandfather provision so that earlier graduates of state or regionally accredited programs may participate. 

Accreditation standards are not expected to become part of Medicare provider legislation, as provider certification requirements are usually addressed in regulation, following enactment of a new law. AMHCA expects that Medicare administrators will lean heavily on TRICARE and VA professional standards when legislation is finally enacted. 

For now, AMHCA leaders think our best strategy is to seek an inclusive grandfather provision under TRICARE and the VA, there-by creating an inclusive model for Medicare in the future.

Mental Health Benefits of Obamacare Are Spelled Out

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced a final rule for the Accountable Care Act that will make purchasing health coverage easier for consumers. The policies give consumers a consistent way to compare and enroll in health coverage in the individual and small-group markets. 

The rule outlines health insurance issuer standards for a core package of benefits, called essential health benefits, which health insurance issuers must cover both inside and outside the health insurance “Exchanges.” The standards for essential health benefits greatly expand the availability of coverage for mental health and substance-use disorder services. 

The rules will eventually expand mental health and substance use disorder benefits and federal parity protections to 62 million more Americans. For more information, see: Essential Health Benefit Rule.

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