Join Our Battle for Medicare Coverage as It Restarts
By James Finley, Associate Executive Director and Director of Public Policy
On March 14, Senators Ron Wyden (D–Ore.) and John Barrasso (R–Wyo.) reintroduced Medicare legislation, adding the services of mental health counselors and marriage and family therapists (MFTs) to Part B of the Medicare program.
View the bill text for S. 562 and the sponsors' introductory comments in the Congressional Record.
This Medicare legislation is AMHCA’s top priority, and we expect our efforts on its behalf will be ongoing during the year. A House companion bill is on hold until a Republican sponsor is found through our grassroots efforts.
The time to promote Medicare recognition of mental health counselors is now. AMHCA has called on all its members to email their two U.S. Senators and urge them to co-sponsor S. 562. You may learn more about the legislation on the public policy pages of our website .
Following are some of the justifications we are using in communications with Congress.
- Other government programs already recognize mental health counselors for independent practice. These programs include the National Health Service Corps, the Department of Veterans Affairs, and TRICARE. Medicare needs to utilize the skills of these providers to ensure that beneficiaries have access to their services.
- Lack of Access in Rural and Underserved Areas. Approximately 77 million older adults live in 3,000 areas with mental health professional shortages. Fully 50 percent of rural counties in America have no practicing psychiatrists, psychologists, or social workers. However, many of these mental-health-professional shortage areas have mental health counselors whose services are underutilized due to their omission from Medicare coverage.
- Medicare Inefficiency. Currently, Medicare is a very inefficient purchaser of mental health services. Inpatient psychiatric hospital utilization by elderly Medicare recipients is extraordinarily high when compared to psychiatric hospitalization rates for patients covered by Medicaid, VA, TRICARE, and private health insurance. A third of these expensive inpatient placements are caused by clinical depression and addiction disorders that can be treated for much lower costs when detected early through the out-patient services of mental health counselors.
- Underserved Minority Populations. The U.S. Surgeon General noted in a report entitled, “Mental Health: Culture, Race, and Ethnicity,” that, “Striking disparities in access, quality, and availability of mental health services exist for racial and ethnic minority Americans.” A critical result of this disparity is that minority communities bear a disproportionately high burden of disability from untreated or inadequately treated mental disorders.
- Medicare provider eligibility for mental health counselors and MFTs is long overdue. These two professions represent over 40 percent of today’s licensed mental health practitioners. Unfortunately, Medicare coverage has not been modernized to recognize their essential contribution in today’s health delivery system. Congressional scoring rules obscure the dollars saved by utilizing their services to treat mental health conditions before they exacerbate into more serious mental and physical disorders.
Congress plans to consider Medicare physician fee legislation later this year, and it is shaping up as a must-pass bipartisan priority. Our Medicare bill (S. 562) could ride along with the catch-all physician fee legislation later in the year.
Our single greatest obstacle to passage is a lack of House Republican support for a companion bill.
AMHCA’s coalition is working with a grassroots network to identify a House Republican willing to take the role of lead House co-sponsor. We have met with a number of potential House Republican sponsors, but winning one over remains a major hurdle. We ask all AMHCA members with good contacts among GOP House members to contact our office to work with us indi-vidually to promote introduction of a House companion bill.
In addition to Medicare advocacy, AMHCA and its coalition partners are continuing to meet with congressional offices on the very slow pace of VA hiring of mental health counselors and marriage and family therapists. We receive a positive reception to our appeals for help, but the problem remains one largely of bureaucratic resistance rather than legislative or regulatory barriers.