If there is one thing every clinician can agree on in every state, it's that we all want a full scope of practice and we all want Medicare. We want to be considered equal to the other professions whose only claim to the pinnacle of the mental health field is that their license has been around longer. It is not about skill set. If it were, CMHCs would be at the top of the list because we are some of the most skilled and trained among all providers of mental health services. That being said, how do we climb the ladder and raise ourselves up and claim equality among the rest of this diverse field?
I believe I have a plan and I believe it can work.
We have to look at both scope of practice and Medicare as separate, but not mutually exclusive goals. I have been told that one of the reasons we don't receive Medicare is because nationally not all states have statutory authority to diagnose and treat, something all other providers of Medicare have the ability to do on a national scale. It was also brought to my attention at this past leadership conference that a much higher number of states don't have the ability to diagnose built into their statutes than I ever thought.
We need to fix this.
Second, I was told that having the ability to hospitalize individuals will reinforce our argument because it will align our abilities with other Medicare providers. In MA, this is something we don't have, but are working on. Our social work colleagues received this ability years ago in MA. It is time that we obtain it as well.
So, with the belief that dx and tx, hospitalization and Medicare are not mutually exclusive we can plan on how to obtain these goals. I believe we can achieve this through states working with one another more directly.
Let me explain how we should aim to accomplish this:
First, we need to compile a list of all the states and break it down into which states have statutory authority to dx and tx, hospitalize and, for additional data, make assessments. I believe the regional directors can help in acquiring this data so we can have many hands for making lighter work. A scheduled conference call amongst regional directors and their respective state leaders would be able to acquire this data much quicker than one person doing all the research or waiting for email replies from 50 states.
Second, states within your AMHCA region write a letter of support from states which already have dx and tx in their statutes expressing the proposed statutes successes in states surrounding the state we are advocating for alongside a signature of support from AMHCA itself expressing the national benefit this ability has had on a national level. In other words, surrounding states with dx and tx would provide letters of support for states that don’t have this statutory authority to show the benefits it would have if they were granted this ability.
Third, the state we are assisting must be able to provide a sponsor of the proposed legislation, preferably a Democrat and Relublican and be able to build an alliance with this individual(s) while simultaneously have "Call to Action" letters ready so the state chapter members can send them to their legislators (typically a legislator will only read requests from their constituency and rarely beyond it).
By coupling the grassroots efforts of the state proposing the bill with examples of its success in surrounding states and overall effectiveness nationally, I believe we can get all states up to speed with the others.
This would be most effective and most efficiently done by regions helping their own states and then regions assisting regions as we move through our successes.
All of this can be done on a state level while AMHCA continues to lobby nationally for Medicare. If somehow one comes before the other, all the better as it will only give more credibility to our other objective.
In organizing ourselves and working with one another in this way, we can not only help fellow CMHCs get the equality we deserve, it will also help us solidify the national identity we all seem to want, but sometimes struggle to define. We will also improve our ability for portability because as states become more equal in our experience and ability we will have less of a learning curve as we move from state to state.
I admit that this seems extensive and time consuming. It may be hard for some to provide resources to states outside your own as they are limited enough as it is. However, we are leaders in this field and if we want to obtain the goal of Medicare, I believe it is in our best interest to look beyond our own states to accomplish this. We cannot give legislators a reason to poke holes in our eligibility. We also cannot solely rely on AMHCA to fend for us nationally when we have additional talent around us. It is too much for just one organization to accomplish. By working together, we can and will make this happen. I hope to hear your responses and ideas moving forward and I am happy to have met a number of you at leadership. If that conference is a sample of the leadership we have in this country, our future is bright and our profession will only grow.