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The Window of Opportunity: Forces that Have Brought Urgency to Recognizing Mental Health Counselors as Approved Medicare Providers

By Whitney Meyerhoeffer posted 05-17-2022 12:48


Over the last 15 years the Mental Health Access Improvement Act (S. 828 and H.R. 432) has been introduced in Congress which would codify marriage and family therapists and mental health counselors as approved and recognized providers in the Medicare program in order to receive reimbursement for treating older adults and people who qualify for disability under Medicare with mental health disorders.  Unfortunately, Congress has not passed the legislation although it has received strong consideration in each chamber, but not at the same time.


There has been frustration and impatience as we have seen little movement on our legislation over the last decade, but it is a new time, and the winds of change are at work in the world of mental health legislative policy.


The Covid-19 pandemic and its impact on our collective mental health and the continuing opioid epidemic have created a new window of opportunity for passage of the Mental Health Access Improvement Act, where the U.S. Congress and the Biden Administration are considering an array of policy proposals to strengthen the behavioral health workforce – as part of overall mental health policy reforms such as insuring mental health parity, expanding tele-mental health, to name a few.


For mental health counselors and marriage and family therapists, the current environment where the political, policy, media, and stakeholder and interest groups are aligned – a window of opportunity – now represents the best moment for passage of the Mental Health Access Improvement Act since the bill’s introduction 15 years ago and see it finally signed into law. Do not be discouraged by lack of success in the past – it is part of the legislative process and policy dance that most bills must go through.


Yes… you have seen our calls for action to reach out to congressional policymakers on Medicare recognition for counselors over the last few years and you may say “here we go again…” and you may do not see progress.


But thanks to your grassroots and advocacy efforts in support of the bill, we are closer to passage of the legislation than ever before, and the bill has gained considerable bipartisan support in Congress and support from various stakeholder groups in the behavioral health sphere. The media is paying close attention to the lack of access being reported by consumers for needed mental health services around the nation.


For example, key Congressional health committees such as the Senate Finance Committee and the House Ways and Means Committee are considering our legislation as part of renewed efforts to strengthen the mental health workforce to address the needs of older adults.  About 40 organizations in the mental health and health care fields have submitted statements to the Finance Committee supporting passage of the Mental Health Access Improvement Act this year.


In the Finance Committee’s recent report on Mental Health Care in the United States: The Case for Federal Action, the committee highlights that, “Workforce shortages impact residents of both urban and rural communities. There are higher rates of SUD and suicide in rural communities, but 50% of rural counties do not have a psychiatrist, psychologist, or social worker. Only about 1.6% of psychiatrists in the U.S. live in rural areas. More than 60% of rural Americans live in a designated mental health provider shortage area. Licensed professional counselors and marriage and family therapists make up a 61% of the rural mental health workforce but are not eligible for payment under Medicare.”


Policy experts from major think tanks and representative from stakeholder interest groups are recommending that Congress immediately pass the Mental Health Access Improvement Act. 

Major reports have been released that show that we have a crisis in the older mental health adult space, where now one in four adults now suffer from a behavioral health condition such as an anxiety or depressive condition or substance use disorder.  The media is constantly reporting on the difficulty that Medicare beneficiaries are experiencing – as well as other population groups – in accessing needed care over the last two years. 


Just over the last month, outside of the Congressional spotlight, there has been considerable attention to mental health workforce issues and specifically the need to include marriage and family therapists and mental health counselors in the Medicare program:

  •  In a special article from AARP on Older Adults Struggle to Find Affordable Mental Health Care, AARP specially referenced as part of the solutions to address workforce issues that “… the proposed Mental Health Access Improvement Act of 2021, introduced in the Senate, would widen the pool of providers that can deliver mental and behavioral mental health services to Medicare beneficiaries. Currently, psychiatrists, psychologists, clinical social workers, and psychiatric nurses can do so; mental health counselors and marriage and family therapists cannot be reimbursed by Medicare for their services. The legislation would add an estimated 225,000 licensed behavioral health providers to those available to Medicare beneficiaries.”


  • On April 13, in a recent comprehensive article by the Associated Press, entitled, "Bipartisan Push on Mental Health Crisis that COVID Worsened", the article goes into detail about the Senate Finance Committee's work and related efforts. Included is a quote about the Senate Finance Committee that "there's discussion about immediately increasing the supply of counselors by allowing a wider range of professionals, including family and marriage therapists, to bill government health programs."


  • On April 6, at a major briefing sponsored by the Brookings Institution and University of Southern California, the program delved into detail on President Biden’s proposed 2022-23 Federal Budget where the White House included major mental health investments including a clear recommendation that marriage and family therapists and mental health counselors should be designated as Medicare providers through federal legislation.


  • On April 26, the Kaiser Family Foundation held a special session on mental health coverage and policy issues where speakers discussed the importance of strengthening the behavioral health workforce through the inclusion of mental health counselors and MFTs in the Medicare program.


  • The Commonwealth Fund issued a survey and report that found among older adults in the 11 countries, U.S. Medicare beneficiaries were the most likely to report being diagnosed with a mental health condition. The rate was highest for Hispanic/Latinx beneficiaries. U.S. respondents were also the most likely to report seeking care for their mental health condition, skipping needed care due to cost, and worrying about material hardship. Possible areas for U.S. reform include removing financial barriers to mental health services through better access to providers.


  • The National Institute for Health Care Management (NIHCM) is holding a special session on May 4, will highlight barriers to accessing mental health care, such as social stigma, scarcity of services, workforce shortages and affordability, that make it difficult to receive treatment.


The unprecedented attention on the need to include mental health counselors and marriage and family therapists in the Medicare program certainly increases the chances that the Mental Health Access Improvement Act will gain more traction in Congress as policymakers learn more about the workforce problems and solutions. 


Although there is wider interest and key forces are aligned, we need your help and support.  We know that you have been asked to contact your members of Congress on several occasions but this year presents a unique time and where new forces have surfaced – and complacency could be dangerous.


If your members of Congress from your state and district do not hear from you, our chances of passing the Mental Health Access Improvement Act are diminished and the policy and political window that is currently wide open, could close suddenly by failing to act.


In the coming days, you will be receiving information on how you can advocate for passage of the Mental Health Access Improvement Act through a Special Virtual Action Day on May 18th.  And we plan to hold more virtual action days throughout the year as necessary.


By reaching out to your members of Congress on a regular basis, you can assure the policy and political window remains open and our bill passes through, allowing you to become recognized as a Medicare mental health provider.


The time to act is now – and potentially time and time again this year until we get over the finish line.