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Federal Legislative Update


Dear Ruthann Anderson,
Medicare Legislation Action Alert
New bills have been introduced in the House and Senate to extend Medicare provider status to mental health counselors and marriage and family therapists. On July 22, 2015 Senators John Barrasso (R-WY) and Debbie Stabenow (D-MI) introduced the “Seniors Mental Health Access Improvement Act” (S. 1830) and on June 12, 2015 Representatives Chris Gibson (R-NY) and Mike Thompson (D-CA) introduced the House version as (HR. 2759). The identical bills would allow Medicare beneficiaries access to mental health counselor services and marriage and family therapists (MFTs) through Medicare. By providing these mental health professionals the opportunity to participate in the Medicare program, the bills expand the number of mental health providers available to beneficiaries.

Describing the need for the legislation, AMHCA notes that in the United States 20 percent of individuals aged 55 and older experience some type of mental health problem. According to the Health Resources and Services Administration, there are approximately 4,000 Mental Health Professionals Shortage Areas in the United States, and half of all counties in the U.S. have no practicing psychiatrists, psychologists or clinical social workers. Seniors in rural communities are the most adversely affected by these shortage areas. The time to promote Medicare recognition of mental health counselors and MFTs is now. Urge your two Senators and Representative to co-sponsor this vital legislation that would authorize MHCs and MFTs to be paid by Medicare for outpatient mental health services to beneficiaries.

Action Requested
AMHCA members are urged to email their two U.S. Senators and one Representative to urge them to co-sponsor S. 1830/HR. 2759. AMHCA members may find their Senators and Representative’s email address on their office websites. See these suggested email messages to Senate and House offices.

Background and Justification
About 50 percent of rural counties have no practicing psychiatrists or psychologists. Mental Health Counselors and MFTs are often the only mental health providers in many communities, and yet they are not now recognized as covered providers within the Medicare program. These therapists have equivalent or greater training, education and practice rights as currently eligible provider groups that can bill for mental health services through Medicare.

Other government agencies already recognize these professions for independent practice, including The National Health Service Corps, the Dept. of Veterans’ Affairs and TRICARE. Medicare needs to utilize the skills of these providers to ensure that beneficiaries have access to necessary services.
  • Lack of Access in Rural and Underserved Areas--Approximately 20 percent of individuals aged 55 and older experience some type of mental health problem. According to the Health Resources and Services Administration, there are approximately 4,000 Mental Health Professionals Shortage Areas in the United States, and half of all counties in the U.S. have no practicing psychiatrists, psychologists or clinical social workers. However, many of these mental health professional shortage areas have mental health counselors whose services are underutilized due to lack of 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. One-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 outpatient mental health services of MHCs.
  • Underserved Minority Populations--The United State 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 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.
Please direct inquiries to James K. Finley, AMHCA Associate Executive Director:

If you wish to stop receiving email from us, you can simply remove yourself by visiting:
The American Mental Health Counselors Association (AMHCA) works to enhance the profession of mental health counseling through advocacy, education, licensure, and professional development.
AMHCA, 801 N. Fairfax Street, Alexandria, VA, 22314, 703-548-6002,



Support the Work of School Counselors: Help Get Funding for Programs Already On the Books!
There are three programs that support the work of professional school counselors and have been approved by Congress. These programs demonstrate positive student outcomes such as reducing discipline, improving school climate and teaching social emotional skills to overcome barriers to academic and social success. These programs, the Elementary and Secondary School Counseling Program, Safe Schools Healthy Students Initiative, and Integration of Schools and Mental Health Systems are described below. (All descriptions were pulled straight from Department of Education’s website.)

ACTION: Please contact your members of Congress and ask that these programs receive full funding as they are effective and immediate ways to help our schools address safety and the mental health of our country’s youth. Increasing our school-based mental health professionals and therefore decreasing our students-to-school counselor ratio, will allow our nation’s schools to address the needs of the whole child, improving our communities and k-12 academic success.
Elementary and Secondary School Counseling Program (ESSCP) -- in ESEA, Title V, Part D
This program provides funding to Local Education Agencies (LEAs) to establish or expand elementary and secondary school counseling programs, with special consideration given to applicants that can:

Projects should: (1) use a developmental, preventive approach, (2) expand the inventory of effective counseling programs, (3) include in-service training, and (4) involve parents and community groups.
This program is still currently active, however has been threatened to be cut for the l. In FY2012, $21 million was rewarded to 60 grantees in 24 states. These grants are often used to hire school counselors and other school-based mental health professionals.
Safe Schools Healthy Students Initiative -- in ESEA, Title IV, Part A
Grants support LEAs in the development of communitywide approaches to creating safe and drug-free schools and promoting healthy childhood development. Programs are intended to prevent violence and the illegal use of drugs and to promote safety and discipline. Coordination with other community-based organizations (CBOs) is required. This program is jointly funded and administered by the departments of Education, Justice, and Health and Human Services.
To be funded, local comprehensive strategies must address the following five elements but may address other elements as well, as determined by the needs of the community:

In 2001, $117 million was appropriated and each year since has been decreased. In 2008, $72 million was appropriated and by 2012, no new money was given out.
Integration of Schools and Mental Health Systems – in ESEA, Title V, Part D

This program provides grants to SEAs, LEAs, and Indian tribes for the purpose of increasing student access to quality mental health care by developing innovative programs that link school systems with local mental health systems. Grants were given out between 2005 and 2010. In 2010, the largest amount was appropriated at $5,913,000, with the average grant of 16 awarded being $347,000.

A funded program must include all of the following:


Medicare Coverage of Licensed Professional Counselors – Bill Introduced in 113th Congress

S. 562—the “Seniors Mental Health Access Improvement Act of 2013"
Sponsors: Senator Ron Wyden (D-OR), Senator John Barrasso (R-WY)


Bipartisan legislation has been introduced in the Senate to establish Medicare reimbursement of licensed professional counselors and marriage and family therapists. As with previous versions of the legislation, S. 562 would cover only medically-necessary outpatient mental health services, and would reimburse licensed professional counselors and marriage and family therapists at the same reimbursement rates, and under the same terms and conditions, as clinical social workers.

ACA strongly encourages counselors to contact their Senators to ask them to cosponsor the legislation.

Please call or e-mail both of your Senators and ask them to cosponsor S. 562, the "Seniors Mental Health Access Improvement Act of 2013," S. 562. (Only Senators can cosponsor legislation introduced in the Senate.) Let your Senators know that this same legislation was passed by the Senate in both 2003 and 2005, and that private sector health plans have been covering counselors for many years.
You can find out who your Senators are by visiting the ACA internet legislative action center at and entering your zip code in the box indicated. Senators and Representatives can be reached through the U.S. Capitol Switchboard at 202-224-3121, and telling the operator which office you would like to be connected with.BACKGROUND
Medicare is the nation's largest health insurance program, covering roughly 43 million older Americans (65 or older), and approximately 9 million Americans with disabilities. The program was established in 1965.
Medicare has covered psychologists and clinical social workers since 1989, but does not cover licensed professional counselors. Many Medicare beneficiaries live in mental health professional shortage areas, and there are more than 120,000 licensed professional counselors across the country ready to provide needed treatment. Lack of access to outpatient mental health treatment harms beneficiaries, and contributes to overutilization of more expensive inpatient care. It also increases the costs of treating chronic medical conditions such as diabetes or congestive heart failure, since many individuals with these conditions have a comorbid depressive disorder.
Medicare coverage of counselors is not a partisan issue, nor is it a new issue. The Senate passed legislation establishing Medicare reimbursement of licensed professional counselors in both 2003 and 2005, during Republican control of that chamber. The House of Representatives has also approved such language twice, in both 2007 and 2009, under Democratic control.
S. 562 will improve Medicare beneficiaries' access to outpatient mental health care in a cost-effective manner, by establishing coverage of highly-qualified LPCs. The current shortage of mental health professionals available to Medicare beneficiaries is going to get significantly worse over the coming years, as the baby boom generation enrolls in the program and current mental health service providers retire. Research shows that licensed professional counselors are proportionately more likely to work in rural and underserved areas than are clinical social workers, psychologists, and psychiatrists.


Counselors continue to be all but shut out of the VA. Here's what you can do to help
While we continue to see a growing need for mental health providers in the VA, there is a large, untapped pool of highly-qualified mental health professionals ready to be enlisted to help provide services to veterans. Nationwide, there are more than 120,000 professional counselors licensed for mental health practice across the country, meeting education and training requirements on par with or more stringent than those of other master’s level mental health professionals, such as clinical social workers and marriage and family therapists. Licensed professional counselors must have a master’s degree in counseling, pass a national exam, accumulate thousands of hours of post-master’s supervision, and adhere to a strict code of ethics.

In December of 2006, Congress and the President enacted legislation explicitly recognizing licensed professional mental health counselors as clinicians within VA facilities (P.L. 109-461). Almost four years later, the VA adopted an occupational standard for “licensed professional mental health counselors” (LPMHC) within the VA. Two years after the standard was adopted, and going on nearly seven years after the enactment of P.L. 109-461, licensed professional counselors are still being largely shut out of the VA mental health workforce. This deprives veterans of access to the best possible pool of highly qualified mental health providers. In 2012, the VA only posted 58 positions for licensed professional mental health counselors nationwide; during this time, the VA posted 1527 mental health clinician positions as open only to social workers.

How You Can Help
Unfortunately, the VA has not taken adequate steps to incorporate counselors into its workforce and won’t unless Congress exerts pressure. Members of Congress can take specific steps to push the VA to begin bringing counselors on board in significant numbers. Specifically YOU need to call your Member of Congress and demand that they direct the VA to:
1. Expand the eligibility criteria for LPMHC positions to include mental health counselors who:

2. Include counselors in its paid trainee program. These positions--long open to both psychologists and clinical social workers--are a well-trod pathway to careers within the VA, and counselors are being unfairly and arbitrarily discriminated against by being excluded from the program.

3. Collaborate with ACA and other groups to help fill vacancies in the VA. ACA has a national network and an office of professional affairs that can help find applicants for these positions.

4. Appoint a liaison to work with the counseling community toward hiring more LPCs in the VA.

5. Issue a public notice to the entire VA healthcare system (Specifically to VISN Directors, VMAC Directors and HR Directors) reminding them that they are empowered to hire counselors, and asking them not to shut-out an entire profession that can provide desperately needed help to our vets.

Support Mental Health in Schools Act of 2013
S. 195, Mental Health in Schools Act of 2013
Sponsor: Sen. Al Franken (D-MN)

Latest Information
School safety and preventative mental health services are key issues currently being discussed on Capitol Hill. ACA has been tracking numerous mental health and education bills that are being introduced in order to increase mental health services for our youth and create comprehensive approaches to bridging the services provided in schools and in the community.

ACA supports the Mental Health in Schools Act of 2013, which was introduced on January 31. It is designed to increase students’ access to mental-health services in schools by establishing a new grant program that supports collaboration between local education agencies and community based health and social service organizations focused on children and youth. It can provide training for school employees to help identify and address the mental health needs of students. Rep. Napolitano of California has introduced a version of this bill in past Congresses.

The Mental Health in Schools Act will provide $200,000,000 in competitive grants of up to $1 million each. See the bill text here:
What you can do
Ask your Senators to sign on as co-sponsors to help build bi-partisan support. To take action right away, use our online email tool with suggested messaging:

If your Senator has already signed on as a co-sponsor, please send a quick thank you message to let her/him know how important this issue is to you.

There have been programs authorized by Congress in the past that have approached mental health in schools in a collaborative way. Many of these programs have been defunded or greatly reduced in funding, including Safe Schools/Healthy Students Initiative and Safe and Drug-free Schools program.

Whether it is new legislation passed that provides mental health services to students by increasing access to mental health professionals, or currently authorized programs that are refunded, there is a great need in schools and our communities for preventative and collaborative efforts. Professional school counselors should continue to communicate to law makers that they are a necessary link for an effective referral process to outside mental health agencies and can ensure the whole child, including supports necessary for academic success, is addressed when students are struggling with trauma and mental health related problems.






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