(Updated March 2009)

LEGISLATION

H.R. 1693 -- “Seniors Mental Health Access Improvement Act of 2009” [Sponsor: Rep. Bart Gordon (D-TN)]
cosponsors (as of March 26, 2009): 2

S. 671 – “Seniors Mental Health Access Improvement Act of 2009”  [Sponsor: Senator Blanche Lincoln]
cosponsors (as of March 26, 2009): 5

LATEST INFORMATION

Legislation has been introduced in both the House of Senate to establish Medicare coverage of licensed professional counselors and marriage and family therapists.  These bills would significantly improve Medicare beneficiaries’ access to outpatient mental health care, in a very cost-effective manner.  Medicare is the nation’s largest health insurance program, covering more than 40 million Americans.  In the next 20 years, the program will nearly double in size as the baby-boom generation becomes eligible for coverage.

Despite being widely recognized by private sector health plans, licensed professional counselors have yet to be recognized under Medicare.  There are more than 110,000 licensed professional counselors across the country, available to meet the large and growing need for qualified mental health professionals to serve Medicare beneficiaries.  Counselors meet education and training standards on par with those of clinical social workers, who have been covered under Medicare for nearly 20 years. 

Congress will pass Medicare legislation this year, in order to prevent a scheduled 20% pay cut for physicians under the program from taking effect on January 1, 2010.  We need counselor coverage to be part of this Medicare package. 

In order to help make this happen, we need as many Senators as possible to cosponsor S. 671, and as many House members as possible to cosponsor H.R. 1693.  The more cosponsors these bills have, the more likely Congressional leaders are to consider them for inclusion in the larger Medicare package.

WHAT YOU CAN DO

Please call or e-mail your Representative and Senators and ask them to cosponsor the “Seniors Mental Health Access Improvement Act of 2009” (H.R. 1693 / S. 671).  This legislation will improve Medicare beneficiaries’ access to outpatient mental health care in a cost-effective manner, by establishing coverage of highly-qualified LPCs.

You can find out who your elected officials are by visiting the ACA internet legislative action center at http://capwiz.com/counseling 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.

Letters and emails should be addressed as follows:

For Senators:                       
The Honorable {full name}
U.S. Senate
Washington, D.C. 20510

Dear Senator {last name}:

For House members:            
The Honorable {full name}
U.S. House of Representatives
Washington, D.C.  20515

Dear Congressman/woman {last name}:

SAMPLE TALKING POINTS:

• Medicare recipients need better access to quality mental health care.
• Although they comprise only 12 percent of the U.S. population, people age 65 and older accounted for 16 percent of suicide deaths in 2004.  Up to 75% of older adults who die by suicide visited a physician within a month of committing suicide.
• Covering LPCs and MFTs will add over 150,000 providers—meeting education and training criteria on par with, if not stronger than, those for currently covered providers—to the Medicare program. 
• Covering LPCs and MFTs is projected to cost only $200-$300 million over five years. 
• Please cosponsor the “Seniors Mental Health Access Improvement Act of 2009” (H.R. 1693 / S. 671)!  This legislation will help increase access to outpatient mental health treatment in a cost-effective manner.

BACKGROUND

Medicare is the nation's largest health insurance program, covering roughly 38 million elderly Americans (65 or older), and approximately 5 million Americans with disabilities. The program was established in 1965, and its mental health benefit has remained largely unchanged since that time.

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 110,000 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.

Under current law, physicians will suffer a more than 20% reduction in payment rates under Medicare starting January 1, 2010, and forestalling this cut will cost a lot of money.  President Obama’s budget proposal calls for roughly $400 billion in spending over 10 years to address the problem, and prevent physicians from no longer accepting Medicare patients.  In this budget context, the estimated $200-$300 million (over five years) needed to cover licensed professional counselors and marriage and family therapists under Medicare is almost a rounding error.

STATISTICS / FINDINGS

• An April, 2004 report by the National Advisory Committee on Rural Health and Human Services recommended to the Secretary of Health and Human Services that Medicare be amended to authorize licensed professional counselors and marriage and family therapists to provide behavioral health services to Medicare beneficiaries.
• A 2002 federally-funded study by the University of Southern Maine (USM) concluded that Medicare should cover licensed professional counselors and marriage and family therapists. The study found no basis for differentiating coverage policy between clinical social workers (already covered under Medicare) and these two provider groups based on the professions' respective state licensure laws.
• Virtually all of the rural counties in this country have a shortage of practicing psychiatrists, psychologists, and social workers, the only providers covered by Medicare (President's New Freedom Commission on Mental Health, July 2003) and about 50% of rural counties have no practicing psychologist or clinical social worker (Quality Through Collaboration: The Future of Rural Health Care, Board on Health Care Services, 2004). Allowing licensed professional counselors to be reimbursed under Medicare provides an increased choice of mental health providers and increased access to services, especially for beneficiaries in rural areas who may have to pay out-of-pocket or go without services. Due to these statistics and the qualifications of licensed professional counselors, the National Rural Health Association and the National Association for Rural Mental Health support Medicare reimbursement for licensed professional counselors.
• "Although the demand for psychiatric treatment has increased dramatically over the past decade, with the proportion of the population receiving treatment for depression alone more than tripling, the number of psychiatrists in the United States has plateaued and is expected to lag notably behind population growth." ". . . as a whole, the psychiatry workforce is aging, working fewer hours, and spending less time in patient care." ." (Wilk, et. al., "Access to Psychiatrists in the Public Health Sector and in Managed Care Plans", Psychiatric Services, April 2005, American Psychiatric Association)
• It is estimated that nearly two-thirds of older Americans with a mental disorder do not receive needed services. The problem is even more acute in rural and underserved areas. (Mental Health Care and Older Adults: Facts and Policy Recommendations, American Psychological Association, July, 2003)
• An estimated 50-70% of all primary care visits are related to mental health factors such as anxiety and depression (National Coalition on Mental Health and Aging, 2004)
• In 2007, the Congressional Budget Office (CBO) estimated that Medicare coverage of both LPCs and MFTs would cost approximately $200 million over 5 years.  In comparison, total Medicare spending over the next five years is projected to be over $2.3 trillion dollars.

FOR MORE INFORMATION

----ACA Legislative Action Center: http://capwiz.com/counseling

Or contact:
Scott Barstow
Director of Public Policy & Legislation
American Counseling Association
5999 Stevenson Avenue
Alexandria, VA 22304
703.823.9800 x234
703.823.0252 fax
800.347.6647
703.823.6828 TDD
sbarstow@counseling.org
www.counseling.org