Medicare bill passed federally allowing counselors to get on Medicare insurance panels beginning January 1, 2024.
Counselors need to credential with CMS & Medicare insurance panels in the same way as other insurance companies in order to begin taking Medicare clients. The MFT/MHC rate is 75% of the psychologist rate
90837 = $125.16 (psychologist rate is $166.82)
There are two Medicare programs: traditional Medicare & Medicare Advantage plans – client chooses what they want when they sign up for Medicare, so counselors should be enrolled with both
The Mental Health Access Improvement Act (S. 828/H.R. 432) would close the gap in federal law that prevents mental health counselors from being recognized as Medicare providers. This legislation would give Medicare beneficiaries access to more than 225,000 additional licensed mental health professionals and help close the widening treatment gap between people on Medicare and people with private insurance.
Passing the Mental Health Access Improvement Act will:
provide you as a licensed mental health counselor the option of enrolling as a provider within the Medicare program, thus increasing your opportunities to earn income;
improve access to mental health care for people age 65 and older, people under age 65 with disabilities and people with end stage renal disease (kidney failure); and
increase mental health provider options for U.S. veterans.
If this legislation becomes law:
licensed mental health counselors like you will receive reimbursement for mental health care services rendered to eligible clients at a rate equal to that currently paid to Medicare providers in the field of social work.
We at the American Counseling Association are calling on you and others in the counseling community to continue engaging your congressional representatives on the need for this legislation. Let them know today that including mental health counselors as Medicare providers will help to close a critical gap in coverage for many people. We need all counselors of all specialties to support this legislation. A win here is a win for the entire counseling community. After you take action, please ask your colleagues, family and friends to do so too and to share this Action Alert with their networks. Thank you for your support.
Please note: The term “mental health counselor” encompasses all licensed practicing counselors working in the United States, regardless of how the licensed counselors are referred to in a particular state.
5/2021
Members of Congress in both parties in the House and Senate have introduced legislation to close the “Medicare mental health coverage gap” - the lack of coverage for services delivered by licensed professional counselors. We need you to push to finally change this outdated policy, which deprives some of the most vulnerable Americans -- seniors and individuals who qualify for Medicare because of disability - access to counseling services. As a licensed professional counselor, you have the expertise to provide lawmakers with “on-the-ground” information about the urgent and unmet mental health needs of Medicare beneficiaries as Congress makes major health policy decisions this year.
Sadly, the COVID-19 pandemic has exacerbated the mental health crisis in the U.S. and highlighted the shortage of mental health providers, particularly for the Medicare population, where high rates of mental illness can co-exist with physical disabilities and result in costly adverse outcomes. The American Counseling Association (ACA) is calling on the counseling community to unite and fight for inclusion as Medicare providers, so we can build resilience and strength for all members of our communities.
DON’T DELAY! YOUR VOICE MATTERS!
The American Counseling Association continues to educate Congress on the role of counselors in mental health and the clients you serve, but they need to hear from you. You gave us your stories that highlighted your challenges. We nowneed you to take the next step and reach out to your representatives in Congress. Here are some of the FACTS they need to know:
Licensed Professional Mental Health Counselors (LPMHCs) account for one third of the mental health care workforce (U.S. Health Resources & Services Administration)
Barriers to care limit access to our nation’s most vulnerable in underserved populations, thus access to Mental Health services are denied despite LPMHCs availability to help. Mental Health Counselors are available to close the provider gap and are critical to the health of our nation during and after the COVID-19 pandemic as essential partners in the nation’s recovery.
Mental Health Counselors are eligible to bill Tricare, and Private Insurance but are left out of providing mental health service through Medicare/Medicaid.
1989 is the last time the Centers for Medicare and Medicaid Services has updated the provider list. Counselors have been denied the opportunity to help Mental Health Clients for over 30 years.
Last Congress, the Mental Health Access Improvement Act gained historic bipartisan support l with 123 cosponsors in the House and 31 cosponsors in the Senate. The legislation was also approved by the powerful House Energy and Commerce Committee.
Counseling services are critically important right now. Loss and isolation during the COVID-19 pandemic has exacerbated mental health issues experienced by those within the Medicare population.
Contact your Senators and Representatives today
5/17/2020
Contact the House Way and Means Committee and the Senate Committee on Finance and urge them to include Licensed Professional Mental Health Counselors in a future COVID-19 stimulus package.
Mental health counselors are eligible to bill Tricare and private insurance, but are left out of providing mental health services to Medicare beneficiaries.
You can write, email or call the House Ways and Means Committee at 202-225-3625 and the Senate Committee on Finance at 202-224-4515.
I am writing today to request your consideration of including the Mental Health Access Improvement Act (H.R. 945 & S.286) in a future COVID-19 stimulus package. The current pandemic has increased the need for mental health services across the nation. Inclusion of H.R. 945 and S.286 will help close the mental health shortage gap. Barriers to care currently limit access to mental health services for our nation's most vulnerable individuals.
I am sincerely asking that the House Ways and Means Committee and the Senate Committee on Finance include Licensed Professional Mental Health Counselors (LPMHCs) in our nation's COVID-19 pandemic response effort.
•LPMHCs are eligible to bill Medicaid, Tricare and private insurance, but are left out of providing mental health services to Medicare beneficiaries.
•As of January 2020, opioid treatment programs (OTPs) are the only programs that can bill Medicare when services are rendered by a mental health counselor.
There is a critical need for counselors in these areas-and outside of them, as well.
•Clients have been known to turn to medications containing opioids when there are gaps in services, potentially leading to additional mental health concerns,
including thoughts/attempts at suicide, increased trauma, and heightened stress and anxiety.
The current COVID-19 pandemic has only increased the need for Mental Health Services, thus widening the gap and making it more difficult to serve those who need these services most. LPMHCs are equipped to provide mental health services, we just need your help in extending the viability of the mental health workforce. The demand is overwhelming in all 50 states and we are here to help.
Please support the inclusion of H.R. 945 and S. 286 in the next COVID-19 relief bill.
Thank you in advance for your support.
9/26,/2019
Centers for Medicare and Medicaid services (CMS) has drafted language into the SUPPORT Act implementation and are requesting comments from the public. The provision from the proposed rule which identifies LPC’s as providers within Opioid Treatment Programs (OTP’s) is below:
“Under the SAMSHA certification standards at § 8.12(f)(5), OTPs must provide adequate substance abuse counseling to each patient as clinically necessary. We note that section 1861(jjj)(1)(C) of the Act, as added by section 2005(b) of the SUPPORT Act defines OUD treatment services as including “substance use counseling by a professional to the extent authorized under state law to furnish such services.” Therefore, professionals furnishing therapy or counseling services for OUD treatment must be operating within state law and scope of practice. These professionals could include licensed professional counselors, licensed clinical alcohol and drug counselors, and certified peer specialists that are permitted to furnish this type of therapy or counseling by state law and scope of practice. To the extent that the individuals furnishing therapy or counseling services are not authorized under state law to furnish such services, the therapy or counseling services would not be covered as OUD treatment services. “
This language specifically names licensed professional counselors as Medicare-eligible OTP providers and is clearly articulated. This would be a huge development, not only for those counselors involved in opioid treatment programs, but in our larger push for inclusion as Medicare-eligible providers.
The American Counseling Association (ACA) is asking that everyone submit comments. As a mental health care provider, you know the importance of being able to access mental and behavioral health services. It is extremely important that your voices are heard!!
Please submit your comments online by the deadline Friday September 27, 2019 by 5:00pm (EST).
If you required additional information please contact the American Counseling Association at 202-823-9800 or by e-mailing advocacy@counseling.org.
8/6/2019
The August Recess has begun in Washington which means that your Members of Congress have returned to their respective home states until Labor Day. Now is a great time to meet with them at events and town hall meetings to discuss Medicare reimbursement for Licensed Professional Counselors (LPCs). You can find out what events they are scheduled to attend in your area by checking their websites, social media, or by calling their nearest district office. You may also look for nearby town halls on the Town Hall Project.
The American Counseling Association (ACA) continues to advocate for Medicare Reimbursement for LPCs by building support for the Mental Health Access Improvement Act (S.286 in the Senate and H.R.945 in the House). We are making progress in persuading Members of Congress to become cosponsors, but we need to add more! In addition to attending events where your representative will be present, below are a few more ways you can advocate on behalf of yourself and your clients:
You can help us by visiting the Take Action page on ACA’s Government Affairs website, and sending your legislators a message concerning this important legislation. (No worries! We’ve already prepared a message for you, but you can add your thoughts as well.)
You can contact your representatives about this Medicare legislation by calling them at the U.S. Capitol, 202-224-3121. When you reach your representative’s office, ask for the staff member who handles health policy and tell them a story about your client(s) (anonymously) who have been affected by your inability to be reimbursed by Medicare.
Even better than a phone call, you can schedule an in-person meeting with a staff member in your representative’s nearest district office to talk about the Medicare bill.
You don’t need to be an expert in legislation, and they don’t expect you to be an expert. You just need to explain the need for reimbursement from your clients’ point of view. You can learn more about the issue here, which also includes two informational handouts.
No matter how you decide to advocate, please let us know about your conversations with your Members of Congress or their staff at advocacy@counseling.org. Feel free to refer any difficult questions they may have to us here at ACA.
Two bills have been introduced in Congress including Mental Health Counselors [LPCs] and LMFTs as Medicare providers. We have been waiting for this for quite some time, we now have an opportunity to make this happen. It is critically important that we contact our two Senators and our Representatives to request them to sign on to these bills. Medicare recognition will open many doors now closed to us. Please call or email them now.
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.
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
LCA members are urged to email their two U.S. Senators and one Representative to urge them to co-sponsor S. 1830/HR. 2759. You may find their Senators and Representative's email address on their office websites. See these suggested email messages to Senate andHouse 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.
Important Points that you can use:
· 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.
National Legislation
S. 562—the “Seniors Mental Health Access Improvement Act of 2013
Sponsors: Senator Ron Wyden (D-OR), Senator John Barrasso (R-WY) LATEST INFORMATION 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.
- See more at: http://www.counseling.org/public-policy/public-policy/public-policy-news-view/position-papers/2013/03/19/medicare-coverage-of-licensed-professional-counselors-bill-introduced-in-113th-congress#sthash.JUJXp5cY.dpuf
Army Directive 2011-09 Signed by the Army
The American Counseling Association, the National Board for Certified Counselors, and the American Mental Health Counselors Association are pleased to announce that on July 26, 2011, Secretary of the Army John M. McHugh signed Army Directive 2011-09, Employment of Licensed Professional Counselors as Fully Functioning Army Substance Abuse Program Practitioners. This directive authorizes “the Army Substance Abuse Program to employ licensed professional counselors and licensed mental health counselors as independent practitioners with a well-defined scope of practice.”
The directive also establishes credentialing and privileging standards for licensed counselors who seek employment through the Army Substance Abuse Program (ASAP). The criteria include:
Successful completion of a master’s degree in counseling from a regionally accredited college or university that has its counseling program accredited by the Council for Accreditation of Counseling and Related Education Programs. (Counselors who are already employed with ASAP or entered the application process for an ASAP counseling position prior to the effective date of the directive do not have to meet the accreditation requirement.)
Possession of a state license as a professional counselor or mental health counselor at the highest clinical level offered by their state licensure board
Passage of the National Clinical Mental Health Counselor Examination
The directive became effective upon signature by the Secretary of the Army on July 26, 2011.
You may recall that the Department of Defense had been charged by Congress with issuing regulations by June 20, 2011 to let licensed professional counselors practice independently within the TRICARE program. We have been told that the Army SAP directive is a temporary policy that allows counselors to practice independently until the TRICARE regulations are completed.The final TRICARE regulations may—or may not—include the same requirements as the Army SAP directive. ACA, NBCC, and AMHCA continue to urge the Department of Defense to adopt broad TRICARE regulations that recognize all qualified professional counselors.
ASAP vacancies are posted here for interested counselors: http://medcell.army.mil/spotlight.asp?id=15. Although this webpage and the job announcements specifically reference social workers and psychologists, we have confirmed with Army SAP leadership that these positions are available to professional counselors.
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