Virginia Association of Clinical Counselors

Must read articles. It includes four new headline articles... 

Final Conference Report on Budget Legislation Excludes Counselors from Medicare

Senate Passes Legislation to Include Counselors in VA Programs

DOD Conferees Fail to Remove TRICARE Physician Referral Requirements for Counselors

Congress Extends Mental Health Parity Act

Despite the combined efforts of the American Mental Health Counselors Association (AMHCA) and the American Counseling Association (ACA) the current version of the budget reconciliation bill conference report does not include a provision that would allow licensed professional counselors to be reimbursed by Medicare. On Sunday, December 19^th at 1:00 a.m., the U.S. House of Representatives filed a conference report and five hours later that report was passed by the House. On December 21^st, the Senate passed the conference report with three minor changes. Because there are small differences between the conference report that the House and Senate passed, the House will have to revisit the conference report when it reconvenes in January.  However, neither version of the conference report currently has the Medicare reimbursement provision.

Medicare reimbursement for mental health counselors has long been a top policy goal for both AMHCA and ACA. The provision would have established Medicare coverage of mental health services provided by licensed mental health counselors and marriage and family therapists. The language was sponsored by Sens. Craig Thomas (R-WY) and Blanche Lincoln (D-AR) and was passed on November 3, 2005, as an amendment offered by Sen. Rick Santorum (R-PA) to S. 1932, the Deficit Reduction Omnibus Reconciliation Act of 2005. The House of Representatives passed its version of the budget reconciliation bill on November 18, 2005. The House-passed version did not include Medicare reimbursement for LPCs.

During the month between House passage of its version of the budget reconciliation bill and the filing of the conference report, AMHCA and ACA members generated many calls to a list of 55 targeted members of the House of Representatives. In addition, multiple presidents and executive directors of state branches of both organizations wrote letters to the members of Congress from their state that ACA and AMHCA were targeting. Finally, AMHCA and ACA built a coalition of provider and consumer groups that wrote a letter to all 55 targeted members urging them to accede to the provision in the Senate bill that would have allowed Medicare reimbursement. The efforts of our members, leaders, and coalition partners are greatly appreciated.

In the coming year, AMHCA and ACA will concentrate on finding a key sponsor from the House of Representatives for the Medicare reimbursement provision. We truly appreciate the heroic efforts of Sen. Thomas in obtaining inclusion of the Medicare reimbursement provision in two bills that passed the Senate over the last two years. However, it is clear that in order to obtain enactment in a conference report, AMHCA and ACA need a similar champion on the House side.

The American Mental Health Counselors Association (AMHCA) and the American Counseling Association (ACA) are pleased to announce that the U.S. Senate, on December 22, 2005, approved S. 1182; the Veterans Health Care Act of 2005, legislation to recognize licensed mental health counselors as providers in Department of Veterans Affairs (VA) programs. AMHCA and ACA have been lobbying both the House and Senate Committee on Veterans’ Affairs on this issue for more than a year.

The counselor provision, which would allow mental health counselors to be eligible for better paying jobs with a greater potential for promotion at the VA, was included in S. 1182, the “Veterans Health Care Act of 2005,” sponsored by Sen. Larry Craig (R-ID), chairman of the Committee. The legislation also requires the VA to make additional improvements in mental health services, including care for veterans with Post-Traumatic Stress Disorder (PTSD).

Currently, the VA cannot hire mental health counselors at the pay grade that clinical social workers can be hired. Psychiatrists, psychologists and clinical social workers fill most supervisory positions at the Department’s hospitals and outpatient clinics. The VA is the largest employer of clinical social workers in the United States and because social workers are in abundant supply, the VA on a full-time basis employs very few mental health counselors. In addition, social workers on staff develop many of the new positions in mental health services, and therefore the agency is most likely to hire social workers first. Psychiatrists, psychologists and clinical social workers are specifically named in VA statutes.

Among other provisions included in the bill, S. 1182 would allow veterans who live in the area impacted by Hurricane Katrina to receive free health care until January 31, 2006. The legislation also contains a provision to expand outreach services at veterans’ centers and would clarify that the parents of an Armed Services member who dies in active service are eligible to receive bereavement counseling as members of that person’s immediate family. 


In 2003, the Advisory Committee on the Readjustment of Veterans, established by the Secretary of Veterans Affairs, published recommendations calling for the expansion of counseling by qualified providers. These recommendations were not only suggested by the Readjustment Advisory Committee, but were formally concurred upon by the VA.

AMHCA and ACA have also met with staff of the House Veterans’ Affairs Committee to make a similar request to allow the VA to add licensed professional counselors to the list of health providers that are eligible to be appointed positions to the VA. At this time, it is unclear as to when the House Committee will act on similar legislation.

On December 18, 2005, conferees from the U.S. House and Senate filed the conference report for the Defense Authorization Act of 2005 (H.R. 1815) versions of which had contained provisions to allow licensed professional counselors (LPCs) to practice independently in TRICARE. Unfortunately, the final conference report, adopted by the U.S. House on December 19, and the U.S. Senate on December 21, did not contain the language that was included in the House or Senate passed versions of the Defense Authorization Act.  



The House bill contained a provision (sec. 701) that would allow professional counselors to be reimbursed for services provided to TRICARE beneficiaries without prior physician referral or supervision. The provision would also permit mental health counselors to enter into personnel service contracts with the Department of Defense (DOD). The Senate amendment contained a provision (sec. 721) that would authorize professional counselors who are state-licensed to provide services without physician referral or supervision in “medically underserved areas,” pursuant to section 332 of the Public Health Service Act (42 U.S.C. 254e).

Instead of including either provision, the conferees simply encouraged the DOD to promote greater utilization of LPCs as part of an integrated health care team and to examine ways to make as efficient as possible communication between primary care and mental health care providers involved in the TRICARE program. In addition, the conferees are requiring that the DOD report within 120 days to Congress on actions taken to improve the efficiency and effectiveness of procedures to facilitate physician referral and supervision of LPCs. The report from DOD to Congress is supposed to review the quality of care being provided under the program. Finally, the conferees encourage DOD to monitor the progress toward achievement of a national standard for graduate education professional accreditation, in order to have uniform professional credentials for licensed mental health counselors.
AMHCA and ACA are disappointed that the conference committee chose to ignore the will of both the House and Senate and not allow LPCs to practice independently within TRICARE. For all of the soldiers and their families who will continue to be forced to wade through the bureaucratic mess of physician supervision and referral, AMHCA and ACA are truly sorry that the members of the conference committee ignored the wishes of the majority of the members of their respective bodies, our members, and the TRICARE beneficiaries who our members treat.
AMHCA and ACA will begin the year by reaching out to key figures at the DOD who will be involved with writing the report to Congress and continue to educate the officials at DOD regarding the strong qualifications of our members, especially vis-à-vis those of MFTs and LCSWs who already have independent practice authority under TRICARE. 

On December 21, 2005, the Senate also passed legislation extending the Mental Health Parity Act (MHPA) for an additional year. This law requires health plans to meet a standard parity for mental illnesses by having equal annual and lifetime dollar limits for all health benefits (i.e., they cannot impose lower dollar limits on an annual or lifetime basis for mental illness that do not apply to all other health benefits).

The original MHPA (passed in 1996) has required renewal every year since 2001. The legislation passed by the Senate (HR 4579) extends the MHPA through 2006. The House passed the bill on December 18 and the President is expected to sign the measure. AMHCA and ACA are continuing to work with the sponsors of full federal parity to bring forward separate legislation to ensure that health plans are not able to impose discriminatory durational treatment limits, cost sharing, and deductibles as applied against treatment for mental illness.