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CONTACT
South Carolina Association
of Licensed Professional Counselors
[email protected]

C. Rudy Guajardo III, MA, LPC, NCC
Executive Director

843-679-0951

843-667-6658 – fax

Legislative Update from the

South Carolina Association of Licensed Professional Counselors

As you know, members of Congress are the key players in obtaining recognition for Licensed Professional Counselors and the services we provide in various ways. There are a number of bills circulating around Capitol Hill focusing on reforming health care, as well as bills in South Carolina around Medicaid issues, etc. To let your congressional representatives know what you want from them, contact them!

The American Mental Health Counselor Assn., the national organization for SCALPC, keeps an eye on national issues for license professional counselors. This issue involving Medicare reimbursement (below) is being monitored by both the nationalorganization and its state chapter, SCALPC. whose website is www.scalpc.org. LPCs in SC should support this organization since it so closely aligns with serving them in particular. Please consider joining!

Important Legislative Changes
May 29, 2013: Click here for Report

March 14, 2013
On March 14, 2013, Senators Ron Wyden (D-OR) and John Barrasso (R-WY) reintroduced Medicare legislation covering the services of mental health counselors (MHCs) and marriage and family therapists (MFTs) under part B of the Medicare program. The time to promote Medicare recognition of MHCs and MFTs is now. Urge your U.S. Senators to support S.562, which would authorize MHCs and MFTs to be paid by Medicare for outpatient mental health services to beneficiaries. View the bill text and sponsor introductory comments in the Congressional Record (page S1853).

Action Requested
SCALPC members are urged to email their two U.S. Senators and urge them to co-sponsor S.562, sponsored by Senators Ron Wyden and John Barrasso. Respondents may find their Senators’ e-mail address on their office websites. Download a sample e-mail message to Senate offices.

Background and Justification
About 50 percent of rural counties have no practicing psychiatrists or psychologists. MHCs and MFTs are often the only mental health providers in many communities, 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 these services.
Lack of Access in Rural and Underserved Areas-Approximately 77 million older adults live in 3,000 mental health professional shortage areas. Fully 50 percent of rural counties in America have no practicing psychiatrists, psychologists, or social workers. However, many of these mental health professional shortage areas have MHCs 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 MHCs 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 and director of public policy, at 800-326-2642, X-105, or e-mail [email protected].

September 2012
Professional Advocacy:
Looking Ahead at Health Care Reform

September 5, 2012 – Alexandria, VA – Clinical mental health counselor (CMHC) practice is changing soon, in ways that will alter the business approach of many professionals now in private practice. Driving the changes are health care reform, unsustainable growth in national health spending, and a very costly, fragmented and inefficient care system with mediocre outcomes by international standards. Public and private payers, but particularly Medicare, are restructuring provider payment arrangements compelling most health professionals and providers to make major changes over the next several years.
The private practice environment of many clinical mental health counselors remains largely beyond direct federal regulation; nevertheless, a major financial constraint on their practice is the lack of Medicare coverage and the impact it will have under the Affordable Care Act (ACA). Under the ACA, Medicare will be refocused toward new delivery and financial arrangements designed to reshape the healthcare environment.
CMHCs will need to adapt quickly to the changing environment or confront the future at a considerable structural disadvantage relative to other behavioral health professionals.
The changing environment is a lot about money, but it’s also about improving the quality of healthcare and demonstrating the value of CMHC services to a broader group of payers and potential business partners.

Accountable Care Organizations (ACO)
ACOs are a critical new service delivery model piloted under the ACA through Medicare and Medicaid demonstration funding. These largely untested delivery models are intended to improve healthcare quality, while achieving better outcomes for patients, thereby increasing the value of health spending. ACOs are composed of providers from across the continuum of care (including acute and long-term care, primary care, home care and behavioral health). They take on responsibility for managing the health of a group of beneficiaries with the goal of improving health outcomes while reducing service fragmentation and realigning payment incentives. ACOs will primarily receive fee-for-service payments as well as bonus payments for improving the health of their beneficiary group or penalties for exceptionally high rates of hospital readmission.
The success of ACOs will depend upon improved care coordination and delivery of the right service at the right time. ACO demonstrations have already begun under various payers such as Medicare, Medicaid and private insurance plans. The ACO service model is currently flexible, with many key unanswered questions about their operation and performance. They currently have options such as giving providers health information technology (HIT) that includes electronic health records and decision-support tools to help providers and patients determine care plans. They also perform key administrative functions, such as negotiating payer contracts for their participating provider partners. ACOs are expected to focus particularly on chronic conditions to prevent unnecessary care and expense. View helpful resources on understanding ACOs at The Commonwealth Fund.

With the ACA providing the funding impetus, the ACO service model is quickly emerging throughout the country. A Commonwealth Fund survey conducted in September 2011 found 154 ACOs already serving nearly 2.4 million Medicare beneficiaries with dozens more in partnerships with private insurers. Furthermore, 13 percent of 1,700 reporting hospitals were either already participating in an ACO, or planning to participate in the next year. Almost three-quarters of all operational ACOs reported sharing clinical information between care settings, such as a hospital and primary care setting. Nearly 85 percent have information systems to track how patients use health care services. CMHC Environmental Changes

Under the ACA over the next several years, 32 million more Americans are expected to obtain either Medicaid or private insurance, with greatly improved coverage for behavioral health services. However, CMHCs confront a major obstacle to successful adaptation to the emerging service models: Medicare’s exclusion of CMHCs from independent provider status. Winning Medicare provider status is more important than ever because new delivery models advanced primarily under Medicare will require provider participation within integrated provider and business/payment models. Alarmingly, integrated networks of Medicare providers will of necessity exclude CMHCs. Following are among the major coverage improvements on the horizon:

• ACA will eventually add roughly 17 million new recipients to Medicaid, all with comprehensive mental health benefits.
• Health exchanges, whether state or federally operated, will offer plans with comprehensive insurance benefits to approximately 15 million new beneficiaries. All plans sold must provide mental health benefits at parity levels.
• Millions of small businesses employees with inadequate mental health coverage are expected to gradually receive parity benefits as old plans are updated.
• All new individual and small group plans sold either inside or outside state exchanges must include parity benefits for mental health and substance use disorders.

Impact on CMHC Practice
Medicare ACOs are intended to improve care and lower costs. They are expected to function as integrated provider systems, but unless the law is changed, they will exclude CMHCs because they are not Medicare recognized providers and cannot participate in the payment model. Such a development would have a highly depressing impact on practice opportunities for CMHCs as more are excluded from the emerging delivery system. These reformed delivery models are expected to phase in over five to ten years, but they have already begun in many communities. If CMHCs are not included in Medicare soon, members of the profession will confront growing disadvantages in the marketplace. Marketplace challenges demand a collective response:

• ACA will expand ACO model delivery systems. Medicare is the primary payer to advance this model. If the model proves effective, it will be expanded to many more Medicare and Medicaid beneficiaries and picked up by private plans.
• CMHCs, lacking Medicare provider status, will be excluded from Medicare ACOs.
• ACOs serving Medicaid or private plans are incentivized to exclude CMHCs from their groups because they cannot see Medicare enrollees that will also receive care in these programs.
• CMHCs will lack a payment source for the cost of acquiring new technology such as electronic health records. Advocacy Considerations

The future of the profession is at stake, and it needs to ramp up Medicare advocacy immediately. More effective congressional advocacy requires a more vigorous, organized and enlarged membership. The profession can shape its future, by organizing for full recognition or risk being left behind. Urge colleagues that have not joined with national and chapter advocacy efforts to become a part of the effort, get involved. AMHCA chapters are essential participants in this national effort; work with them to ensure their participation. ACOs are expected to phase in over time, regardless of which Party emerges victorious in November. The model has strong bi-partisan support and partisan efforts to repeal the ACA will not curtail the movement toward ACOs. Lastly, AMHCA will ramp up its
efforts going into 2013. We plan to hold our 2013 national conference in the
Washington, DC area on July 18-20, 2013. Please plan to attend and “storm the Hill” to push
your Representative and Senators for action on Medicare recognition.
Jim Finley

Associate Executive Director/Director of Public Policy
[email protected]