Public Policy and Legislation
IMHCA P.O. Box 1217, Meridian, Idaho 83680
7/1/2011: Thanks to your emails and calls in opposition to the recent proposed rate cuts for mental health providers, the Department of Health and Welfare has reinstated the previous rates for providers in their current fee schedule.  According to Department of Health and Welfare official, Leslie Clement, the reinstated rates were posted to the DHW website on July, 1, 2011. 
8/2011: In June 2011, Medicaid came out with a new fee schedule that cut mental health provider rates by 33%.  As a result of this action, there was strong opposition demonstrated by members and organizations which resulted in the  funds being reinstated. To see the current Medicaid fee schedule visit the Idaho Department of Health and Welfare website or visit IMHCA’s website at www.idahomentalhealthcounselor.org for more information and updates.

Agencies in Idaho will need to become nationally accredited by July 1, 2011, if they want to provide Medicaid services.  National accreditation can cost up to several thousand dollars, the payment of which will be the sole responsibility of agencies themselves and not Medicaid.  See HB 260 for more information on how this change might impact you.

Substance abuse dollars have been divided into four areas: Adult Corrections, Juvenile Corrections, Drug Courts and Department of Health and Welfare.
01/18/2012:

The Department of Defense issued regulations at the end of 2011 (online at http://www.gpo.gov/fdsys/pkg/FR-2011-12-27/pdf/2011-33109.pdf) which would let licensed professional counselors practice independently within TRICARE, the health care program providing services for an estimated 9.6 million active duty service members, retirees, and their families.  For many years, all other master s level mental health professionals have been allowed to practice independently, while TRICARE beneficiaries can only see licensed professional counselors under physician referral and supervision.
 
Current Referral and Supervision Requirements Still In Effect

Although the rule stated that it was  effective  on December 27, 2011, it now appears that counselors will not be able to see TRICARE beneficiaries independently for a few months.  According to staff with the TRICARE Management Activity (TMA, the agency charged with managing the program), the Department of Defense is maintaining existing requirements for physician referral and supervision of counselors  services until it has reviewed comments on the regulation and made any final changes it deems necessary in light of the comments it receives.  DoD staff indicate that TMA expects to finish this process and begin implementing the regulations later this year.

ACA encourages counselors interested in this issue to submit comments.  Comments must be submitted by February 27th.  You can do this through the website http://www.regulations.gov.  In the drop-down box in the middle of the page entitled  Select Document Type , select  Rule , and in the box next to it entitled  Enter Keyword or ID  type in  certified mental health counselors .  Click  Search , and the top result listed on the page that comes up should be entitled  TRICARE: Certified Mental Health Counselors.   You ll see a link for  Submit a Comment  on the right-hand side of the page.

ACA will be submitting comments as an organization, and we will be collaborating with both the National Board for Certified Counselors and the American Mental Health Counselors Association in developing our comments.  ACA has worked closely with both NBCC and AMHCA over the years in advocating for independent practice authority for counselors within TRICARE.

ACA s comments are likely to include items such as the following:
An expression of strong support for DoD s proposed transition period, during which counselors with degrees from programs that have not yet become CACREP-accredited can apply for certification as independently-practicing mental health counselors; A request that TRICARE recognize all relevant counseling master s degree titles for practice as a mental health counselor; A request that TRICARE recognize all supervised experience obtained by counselors that meets the criteria used by the licensure board for the jurisdiction in which they practice; A request that TRICARE consider extending the transition period during which the agency will certify counselors with degrees from regionally-accredited institutions who have passed the NCMHCE, and counselors with degrees from CACREP-accredited programs who have passed the NCE through December 31, 2015.  This would be especially helpful if the DoD regulations aren t implemented until the end of 2012. 

For more information, or for a synopsis of TRICARE's proposed requirements for independent practice, contact Scott Barstow with ACA at sbarstow@counseling.org.
4/26/12:

Yesterday, the U.S. Department of Veterans Affairs (the VA) announced that it was adding Mental Health Counselors and Marriage and Family Therapists to its workforce as part of the hiring of an additional 1,900 mental health staff nationwide that VA announced last week.  Included in the announcement was this quote from VA Secretary Eric K. Shinseki,  The addition of these two mental health professions is an important part of VA s mission to expand access to mental health services .  The American Counseling Association agrees with that statement, but it looks upon this announcement with a great deal of caution; to date, the VA has hired only a handful of LPCs.  The VA's failure to adequately provide mental health care to veterans--highlighted by a new report from the VA Inspector General's office--was the focus of a hearing held yesterday by the Senate Committee on Veterans Affairs, and at the hearing, Senator Jerry Moran (R-KS) told the VA that among other steps, he wanted to see the VA begin hiring more licensed professional counselors.

Over six years ago, Congress passed the  Veterans Benefits, Healthcare, and Information Technology Act of 2006  (P.L. 109-461) which recognized Licensed Professional Mental Health Counselors (LPMHCs) to work and provide treatment to veterans in the VA as full-fledged mental health clinicians.  Over a year and a half ago, the VA adopted an occupational standard for the hiring of LPMHCs.

From the perspective of counselors, very little has happened since the law was enacted and the standards were adopted.  ACA has not seen any evidence that the VA is hiring significant numbers of LPMHCs at VA facilities.  A review of the job postings on USAjobs.gov for this calendar year shows that, on average, fewer than 1 (one) LPMHC position is advertised in a given week, while dozens of clinical social workers positions are advertised. LPCs meet education, training, examination, experience, and ethical requirements on par with those of clinical social workers.  Veterans clearly need better access to mental health treatment--as shown by the recent report by the VA Office of the Inspector General on waiting times for initial mental health evaluations--and there are thousands upon thousands of fully-licensed counselors ready and willing to help provide urgently needed care. Many of these counselors are veterans themselves, and yet they cannot find work with the VA providing s  ervices to their fellow veterans.

The VA's recent statement regarding the hiring of counselors gives us hope.  However, other statements by the VA made just last week--indicating that they do not see a "national need" to establish traineeship positions for LPMCs, and implying that they do not consider LPMHCs to be mental health clinicians--give cause for skepticism.  Ultimately, actions speak louder than words.  ACA will continue working with Congress, other concerned organizations, and veterans service organizations to ensure that the VA finally begins recognizing the counseling profession.

ACA is continuing to collect anecdotal evidence of counselors' experience in attempting to find mental health clinician positions at VA facilities.  Please share any experiences you have on this issue with Art Terrazas of ACA's public policy staff, at aterrazas@counseling.org. 
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Ken Dudley
Public Policy and Legislation Chair