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The Federal Scene The CAMFT Board of Directors recently had their annual sojourn to Washington DC to visit with California members of Congress and the Senate to attempt to garner support for MFT inclusion in Medicare. Aided by CAMFT's knowledgeable and well-connected Federal Lobbyists, the Board felt that they made some headway in this effort, even though much remains to be done. On February 5, 2003, Senator Craig Thomas (R-WY), Senator Barbara Boxer (D-CA) and five other Senators introduced S. 310, the bill to provide coverage for marriage and family therapist services under Medicare Part B reimbursement. The bill was referred to the Senate Finance Committee for consideration. Our lobbyists have been working to add co-sponsors to the bill, especially from the Finance Committee. Senate Democratic Leader Thomas Daschle (SD) is now a co-sponsor. It would be outstanding if we could get Senator Dianne Feinstein to become a co-sponsor as well, however, to date she has not been receptive to the idea. The Board met with
Senator Dianne Feinstein's staff in hopes of convincing the Senator to
also sign on as a co-sponsor to S. 310. At this time she is quite reluctant,
citing cost as her main objection. Our Board also met with Congresswoman
Mary Bono, a Republican, with the hope that she would be a co-sponsor
of the companion House Bill. Congresswoman Bono is also reluctant for
the same reason: cost. They are both of the belief that there will be
additional costs when a new provider is added to an already existing benefit. CAMFT is represented in Washington by the Downey McGrath Group, Inc. Thomas J. Downey is the Chairman of the firm, which was founded in 1993. Mr. Downey, a Democrat, represented the 2nd District of New York in Congress from 1975 to 1993. He served on the House Ways and Means Committee for fourteen years. Raymond J. McGrath, President of the firm, a Republican, represented the 5th District of New York in Congress from 1981 to 1993. Mr. McGrath served on the House Ways and Means Committee for eight years. As prior Congressmen, and as representatives of both parties, they are well-known, remain well connected, and have influence with Republicans and Democrats. They are often able to open doors that would otherwise not be available to us. Other members of the firm are also working diligently on the Medicare effort. Downey McGrath is working cooperatively and effectively with AAMFT and their lobbyist, Capitol Associates, Inc., in a coordinated effort, with the goal to achieve Medicare inclusion. The key arguments being used in support of MFT inclusion in Medicare are as follows: It is an equality issue-marriage and family therapists are mental health professionals trained to diagnose and treat mental and emotional disorders. Currently 46 states regulate MFTs as independent mental health providers. MFTs have a minimum of a two year masters degree, 3,000 hours of supervised experience, and must successfully pass a rigorous written examination and in California, a rigorous oral examination. These requirements are substantially equal to the requirements for other core mental health disciplines recognized by Medicare. It is a fairness issue-Medicare currently recognizes and reimburses psychiatrists, psychologists, clinical social workers, and clinical nurse specialists as covered mental health providers. MFTs are the only core mental health professionals not reimbursed by Medicare. MFTs are recognized as a core discipline- The Federal Health Resources Services Administration (HRSA) recognizes the profession of marriage and family therapists as one of the five core mental health disciplines, and in fact, includes MFTs in the statistics for the purpose of determining federally designated mental health shortage areas. However, since MFTs cannot be reimbursed by Medicare and since MFTs represent the greatest number of mental health clinicians in this state, these shortage areas in California are much worse than HRSA's statistics reflect. MFTs are reimbursed by other systems-CHAMPUS/TRICARE recognizes and reimburses MFTs as independent health care providers. Insurance companies and managed care companies reimburse MFTs. The Victims of Crime Program in California reimburses MFTs. MFTs may be reimbursed by MediCal and by the Federal Employees Health Benefits Program and MFTs are employed by or reimbursed by a host of other systems for the diagnosis and treatment of mental disorder. There is no new service being reimbursed-Some mistakenly believe that a new service is being added to Medicare-that we are seeking that marriage and family therapy is to be reimbursed. That is not the case. Marriage and family therapists would be reimbursed for only the currently existing benefit-the diagnosis and treatment of mental disorder. The discrepancy in recognition and reimbursement for Medicare-covered services provided by MFTs is unfair to patients as well as providers-In the last year it has been determined that there are substantial access issues in California, as well as across the country. Inclusion of MFTs as a covered provider group is supported by health care providers and Medicare recipients, and is a legislative priority for Congressional rural caucus members. Costs are negligible-Last Fall, on behalf of AAMFT, Brigham Young University did an independent cost study to estimate the potential burden on the federal treasury of including MFTs as Medicare providers. They estimated that the impact on Medicare costs would be about $15 million over five years. Fifteen million over this period of time is generally considered inconsequential. We, of course, believe that including marriage and family therapists should provide a cost savings since MFTs will be reimbursed at 70 percent of the cost of more highly reimbursed clinicians. Inclusion in Medicare is critical to MFTs. Medicare reimbursement on its face is important, but it is also important because so many other systems look to Medicare language to determine who gets reimbursed. Further, unless MFTs are reimbursed by Medicare, the profession will never be treated as an equal with the other mental health disciplines. Medicare recognition is crucial even if you as an individual never treat a Medicare patient. We ask every licensed marriage and family therapist and aspiring marriage and family therapist to take an interest in this effort and to do your part. Ask your Congressperson to sign on as a co-sponsor to HR 1655. Ask Senator Dianne Feinstein to sign on as a cosponsor to S. 310. You may do so by writing -send a letter, preferably by e-mail or fax, or at least make a phone call to the district or Washington Office and express your recommendation to a member of their staff. Use the information above to supplement what you say and embellish it, if you wish, with information about yourself and your abilities to work with and assist elderly clients. If you have the time, attempt to meet with your Congressperson. Also, note the following sample letter for the basic information you need to get you going.
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