The Federal Scene
STATUS OF MEDICARE LEGISLATION

Mary Riemersma, Executive Director

There are currently several bills in the Senate and House with the intent to have marriage and family therapists recognized within Medicare. In the House are HR 898, HR 3899 and HR 1522, and in the Senate are S 1760 and S 690. HR 898, if successful, would expand utilization to marriage and family therapists, S 1760, HR 1522, HR 3899 and S 690 would expand utilization to marriage and family therapists as well as licensed professional counselors (LPCs). LPCs are licensed in 45 states throughout the country, however, LPCs do not exist in California. Getting MFTs included in Medicare is critical to the profession, both to be able to work with the elderly and disabled, to be reimbursed by Medicare, and to be treated on par with the other mental health disciplines, also, many employment and reimbursement opportunities rely upon Medicare language. Passage of any of these measures, however, is no simple task. There are numerous, and sometimes insurmountable, obstacles that stand in the way of passage.

We have yet to receive a score from the Congressional Budget Office (CBO) placing a price tag on the inclusion of marriage and family therapists. Of course, we argue that there will be no increased costs, and in fact may even be cost savings. CBO likely believes otherwise. We have been seeking this score for nearly three years.

Additionally, MFTs along with various other professionals, were previously relegated to a study by the Medicare Payment Advisory Commission (MedPAC) to determine the appropriateness of MFTs and other being included under Medicare Part B (the section of Medicare where we are seeking inclusion). MedPAC met in late March to consider MFT and other professions for inclusion in

Medicare, primarily looking at three issues:

  • Is there an existing mental health access problem?
  • Is there an equity issue?
  • Are there cost considerations?

Apparently, MedPAC was reluctant to acknowledge an access issue, even though there is documentation to support a shortage of mental health professionals in rural areas. There was also the belief that the access problem, if demonstrated, might only be addressed in California with the large population of MFTs here. As we understand, MedPAC did not really delve into the equity issue, and they likewise had no information on cost. Further, the presentation made to MedPAC by their staff person, a physician, was biased against the profession. The good news is that this particular staff person has now left the Commission and a new staff person has been given lead responsibility for the report to the Commission. Fortunately, the new lead is a former colleague of our Federal lobbyist. We trust that this relationship will reap rewards. Further, our lobbyist will be working with MedPAC staff to identify Mental Health Professional Shortage Areas. Additionally, we are being assisted by the California Primary Care Association, who is very supportive of MFT inclusion both in Medicare at the Federal level and in MediCal, at the State level. They, too, have been in communication with MedPAC and have supplied them with information about need and access. They are also attempting to rouse their related organizations throughout the country to join with the CPCA in the quest to expand Medicare reimbursement.

Medicare is the primary charge of our Federal lobbyist, Capitol Associates Inc., which CAMFT and AAMFT jointly underwrite. However, in addition, CAI, and primarily Bill Finerfrock on CAI's staff has also been working to assure MFT inclusion in Federal legislation called the "Health Care Safety Net." The bill would create a Federal definition of "mental and behavioral health professional" for purposes of the National Heath Service Corps Loan Repayment Program. This bill also creates a new Tele-Mental Health program, and MFTs will likely be added to this section as well, even though at this time, the legislation relies upon the language contained in Medicare law.