The Therapist
(May/June 2007)

We are at the beginning of a new legislative cycle and therefore at an imperative point to again encourage the passage of a bill to include MFTs in Medicare reimbursement. Although we have come close in the past to achieving this goal, we continue to need additional support in Congress to pass such a bill. We at CAMFT encourage you to contact your United States Congressperson and Senator Dianne Feinstein to encourage them to sponsor legislation that provides for Medicare reimbursement of MFTs.

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 48 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 two rigorous examinations in California. These requirements are substantially equal to the requirements for other core mental health disciplines recognized by Medicare, such as clinical social workers.

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 to determine 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. The Federal Veteran’s Affairs Program 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 disorders.

There is no new service being reimbursed: Some mistakenly believe that a new service is being added to Medicare and that MFTs are seeking reimbursement for marriage and family therapy. That is not the case. Marriage and family therapists would be reimbursed for the current existing benefit=the diagnosis and treatment of mental disorders.

The discrepancy in recognition and reimbursement for Medicare-covered services provided by MFTs is unfair to patients as well as providers: 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.

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.

CAMFT is asking that every licensed marriage and family therapist, and aspiring marriage and family therapist, take an interest in this effort and do your part. Ask your Congressperson1 and Senator Feinstein2 to sponsor legislation to allow reimbursement of Medicare to MFTs.

You may do so by writing your Congressperson/Senator (by letter, e-mail or fax) and expressing your recommendation to the member of Congress or 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 Medicare clients, or your inability to qualify for a position because Medicare does not recognize MFTs.

Also, note the following sample letter for the basic information you need to get you started.

Catherine L. Atkins, J.D., is a Staff Attorney at CAMFT. Cathy is available to answer members’ questions regarding business, legal, and ethical issues.

References
1 http://www.house.gov