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Bill Advocates for Counselors and Marriage and Family Therapists to be on Medicare Panel
On January 21, 2021, Mike Thompson-05) and Rep. John Kato (Ny-24) reintroduced the Mental Health Access Improvement Act. This bipartisan bill, which will amend title XVIII of the Social Security Act was first introduced in 2013. It would permit counselors and marriage and family therapists to provide mental health services to Medicare beneficiaries. The would make counselors eligible for Medicare telehealth reimbursement. Per the proposed act, “the amounts paid shall be 80 percent of the lesser of the actual charge for the services or 75 percent of the amount determined for payment of a psychologist …’’. To date, only licensed psychiatrists, psychologists, clinical social workers, and psychiatric nurses have been allowed to provide such services to seniors covered by Medicare. For more information on other anticipated Medicare and private payer changes click here.
Senator Thompson has more than a decade of advocating for counselors to get medicare reimbursement. He has proposed a number of bills supporting the reimbursement of counselors for Medicare. For more information about his work, see his Congressional webpage and write to your elected officials to support his advocacy on behalf of counseling. Such advocacy by the professional community is needed for both counseling as a profession as well as clients during these times of increased behavioral turmoil.
Medicare Telehealth Reimbursement: Improved Access to Care and Provider Shortage Lessened
This legislation would increase access to mental health services for millions of seniors, while at the same time, help lessen the shortage of America’s mental health provider population currently serving seniors. While mental health counselors and marriage and family therapists have the training and education to be licensed to provide services to mental health clients, they are not currently eligible for Medicare telehealth reimbursement. Therefore, seniors seeking their services have to pay out of pocket if they elect to see a counselor or marriage and family therapist.
This bill is a win-win for seniors who will have greater access to care at a lower cost, and for counselors and marriage and family therapists who desire to serve the senior population but find their hands tied by current Medicare regulations. Said Rep. Thompson, “Often seniors are at a greater risk for mental illnesses and can find it hard to get access to the mental health services they need…. When we address these mental health care needs, we help ensure they don’t lead to greater health problems that can be costly for our nation’s seniors. ” For a relevant study regarding the connection between mental health and physical health in older adults, see The dynamics of physical and mental health in the older population. 2017 Jun;9:52-62.
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Those social workers, psychologists and psychiatrists who are lobbying against the inclusion of LMHC (Licensed Mental Health Counselors), or LPC (Professional Counselors) for reimbursement by Medicare, are the same group of people who lobbied against the concept to regulate the practice of “psychotherapy “ . It was the LMHC’s , LMFT’s and Psychoanalysts who legally fought to protect the public from untrained people who called themselves “psychotherapists”.
Yes, exactly, anybody without any training whatsoever was able to hang a sign on their door and provide “psychotherapy” . Outrageous, isn’t it? But, this is the way it was until year 2002 when in NYS LMHC’s, LMFTs and Psychoanalysts became Licensed to provide services and get reimbursed by health insurances. This is also when the practice of Psychotherapy and Mental Health Counseling was regulated by setting educational and training standards to practice.
My point is that the same people or groups that lobbied in each State of America to allow the practice of psychotherapy to go unchecked, and excluding LMHC’s to be reimbursed are the same people who are lobbying to deny access to patients who are seeking mental health services rendered by LMHCs. ( I believe that most rational people who need surgery would want to be treated by a fully trained physician who specializes in surgery.) Social Workers, psychologists, and psychiatrists lobbying against LMHC’s from being reimbursed by Medicare are harming patients who seek treatment by mental health counselors. They are repeating the same malicious act as they had prior to the year 2002. The Federal government should not allow this harmful behaviors to continue.
I have been licensed as an LPC for almost 40 years, and teach in a 60-hour clinical mental health masters degree program. It is pretty rigorous, and there are other programs on campus that prepare students for social work, rehab counseling, or psychology masters degrees. Each discipline focuses on slightly different aspects of behavioral health, but we all study research, ethics, special populations, theory, methods, diagnosis and treatment. But what I have found is that the amount of actual training in conducting counseling and psychotherapy is surprisingly limited for all of the courses that we must take. Since I supervise LPC-Associates who are accruing their 3000 hours (in Texas) once they graduate, I can attest that their skills and confidence have very little to do with the courses they’ve taken, and much more to do with personality, intelligence, developmental history and character. Since those matters are beyond what we can teach, perhaps we should acknowledge the commonalities in our training and licensure requirements, and then let the customer made the important discriminations themselves. This artifact of governmental negligence is far from surprising, but we don’t need to allow ourselves to find a rational basis for discrimination when there is none. To compare ourselves favorably to strangers goes nowhere in bringing about systemic changes.
Those of you LCSWs who are arguing this. Stop and think again. Your not thinking clearly. Open your mind it will make you a better practitioner and focus elsewhere. If you think because of the amount supervision or whatever else you think that LPCs don’t deserve reimbursement your missing the point. There is a shortage of mental health providers as it is. It not fair that people like me who built that relationship will lose reimbursement. LPCS deserve better Medicare recipients deserve better. It’s time for change.
All mental health professionals have a focus on how they treat clients. This bias should not extend to insurance companies or the federal government. Standards of practice and scope of practice must be evaluated and determined under scientific principles and medical standards. Regardless of the degree or licensure, training should not dictate care as long as the professional is trained to perform a specialized service. For instance, a surgeon, compared to a general practitioner, holds very different skill and training sets. What is alarming is that an MD can offer psychological counsel and even nutritional guidance when their skill sets are not focused on those arias of expertise. Again, the specialist should be compensated for practices based on their training and skills. All of this training and or certification must be disclosed and recorded in some fashion, and the third-party payers are only responsible for ensuring that the survives they are paying for are the same services the clinical professional is trained or certified to provide.
With all due respect to all my fellow professionals, I would like to respectfully disagree with Sara Little on several comments. For starters I am a LMHC and hold multiple certifications and what has held most important is the 24 years of experience I have gained throughout the years. I have been a clinical supervisor for hospitals, and several agencies. In addition I have supervised LCSW’s, LMSW’s, CASAC’s and LMHC’s. Even Psychiatrists and Psychologist in the hospital and other agencies will seek my assistance and for the sake of the love and respect I have for patients and my profession I humbly assisted to the best of my ability.
In NYS you take the NCMHE and when you read the comparison chart for LMHC, and LCSW it’s very similar, in fact LMHC has more consentration on mental health courses/curriculum and internships pre and post Masters. However, I think it is unfair to say that is a disservice for LMHC to be on Medicare panels,(we’re accepted on most PPO/Private panels) when in fact not allowing LMHC, LPC’s and other hard working, smart and well deserved professionals assist a nation that it in need now more than ever! My heart aches for people whom are in need of assistance and are not able to get the help and at times they are not pleased with some of the providers they are working with. So with all due respect, why allow us on most private insurance panels and not Medicaid or Medicare? very contradicting and that is a disservice. Hope and pray you all do well in your professional endeavors and pursuit of wellness for our nation.
It’s not even about age. After a certain point of getting disability, you start to receive Medicare (about three years). You can literally be disabled due to mental health reasons. There are literally people disabled for mental health reasons that cannot find adequate providers… also, LPC education FOCUSES on mental health treatment and REQUIRES a masters where you will have done all counseling-related classes, a practicum, and an internship in actual counseling.
I don’t think that the quantity of experience is what matters. The clinicaly trained Master’s trained Social Worker’s orientation teaches person in situation as a foundational cornerstone – to assess a person’s environment for possible contributors to their current functionality (emotionally or otherwise). I don’t feel that a “turf war” is warranted LPC vs. LCSW vs. whomever. All accreditated educational endeavors should be embraced and valued. With that being said, there is a definite difference in the educational emphasis of the different disciplines. What is best for the patients is what should be most important. Geriatric/disability populations which are often covered by Medicare do need professionals who are not merely going to zero in on the cognitive issues they may be experiencing as the Holy Grail of what will help to “right the patient’s ship”. How will the patient benefit in assisting them to identify and process family dynamics as THE focus of treatment when they go home and have no food in their refrigerator due to not knowing how to navigate their community systems? As Maslow’s hierarchy of need dictates – unfulfilled needs negatively impacts our ability to function adequately. The patients and what particular populations need should always come ahead of our egos when it comes to providing the most appropriate services for them – otherwise, what are we in this “helping profession” for – to help others feel validated and valued or just ourselves?
Actually, Sara, the article did not claim that Counselors and Marriage and Family Therapists have the same training as Psychologists; it said that “mental health counselors and marriage and family therapists have the training and education to be licensed to provide services to mental health clients.” It was comparing the training and experience of Counselors and Marriage and Family Therapists to that of Licensed Clinical Social Workers. Those requirements are currently almost identical in every state.
I was disheartened by those alreAdy approved providers who want to look down on counseling and Mfts just to keep us out of their client pool. Inaccurate info was put out there. I know many who are unqualified in spite of training. And requirements vary by state also.
The goal here is to provide more access to qualified help. Sad to see this even though I’m not surprised.
It is not positive for any professionals to be threatened by including professionals with other training and degrees to treat seniors. Several Medicare patients under my care have stopped treatment when they have started Medicare because I cannot bill Medicare.
What concerns me in these comments and how defensive some are about degrees, training, supervision, etc. We have Ethics, all of us, to adhere to in treating any senior or Medicare patient. It is outdated and political to argue about one trained profession being better or less than anyone else. We all have individual circumstances with our backgrounds and training.
The criteria needs to change and Medicare has to care more about the access that it increases, the availability it will increase, and all of us support each other. Think about our Ethics, please.
I am a Licensed Professional Counselor and a Licensed Independent Mental Health Practitioner in the State of Nebraska. Additionally, I earned Certification in the Specialization of Gerontology as part of my undergrad Degree with the emphasis of my degree being in Gerontology, Psychology & Religion. I have had extensive experience working with the elderly insomuch as there is a direct correlation between declining health and increased mental health concerns. I have worked with the Federal Program known as PASRR (Pre-Admission Screening & Resident Review, established in 1987) for 8 years. This program specifically deals with major mental illness and admission to Medicaid Certified Skilled Nursing Facilities. To me the notion of “turf wars” is ludicrous if we are all in are in our respective fields with the client’s well-being uppermost in our minds and intentions. There is a huge need for more mental health practitioners, regardless of the specific degree, This battle has been brewing for a number of years and it is time to put it to rest. Let’s all take care of our citizens who need our services. If we have the degree, clinical experience and desire, we should be able to help ALL citizens who need our services with equal reimbursement across the fields of Social Work or Counseling.
This is a long time in coming. I know the bill has passed several stages and has bipartisan support. I can think of no downside and do not expect pushback from the minority party as is often the case no matter which party is in power. As previously discussed, there is a difference between the social work program and counseling psychology. Years ago, social work programs required far fewer intern and supervision hours, but as counseling psychology programs increased in popularity, changes were made to the requirements for social workers. With training programs fairly similar, all hands on deck. I am certain that LCMHC and LMFT’s can pick up the Medicare regulations in short order.
It concerns me that limited consideration is given to factors such as level of education and field knowledge and experience. I know LCSWs who received their license in May 2021 and can bill Medicare for services, while LPCs with over 20 years of experience are deemed unqualified. I am not advocating for this change because I need more clients but because of the number of older clients who are struggling to find a provider with whom they can connect regardless of their title and the rights of seniors and others who receive Medicare insurance benefits to choose their healthcare providers as other individuals.
As an LPC or in the state of Maryland, we are called the licensed clinical professional counselors. In TN, one can become an MHSP status that requires another exam after the NCC status, so that totals more than 3000 hours post-graduate school, over 100 hours of clinical supervision, then another 3-5 years to have supervisor status, plus I have a PhD in addictions with over 4000 clinical hours. NBCC and ACA have been fighting to get Medicare to recognize LPCs. The US licensing boards need to all be in sync as LCSWs are in the US. So, let’s not keep comparing LCSWs and or LPCs. LCSWS have been around a lot longer but never got LCSW status until the mid-1990s and many waivered in and never took an exam. The key is there are enough clients to go around for everyone. The field of counseling, social work is constantly changing and many CEUs are transferable in both professions.
Carol, Thank you for your comments. Given that behavioral health is the largest unmet need in all of healthcare, I have to agree that there are more than enough clients and patients to go around. It is time to do away with turf wars and learn to practice what we preach to families who come in for family therapy. If we had our own house in order, we wouldn’t be kicking each other under the table. We’d be working as a behavioral team for the greater good.
I am an LPC in Michigan. When I worked at a for-profit clinic I was able to see Medicare patients. My “supervision” was a psychologit’s signature on a progress note. The patient was never discussed. My supervisor had far less training than me. I went into private practice and my Medicare clients cannot see me unless they pay out-of-pocket. I see some, because they couldn’t bear starting with a new therapist for a nominal cost. This is financially difficult for me (but worth it for the client’s continuity of care). I have 10 years experience, 3000 hours of clinical work (100 of those supervision) as an LLPC,. I am a member of NCC (which requires an exam and CEU’s beyond what my license requires). I am an EMDR practitioner. I have over 300 CEU hours, most based in specialized trauma modalities. If you are entitled to a higher level of reimbursement I am all for it. But don’t think for a minute that LPC’s are not qualified to treat Medicare patients.
Licensed Professional Counselors in Texas are required to have a minimum of 3,000 hours of post-graduate supervision as a Licensed Professional Counselor Associate. They must hold at least a 60 hour Masters Degree in counseling or a counseling related field. Their counseling degrees include significant clinical coursework, which is not always the case in a master’s social work program. An LSCW and an LPC are clinically comparable. There is absolutely no clinical basis for excluding LPCs from the Medicare program. In fact, adding LPCs will help to address the significant and critical challenges Medicare recipients have in securing mental health treatments.
Jan, Thank you for your comments. We are at a point in time where past turf wars need to be put to rest to handle the behavioral problems faced in this country. I agree with you 100%.
As I understand it, it is the licensed social worker’s option to pursue the “R” designation which is what requires twice the length of supervision. However, LCSW’s without the “R” designation can treat Medicare recipients while LPCs cannot, which is an inequity that negatively impacts the recipients themselves. LCSW’s and LPC’s have similar training and experience requirements. LCSW’s are required (in Oregon) to complete 3500 hours of work in the field with a minimum of 2000 supervised client contact hours. LPC’s are required to complete a minimum of 2400 supervised direct client contact hours over a minimum of 3 years for licensure (other work in the field – time at work without seeing clients- doesn’t count toward this number). I’m not sure if you get paid more than LCSW’s (without R designation) – it sounds fair if you do- but LPC’s are just as qualified to provide counseling as LCSW’s with the same level of experience.
It is great that MFT and LPC get the same respect and benefits as other professions. Medicare needs more providers and MFT and LPC have equivalent experience as LCSW- Its is the ignorance of people in the profession that makes it difficult for other behavioral health providers to be reimbursed for the same or better quality of education received and as a result those who benefit from mental health services suffer. If they are going to raise any fees, it should be for all, or only for psychologists, since they do have a lot more training, experience and education than any other master’s level counselor.
I am a Licensed Clinical Social Worker (LCSW-R) who has been treating Medicare recipients for 28 yrs. In order to be able to be reimbursed by insurance companies I had to have 6 yrs of clinical supervision by a psychiatrist, psychologist, or another LCSW with her/his R number.
The counselors and marriage/family therapists who you are referring to do not have nearly the supervision and yrs of experience that LCSW-R’s have. I believe it is only 3 yrs, half the time of supervision and experience.
If Medicare is going to allow the professionals with much less experience to be reimbursed by Medicare, I would hope that their rate of reimbursement be equally less than the reimbusement allowed for LCSW-R’s, as this is what makes sense and is fair.
Or another way would be to increase the rate of reimbursement for LCSW-R’s.
This statement is NOT accurate: licensed mental health counselors (LMHC) and marriage/family therapists (LMFT) do NOT have the same training as Licensed Psychologists, who spend at least 4 years in post-baccalaureate training. LMHCs and LMFTs are not trained to conduct and understand research (thus being less qualified to judge research claims) and they are not required to undergo the same hours of pre and post graduation internship. Please correct this misconception. I know many excellent LMHCs and LMFTs, who know enough to check in with a more-thoroughly-trained professional when they come across a situation that is beyond their expertise, but to say that their training is equivalent to that of a PhD-trained Psychologists does patients a great disservice, and can cause harm.