Medicare reimbursement for state-licensed professional counselors
Gaining Medicare coverage of counselors has been one of ACA's highest priorities for some time. Although we came up short in the last Congress, this year has seen unprecedented progress on the issue, and we've succeeded in laying the groundwork for getting this accomplished within the next two years. There were four bills-two in the House of Representatives, two in the Senate-introduced in the last Congress, which would have established Medicare coverage of state-licensed professional counselors.
In June 2002, the House passed a Medicare bill (H.R. 4954), which would have added a $320 billion prescription drug benefit and $30 billion in increased provider payments to the program (costs measured over ten years). House Democrats opposed the measure as not going far enough to meet seniors' prescription drug needs. Before adjourning for the August recess, the Senate considered four separate bills to establish a Medicare prescription drug benefit, none of which gained the 60 votes needed for passage under the Senate's budget rules. For much of August and September, the Senate Finance Committee worked toward fashioning a provider "givebacks" bill to remedy perceived defects in Medicare's payment rates. ACA, the American Mental Health Counselors Association (AMHCA) and the American Association for Marriage and Family Therapy (AAMFT) had viewed this as a potential vehicle for gaining enactment of S. 1760, one of the four bills before Congress (along with S. 690-introduced by Senator Wellstone, H.R. 3899, and H.R. 1522), which would have established coverage of professional counselors and marriage and family therapists.
In October 2002, Senators Max Baucus (D-MT) and Charles Grassley (R-IA) introduced their Medicare provider payment increase package as S. 3018, the "Beneficiary Access to Care and Medicare Equity Act of 2002." The bill was estimated to cost $41 billion over ten years, making it significantly more generous than the provider payment increases passed by the House as part of H.R. 4954.
Despite the size of S. 3018-and despite heavy, coordinated lobbying by ACA, AMHCA, and AAMFT-no provision was included to establish coverage of licensed professional counselors (LPC's) and marriage and family therapists (MFT's). We were told that there simply wasn't enough support expressed for the provision on the part of Finance Committee members, and that there were other interest groups pushing specific changes to Medicare's benefit package who had been waiting at the table longer and yelling louder.
Our failure to make it into S. 3018 was disappointing, especially since all the policy arguments were in our favor. There is substantial evidence that Medicare beneficiaries need better access to services, particularly in rural areas. ACA and AMHCA joined in commissioning an actuarial study by The Lewin Group which found that the likely five-year cost of establishing Medicare coverage of LPC's would be only $16.3 million, an exceedingly small figure within the context of Medicare legislation. Although the Medicare Payment Advisory Commission (MedPAC) voted earlier this year to recommend against Medicare coverage of LPC's and MFT's (and pastoral counselors), their report to Congress accompanying this recommendation was unconvincing in its rationale for the decision.
Unfortunately, time ran out on the 107th Congress before the Senate could pass S. 3018.
Members will need to revisit the issue early in the 108th Congress. We need to significantly increase our grassroots pressure in support of Medicare coverage of LPC's to prepare for this. Simply put, unless counselors get active on this issue and call, write, visit, and e-mail their members of Congress, we will not succeed in changing Medicare law.
ACA will continue working with AMHCA and AAMFT, in order to get our provision included in the next go-round of Medicare legislation.
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