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On October 11, 2012, the Army Substance Abuse Program (ASAP) released a memo clarifying grandparented requirements for professional counselors. The ASAP had placed a temporary hold on the hiring of professional counselors until these requirements could be established. The new requirements allow counselors who were employed by ASAP, or who had already entered the application process prior to the release of Army Directive 2011-09, to be privileged as independent providers if they hold a master’s degree from a regionally accredited institution, pass the National Clinical Mental Health Counseling Examination (NCMHCE), and hold the highest level of licensure in their state. The grandparented requirements offer counselors who are ASAP employees or prospective employees an alternative to the CACREP degree requirement established in Army Directive 2011-09, which set hiring and privileging standards for professional counselor.
The Senate bill granting Medicare recognition to counselors and MFTs continues to gain sponsors. Six additional Senators have signed on to S. 562, including Sens. Boxer (D-CA), Durbin (D-IL), Tester (D-MT), King (I-ME), Schumer (D-NY) and Johnson (D-SD).
Additionally, a letter was circulated to members of the Mental Health Liaison Group supporting S. 562. Twenty six organizations signed on to the letter, including organizations representing mental health professionals, consumers, government executives, mental health clinics and behavioral health insurers.
The prospects for Medicare legislation this year are diminishing as Congress struggles to even pass a budget. However, omnibus proposals may create an opportunity, and NBCC will remain vigilant in monitoring the landscape.
On September 15, 2011, Rep. Barbara Lee (D-CA) introduced H.R. 2954, which includes a provision to extend Medicare reimbursement to professional counselors and marriage and family therapists. Rep. Lee sponsored the bill on behalf of the Congressional Tri-Caucus—comprised of the Congressional Hispanic Caucus, the Congressional Black Caucus and the Congressional Asian Pacific American Caucus. The legislation has 71 cosponsors and includes a host of health care priorities for the three caucuses.
H.R. 2954 is the first House bill to provide Medicare recognition to counselors in the 112th Congress. The coalition of counseling and MFT groups has been lobbying for a stand-alone House bill since S. 604 was introduced by Sen. Ron Wyden (D-OR). Several representatives have expressed interest in the legislation, but the coalition is seeking strong bipartisan support before introduction.
On October 11, 2011, Sens. Kent Conrad (D-ND) and John Barrasso (R-WY) introduced the Craig Thomas Rural Hospital and Provider Equity Act of 2011, S. 1680. This bill was filed on behalf of the Senate Rural Health Caucus to identify health care priorities for rural legislators. Cosponsors include Sens. Tom Harkin (D-IA), James Inhofe (R-OK), Tim Johnson (D-SD), Amy Klobuchar (D-MN), Pat Roberts (R-KS) and Chuck Schumer (D-NY). The caucus recognizes the need for increased access to mental health professionals and included language providing Medicare recognition to counselors and MFTs in section 17 of the bill. S. 1680 provides another vehicle for moving this legislation and brings the total number of Medicare bills to three.
The struggling economy has complicated the prospects for Medicare legislation this year. Congressional energy is consumed by the debt crisis and the need to grow jobs and turn around the financial system. Before taking its August recess, Congress passed legislation to increase the debt limit by $2.4 trillion coupled with $900 billion in immediate cuts and $1.5 trillion to be cut by a supercommittee of 12 legislators (three House Democrats, three Senate Democrats, three House Republicans, three Senate Republicans). If the supercommittee fails to enact the required savings by November 23, automatic cuts will occur on December 23. The supercommittee has been meeting to identify areas of agreement.
All legislation is considered within the context of Congress’ focus on cutting spending and increasing revenue. While the counselor-MFT Medicare legislation is scored by the Congressional Budget Office to cost only $100 million over five years (inconsequential in budgetary terms), it is still viewed critically for increasing spending. Legislators have been hesitant to sponsor the legislation for fear of seeming indifferent to the budget situation. However, sweeping health care proposals to address the financial crisis also may represent opportunities for including the coalition’s Medicare language. The threshold for inclusion in any package remains high, but not impossible. The coalition will be exploring all avenues and seeking opportunities to include its legislation in any moving vehicle.
On March 17, 2011, Sen. Ron Wyden (D-OR) introduced S. 604, the Seniors Mental Health Access Improvement Act of 2011. S. 604 is identical to past Medicare bills and adds licensed professional counselors (LPCs) and marriage and family therapists (MFTs) to the list of recognized Medicare mental health providers.
S. 604 has six original cosponsors, including Sens. Barrasso (R-WY), Begich (D-AK), Brown (D-OH), Durbin (D-IL), Inouye (D-HI) and Johnson (D-SD). Sens. Boxer (D-CA) and Conrad (D-ND) signed on as cosponsors after introduction. The bill must pass the Senate Finance Committee, where Sens. Wyden and Conrad serve as members.
The coalition of counseling and MFT organizations is seeking to add cosponsors to S. 604, as well as identify a House champion. Several representatives have expressed an interest in a House bill and a sponsor is expected to be named soon.
The prospects for passage of the Medicare bill are unclear. The very tight budget environment creates a higher threshold for passing any legislation with an associated cost. While the cost of our provision is modest compared to the overall budget, every issue will be given increased scrutiny. The most likely vehicle for inclusion is legislation to halt increases in the physician payment scale that will be on the congressional agenda later in the year.
On Sunday, March 21, the House of Representatives passed the Senate health care reform bill, sending it to President Obama for signature. While language adding counselors to the list of Medicare providers made it through a preliminary vote in the House Budget Committee, it didn’t survive compromise with the Senate in the Rules Committee, thus ending its chance for inclusion in the final package.
NBCC, along with ACA, AMHCA, AAMFT, and CAMFT worked aggressively to get and keep our language in the reform package throughout the process. While the original House-passed legislation included our provision, the Senate bill did not. Development of the final product became a highly political process that hinged heavily on budgetary issues. Our cost was modest compared to the overall reform price tag, but all new spending was closely scrutinized and many similar provisions did not make it through this screening--including the social work Medicare priority relating to skilled nursing facilities. Success of the reform package was uncertain until the very end, when the House marshaled the votes to pass the Senate bill 219-212, along with a “reconciliation” bill on a vote of 220-211 that incorporates the House-Senate compromises. The reconciliation bill must still pass the Senate, but only 50 votes are required so approval is almost certain. Both measures will be sent to the President for signature.
While we did not succeed in final passage, we have again moved the ball even closer to the goal. We will continue our push for inclusion of Medicare counselor coverage in all relevant health care vehicles, and potential opportunities this year are already being rumored. Your advocacy efforts helped bring us to the brink of success and we hope you will keep up the calls and letters in our next big push. We cannot succeed without your help and will not stop until we get the ball across the goal line. If you have any questions, please contact NBCC at firstname.lastname@example.org.
Thank you for your support and perseverance.
NBCC VP for Legal and External Affairs
The health care reform debate is in the final stages and Medicare recognition of licensed professional counselors remains under consideration. The congressional leadership is putting the final touches on legislation to be voted on in the House this week, and if passed, referred to the Senate and ultimately the President. While NBCC recognizes that NCCs hold a variety of positions relating to the overall health care reform proposals, we believe all counselors can support legislation that provides Medicare reimbursement to counselors. To make this happen, we urge all NCCs to contact your U.S. Representative and Senators to request inclusion of our Medicare provision in the final health care reform package.
To find your legislators, go to the following link and put in your zip code: www.congress.org/communicate. Then call the Capitol Hill switchboard (202-224-3121) and ask to be referred to your Representative and Senators. Not sure what to say? We’ve included a sample message (below):
“My name is [name] and I am a National Certified Counselor living in [city and state]. I am calling to urge inclusion of language providing Medicare coverage of professional counselors and MFTs in the health care reform package, as provided in Section 1308 of the House reform legislation.”
If you have any questions, please contact NBCC at email@example.com.
Thank you for your support.
Thomas W. Clawson, Ed.D., NCC, LPC
The U.S. House of Representatives passed a health care reform bill (H.R. 3962) on November 7, 2009, that includes language adding professional counselors to the list of eligible Medicare providers. The Senate released its health care reform bill (substituted for H.R. 3950) on November 18; however, it does not include counselors as Medicare providers. NBCC continues to press to have Medicare recognition language included in the final health care reform package and urges all NCCs to contact their senators to help make this happen.
Legislation adding counselors to the list of eligible Medicare providers passed the Senate in 2003 and 2005, and the House in 2007 and 2009. It has, however, never passed both chambers at the same time.
Health care reform legislation (H.R. 3200) with language providing Medicare reimbursement to counselors and marriage and family therapists (MFTs) passed three House committees of jurisdiction in July 2009. The three House bills were merged into H.R. 3962 and the combined legislation was passed on November 7, 2009.
Efforts to get similar language in the Senate Finance Committee bill (S. 1796) fell short in October 2009. The Senate HELP Committee, which doesn’t have jurisdiction over this issue, did not include it in the legislation (S. 1679) passed in September 2009. The two Senate bills were combined and placed in a House bill (H.R. 3950) that has been referred to the Senate. This bill does not contain counselor inclusion in Medicare, but changes will be made to it on the floor.
A critical procedural vote on Saturday, November 20, 2009, obtained the 60 votes needed to bring H.R. 3950 up for debate. Once revised on the floor, the legislation will need another 60 votes to pass the Senate. If approved, the Senate bill (H.R. 3950) and House bill (H.R. 3962) will be merged in conference and referred back to each chamber for final passage.
It is critical that senators understand the importance of including language providing Medicare reimbursement of counselors in the final health care reform legislation. This can happen on the Senate floor and during the conference negotiations. Senators need to hear from NCCs urging support for inclusion of Medicare reimbursement of counselors in the health care reform legislation.
Sample Message for Senators
“My name is [name] and I am a National Certified Counselor living in [city and state]. I am calling to ask Senator [name] to urge inclusion of language providing Medicare coverage of professional counselors and MFTs in the health care reform package.”
Health care reform has been a top priority for Congress and the Obama Administration during the summer and fall months. House and Senate committees have passed health reform legislation, and at the time of this writing, the committee process is ending and floor consideration will soon begin. As part of this process, NBCC, the American Counseling Association (ACA), the American Mental Health Counselors Association (AMHCA), the American Association for Marriage and Family Therapy (AAMFT), and the California Association of Marriage and Family Therapists (CAMFT) have been working as a coalition to get language providing Medicare reimbursement to counselors and marriage and family therapists (MFTs) included in the reform legislation.
Five congressional committees have jurisdiction over health care reform legislation, including three House (Ways and Means, Energy and Commerce, and Education and Labor) and two Senate (Health, Education, Labor and Pensions (HELP), and Finance) committees. The three House committees passed their reform legislation (H.R. 3200) in July, as did the Senate HELP Committee (S. 1679). H.R. 3200 includes language recognizing LPCs and MFTs in Medicare, but S. 1679 does not because the committee lacks jurisdiction. The final committee to consider health care reform legislation is the Senate Finance Committee. Markup on its America’s Healthy Future Act of 2009 began in mid-September. Despite significant coalition advocacy, the original mark introduced by the Chairman, Senator Max Baucus (D-MT), did not include Medicare coverage of counselors. Senator Blanche Lincoln (D-AR), sponsor of the stand-alone Medicare bill S.671, filed an amendment to add the language during markup, but was not able to get a vote on it. The Senate Democrats likely have the votes to move legislation out of the Finance Committee and to the Senate floor. Before this can happen, the Finance Committee bill will need to be merged with the HELP Committee bill. The content of the combined legislation will be critical to how it is received in the Senate and whether it can muster the 60 votes needed to avoid a filibuster.
On the House side, the three committee bills will also be merged together and brought to the floor. The House bills have greater similarity than the Senate bills, so that negotiation process won’t be as challenging. However, there are significant divisions between Democratic liberals and moderates in the House, so the final version will also face obstacles based on its content. If the two bills can be approved on their respective floors, they will be sent to conference for reconciliation. This too will be a complicated and political process that will help shape the future of health care and determine the final bill’s likelihood for adoption. While there is language in all three House bills providing Medicare recognition of counselors, it will be a fight to keep the language in conference.
NBCC will be working with our certificants and coalition members to see this through to passage.
Progress is being made in the effort to further open the Department of Veterans Affairs (VA) to counselors. At the urging of NBCC and our coalition partners, Reps. Tom Rooney (R-FL) and John Carter (R-TX) agreed to request report language directing the VA to add counselors and marriage and family therapists (MFTs) to the VA trainee support program. Both are members of the Military Construction, Veterans Affairs and Related Agencies appropriations subcommittee, with jurisdiction over VA funding. Sen. Mark Pryor (D-AR) also agreed to submit the language to the corresponding Senate subcommittee, of which he is a member.
The report language was necessary because, in a January meeting, the VA Office of Academic Affiliations (OAA), which oversees the program, again refused to add the professions. The OAA provided a set of specious criteria for participation and claimed counselors and MFTs did not meet them. When pressed, the OAA revealed that it performed no research to reach its conclusion and also could not confirm that the currently participating professions meet these criteria (which they do not). Congressional offices have expressed a bipartisan desire to support this effort as a step toward increasing the hiring of counselors and MFTs.
Similarly, on April 15, Sen. Jerry Moran (R-KS) asked VA Secretary Shinseki and Undersecretary Petzel about the slow pace of counselor and MFT hiring. The questions were requested by the coalition and raised at a VA hearing on the budget. Dr. Petzel offered a rare acknowledgement that “we are behind the power curve in hiring” these professions.
NBCC is also working with veteran service organizations to improve mental health care. In May, the National Executive Committee of the American Legion adopted a resolution urging Congress to include counselors and MFTs in the VA trainee program. The resolution was the result of collaboration between the American Legion and our coalition.
On June 12, Senator Jon Tester (D-MT) introduced Senate Bill 1155, the Rural Veterans Mental Health Care Improvement Act. Among other things, this bill would include counselors and MFTs as participating professions in the OAA’s health professionals trainee program. NBCC led the effort to obtain congressional support for inclusion of counselors in the VA’s flagship recruitment program.
On May 31, 2011, the U.S. Office of Personnel Management (OPM) issued a letter to the Department of Veterans Affairs (VA) indicating that the agency would not immediately be creating an occupational series for professional counselors or marriage and family therapists (MFTs). The OPM indicated that it is in the process of reviewing occupational groups and would consider development of new series when the 100 series is reviewed.
NBCC has been a strong proponent of the development of an occupational series for professional counselors since before the profession was legally recognized within the VA. Creation of an occupational series for counselors is integral to federal government employment and national parity. Failure to create an occupational series forces counselors who work for the federal government to be employed in:
The effort to obtain an occupational series took a big step forward in 2006 when Congress enacted legislation authorizing the employment of counselors in the VA. To create a series, a federal agency must request one from OPM. NBCC pressed VA Assistant Secretary for Human Resources and Administration John Sepulveda for an occupational series during a group meeting on the new law in September 2009. Mr. Sepulveda committed to the issue and followed through on that commitment, submitting a request to OPM in 2010.
NBCC is dissatisfied with the open-ended time line and has been pressing for more timely action. The coalition of counseling and MFT organizations has communicated with the staff of the House Oversight and Government Reform Committee and the Senate Homeland Security and Government Affairs Committee to discuss legislative and administrative options. The committee staff helped to facilitate a coalition meeting with OPM staff on November 1. The meeting was very productive and the groups were given a tentative time frame of fiscal year 2013 for potential commencement of the development process. While OPM did not guarantee that it will create the series, and the timeline is tentative at best, the process is moving in the right direction and the coalition will continue to press for prompt action.
On August 16, NBCC participated in a conference call hosted by the Indian Health Service (IHS). The call was to discuss the role of counselors within IHS and efforts to increase education and employment. The discussion focused on using dissemination outlets and Web sites to share information, as well as including counselors in IHS scholarship and other agency programs. NBCC will continue exploring opportunities for collaboration with the IHS in areas of joint interest.
The Role of Government and Lobbying in the Creation of a Health Profession: The Legal Foundations of Counseling, published in the Journal of Counseling and Development, provides the legislative history of the counseling profession along with priorities for the future.
Bergman, D. M. (2013). The role of government and lobbying in the creation of a health profession: The legal foundations of counseling. Journal of Counseling & Development, 91: 61-67.doi: 10.1002/j.1556-6676.2013.00072.x
On January 10, 2012, NBCC participated in a roundtable hosted by the White House Joining Forces initiative. First Lady Michelle Obama and Dr. Jill Biden created Joining Forces to improve the lives of service members, veterans and their families. NBCC was invited to the roundtable along with the leadership for more than 30 major health care associations.
The roundtable was a forum to discuss health care issues, with a focus on post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Joining Forces teamed with the Joint Chiefs of Staff to address short-term opportunities for expanding collaborative partnerships between the Department of Defense (DoD), the Department of Veterans Affairs (VA) and the private sector. The meeting was preceded by a tour of the National Intrepid Center of Excellence (NICoE) located in Bethesda, Maryland. NICoE is DoD's world-class facility for wounded care, and a leader in advancing TBI and psychological health treatment research and education. Among the distinguished speakers at the event was Admiral James Winnefeld Jr., vice chairman of the Joint Chiefs of Staff.
First Lady Michelle Obama opened the roundtable with a passionate discussion of the need to honor our service members and veterans. Dr. Robert Petzel, VA undersecretary for health, and Dr. Jonathan Woodson, assistant secretary of defense for health affairs, also spoke of their departmentsâ€™ commitments to this cause. NBCC is committed to the White House initiative and to ensuring that counselors are properly trained in the treatment of PTSD, TBI and other issues affecting military personnel.
Paris 2008 – NBCC has used its official status with the United Nations Educational, Scientific and Cultural Organization (UNESCO) to advocate for counseling as a component of the agency’s education policies and programs.
Executive Vice President Ted Iliff represented NBCC at the biennial General Conference held at UNESCO headquarters during the last half of October. NBCC was invited to participate in the conference because of its status as a non-governmental organization (NGO) partner in official relations.
While attending the Education Commission strategy and planning meetings, Iliff noted that UNESCO documents and statements concerning its keystone “Education for All” (EFA) initiative spoke of a holistic approach to fostering education. However, they made almost no reference to any form of guidance or counseling.
During the commission’s debate on EFA, Iliff raised the issue of counseling’s benefits to the more than 60 national delegations attending the session.
“Counseling is a set of skills that can be taught at various levels of complexity to fit a school’s cultural, social and economic environment,” Iliff said.
“Training in counseling skills can help teachers and other school personnel identify signs of stress, trauma, depression, addiction, abuse and many other mental health problems that threaten a child’s development. Add career or vocational counseling, and you enter into the realm of sustainable development.”
Iliff quoted from a UNESCO report on EFA progress that cited concerns about gender inequality, poor attendance and high drop-out rates, among others. He said counseling can help educators deal with all those problems.
UNESCO’s new assistant director-general for education, Nicholas Burnett, later told Iliff that he welcomed the comments about the value of counseling and would consider those points as he formulates new policies related to achievement of EFA goals.