Advocate Now to Advance Medicare Recognition

– James Finley

Just before recessing for the November elections in late September, the Senate continued their now three-year long struggle to pass mental health legislation that responds to the epidemic of mass gun violence and its political linkage to inadequate mental health services. The House passed a watered down bill on July 6 of this year, but the Senate could not get its bill to the floor before the elections recess that began last week. Movement on the Senate version has been bogged down largely over disagreements on federal gun laws. The House bill, Helping Families in Mental Health Crisis Act, (HR.2646), won overwhelming support (422-2) on the House floor, but only after all new spending provisions were removed. Nevertheless, many national mental health groups view it as a step toward delivery system reform. AMHCA and its coalition partners attempted, unsuccessfully, to add our Medicare provider status amendment to the House bill, but were unsuccessful so we have not endorsed it.

The Helping Families in Mental Health Crisis Act creates a new position of Assistant Secretary for Mental Health and Substance Use Disorders and establishes the National Mental Health Policy Laboratory and the Interagency Serious Mental Illness Coordinating Committee. Over the concerns of many Democrats, the bill authorizes no additional federal spending, but does expand the number and type of mental health services that states may cover under Medicaid; prohibits Medicare and Medicaid from restricting access to drugs used to treat mental health disorders; and expands the Certified Community Behavioral Health Clinics demonstration program. The Senate companion bill, the Mental Health Reform Act, (S.2680), is similar, but due to committee jurisdictional restrictions, does not yet include any Medicare or Medicaid provisions. Advocates hope to add Medicare provisions on the Senate floor, a move that would require floor time for consideration and amendments have the potential to derail the delicate agreement on the underlying bill. In addition, an ongoing dispute on gun issues could halt floor consideration. Senator John Cornyn (R-TX) Majority Whip and a key player on the bill, announced in late September his hope to pass the Senate version during the upcoming lame duck session in December.

GOAL: Add Medicare Provider Bill to Mental Health Reform Bill

AMHCA has long viewed the mental health reform bills as good vehicles to carry our coalition’s Medicare provider status legislation. Our Medicare coalition has held many meetings with congressional offices to urge inclusion of our Medicare provider status language (seen in bills S.1830/HR.2759) into the mental health reform package. The Medicare provider status language was ultimately excluded from the House bill due to its budget impact. The Helping Families in Mental Health Crisis Act required no new spending to pass the floor and AMHCA’s amendment carries a substantial new spending estimate from the Congressional Budget Office.

In the Senate, AMHCA is continuing to work with our coalition partners to add an amendment that has our Medicare provider status language to the Mental Health Reform Act, S.2680. Our coalition also has brought to the Senate sponsors language for the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA) and  the United States Public Health Service (USPHS) amendments that would address clinical mental health counselor recognition in federal workforce data collection programs. AMHCA anticipates that discussion of the mental health reform legislation will continue throughout the remainder of 2016, providing an avenue for consideration of our Medicare provision.

Action Requested: AMHCA hears regularly from congressional offices that constituents (i.e., mental health counselors) haven’t spoken up in support of Medicare recognition legislation. Therefore, AMHCA continues to urge more grassroots messages from our members to congressional offices. With legislators now back in their states and districts campaigning, we strongly encourage AMHCA members to request their Senators and Representatives to cosponsor our Medicare provider status bill (S.1830/HR.2759).


Congress Appropriators Delay Final Health Spending for FY2017

Before recessing in late September, congressional appropriators on Labor and Health and Human Services (HHS) delayed action on a spending bill for Fiscal Year 2017. Each year a bill is necessary to fund the HHS, including the SAMHSA and the National Institutes of Health among other agencies. This means Congress will need to establish final federal spending levels in December, after the elections.

White House Event on Suicide Prevention

AMHCA was invited last week to a White House briefing on suicide prevention. Participants heard from many experts on national issues in suicide prevention. Former Rep. Patrick Kennedy also provided a forceful reminder of the importance of mental health parity enforcement to make progress in the field.

House Passes Mental Health First Aid Training

On September 26, the House passed the Mental Health First Aid Act (HR.1877) on a voice vote. The bill authorizes SAMHSA to award grants to initiate mental health first aid training programs. Such project grants would include training on: (1) the skills, resources, and knowledge necessary to assist individuals in crisis to connect with appropriate local mental health care services; (2) mental health resources, including the location of community mental health centers; and (3) protocols for referral to mental health resources.

Individuals eligible for training under the program include: first responders; law enforcement personnel; teachers and school administrators; human resources professionals; faith community leaders; nurses and other primary care personnel; students enrolled in school; parents of students; and veterans. The bill authorizes approximately $15 million per year for SAMHSA’s mental health training program from 2017-2021. Like all SAMHSA activities, Congress would still need to actually fund the program in its annual appropriations act, when competition to provide funding is extremely high. The Senate passed a similar bill (S.1893) in January of this year, and conferees are expected to reconcile and pass a final version for the President’s signature.

Revised Medical Criteria for Evaluating Mental Disorders

On Monday, September 26, 2016 the Social Security Administration (SSA) published final rules, effective January 17, 2017, that revise medical criteria for evaluating mental disorders. The new criteria for evaluating mental disability claims, the Revised Medical Criteria for Evaluating Mental Disorders, is the most comprehensive revision to SSA’s criteria since 1985.

The ability to diagnosis someone with an intellectual disability (IQ, learning etc.) is within the purview of a licensed clinical mental health counselor, if they may administer intellectual aptitude exams. Many clinical mental health counselors have been trained or can be trained to administer and interpret such exams, as it is usually a course of psychological tests and assessments specific to clinical mental health counseling. Ethically, it is incumbent upon a licensed professional who administers such tests to receive training and supervision in their use.

The standards and terminology for evaluating claims involving mental disorders will now reflect information from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-V). SSA updated diagnostic and functional criteria will allow examiners to more quickly identify people who may qualify for disability benefits based on an intellectual disability. To learn more about the rule see here.

Most important for mental health counselors, the final SSA rule clarifies that evidence from CMHCs may be considered in the disability determination process. A critical passage in the rule reads in part: “We will consider all relevant medical evidence about your disorder from your physician, psychologist, and other medical sources, which include health care providers such as physician assistants, psychiatric nurse practitioners, licensed clinical social workers, and clinical mental health counselors.” Follow this link to the final rule.