Why YOU Should Care About Medicare Coverage of MFTs  

1. To enhance the quality of care and expand access to urgently needed mental health services. Today, MFTs are not covered by Medicare even though the other four federally-defined core mental health professions (psychiatry, psychology, social work and psych nursing) are covered An AAMFT member reported one example of how MFT non-coverage prevents Medicare beneficiaries from obtaining urgently needed services. A depressed elderly man visited the office of this MFT seeking therapeutic assistance. When the man found out that Medicare did not reimburse this MFT, he declined the service, despite the fact that the MFT offered to provide the treatment at no charge.  Soon after the visit, the man killed his wife and then himself.  

Not all unmet mental-health needs result in murder or suicide, but there are demonstrated health care and financial consequences, especially in rural and underserved areas.  Adding MFTs to Medicare would enlarge the pool of providers and increase access to quality behavioral health services across the country.  

2. To increase your income. Obtaining Medicare recognition of MFTs will increase funding streams for the profession in both the public and private sector.  Medicare is the largest health care program in the country covering nearly 40 million beneficiaries (~15% of the population).  Because many Medicare beneficiaries are “dually eligible” for Medicaid, state Medicaid programs may be reluctant to cover MFTs, eliminating another 15% of your potential pool of clients. Further, many managed-care plans follow Medicare law for their recognition of providers.  Many private plans have Medicare products, so prefer uniform provider networks that save administration costs, as well as preferring the Medicare “Good Housekeeping” seal of approval.  Medicare recognition extends far beyond just its own beneficiaries and affects all segments of the health care financing system.  

3. To eliminate unfair discrimination against MFTs. The federal Health Resources and Services Administration defines MFTs as one of the five “core mental health professions,” along with psychiatry, psychology, psychiatric nursing, and social work. MFT is the only core profession that is not recognized by Medicare, despite similarities in education and training to other covered providers.  

Doesn’t Medicare Pay Poorly and Require Lots of Paperwork?  

Medicare coverage of Marriage and Family Therapists will not make you rich and every MFT may not even want to participate.  However, Medicare generally pays more than Medicaid, and many private health plans now link their payment rates to those of Medicare.  

The paperwork and other rules required by Medicare may be burdensome, but they are comparable to those for major private health plans. While the rates of payment and administration may not be ideal, it is not significantly different than the rest of the health care payment system.  

Most importantly, Medicare coverage of MFTs is much bigger than just whether the profession can be reimbursed.  MFT Medicare coverage relates to professional parity and recognition and is a necessary step to fully equality for the MFT profession.  

What YOU Can Do TODAY  

Go to http://www.aamft.org/Advocacy/index_m.asp and advocate for MFT inclusion in Medicare.  The process is quick and easy, and will make a difference.  Act today to help your clients, your profession, and yourself.

Medicare Coverage of Marriage and Family Therapists  

Issue  

Improving access to Medicare-covered mental health benefits by recognizing state licensed Marriage and Family Therapists (MFTs).    

Background  

Bills in the current Congress for Medicare to cover MFTs are S 784 and HR 1447. S 784 is sponsored by Sens. Bingaman, Boxer, Cochran, Dayton, Dorgan, Durbin, Inouye, Jeffords, Lincoln, Pryor, and Thomas, while HR 1447 is sponsored by Reps. Abercrombie, Berman, DeLauro, Gordon, Herseth, Hinchey, Kildee, LaHood, John Lewis, McNulty, George Miller, Napolitano, Olver, Payne, Pickering, Reyes, Ros-Lehtinen, Sanders, Chris Smith, Strickland, Towns, Waxman, Westmoreland, Wexler, Joe Wilson, and others.  

In order for a mental health service to be covered by Medicare, the service must be for the diagnosis and treatment of mental illness.  In addition, the mental health service must be delivered by a “covered” practitioner who is legally authorized to perform that service under state law.   The “covered” mental health professionals recognized by Medicare presently include psychiatrists, psychologists, mental health clinical nurse specialists and Clinical Social Workers (CSWs).  Marriage and Family Therapists (MFTs) are not listed as Medicare-covered providers despite the fact that MFTs have education, training and practice rights equivalent to or greater than existing covered providers.   

Several recent reports have indicated that limited access to mental health services is a serious problem in the Medicare program.  This is particularly true in rural areas, which have historically had difficulty attracting and retaining health professionals.  According to a recent Surgeon General’s report, 37% of seniors display symptoms of depression in a primary care environment.  Equally striking is that fact that this depression often goes unrecognized and therefore untreated.    The failure to treat depression often leads to more primary care visits and higher Medicare expenditures.  The unavailability of qualified mental health professionals compounds the mental health crisis among the elderly population and increases the costs to the program.  

Currently, the federal government recognizes five mental health disciplines as core mental health professionals.  These are psychiatrists, psychologists, mental health clinical nurse specialists, clinical social workers and marriage and family therapists.  Of these five groups, only marriage and family therapists are not recognized by Medicare.  

The cost of adding MFTs to Medicare is modest. According to the Congressional Budget Office (CBO), the cost of adding both MFTs and Licensed Professional Counselors (LPCs) to the Medicare program would be 30 million dollars per year.  Assuming generously that MFTs account for half those costs, the total outlay will still be a nominal 15 million dollars per year for recognition of MFTs in Medicare.   

Discussion   

Throughout the states, MFTs are legally authorized to provide the same services as clinical social workers.  As with CSWs, not every service a marriage and family therapist performs is covered by Medicare.  However, we are not seeking to expand the Medicare benefit package, but instead increase the pool of qualified providers.  Stated another way, we are allowing Medicare beneficiaries who need medically necessary covered mental health services to obtain those services from a marriage and family therapist.  

Significant shortages of mental health professionals continue to exist in many areas of the country, and rural counties suffer disproportionately.  Among 1253 rural counties with 2,500 to 20,000 people, nearly three-fourths lack a psychiatrist, 58 percent have no clinical social worker, and 50 percent are missing a master’s or doctoral psychologist.  The supply of all these professionals is far lower in the 769 counties with fewer than 2,500 people.  Further, the Health Resources Services Administration indicated that 90% of psychiatric and mental health nurses with graduate degrees were in metropolitan areas.   There are many counties where only a marriage and family therapist may be present to serve the elderly population.  A targeted study of licensed professionals in a sampling of states found many counties with no Medicare mental health providers, but with a marriage and family therapist: including Clayton, Iowa; Hamilton, Florida; Hutchinson, Texas; and Brunswick, Virginia; to name a few.    

Federal government agencies also understand the valuable role MFTs play in increasing access to mental health services.  The advisory committee to the Secretary of Health and Human Services recently encouraged inclusion of MFTs in the Medicare program.  The National Advisory Committee on Rural Health and Human Services specifically recommended “that the Secretary expand the range of certified mental health providers under Medicare to include marriage and family therapists” in its 2004 report.  

The Health Resources and Services Administration (HRSA) further recognizes MFT’s  participation in caring for  underserved populations.  One of HRSA’s responsibilities is to identify areas of the country with mental health shortages. The purpose of this designation is to identify communities with unmet mental health service needs and pursue opportunities to recruit qualified mental health professionals to those communities.  

Ironically, HRSA counts marriage and family therapists among the “core” providers qualified to deliver necessary mental health services.  The failure of the Medicare program to recognize marriage and family therapists leaves many elderly beneficiaries without access to care and creates a conflict in federal law.  For example, in communities where the only mental health professional available is a marriage and family therapist, the Health Resources and Services Administration may count that MFT and consider the community well-served.  In fact, the elderly of that community have no access to the MFT because Medicare will not recognize the provider.  Consequently, the government doesn’t even know that there is an access problem because the two federal programs don’t have consistent criteria.   

Marriage and family therapists are not seeking to expand the scope of mental health services covered by Medicare, nor are they seeking to expand their own scope of practice.  Instead, MFTs are simply trying to correct an inequity that restricts beneficiaries’ access to a particular type of qualified mental health provider.  

Furthermore, MFTs are not seeking higher payments for their services than are currently paid to clinical social workers.  Under our proposal, marriage and family therapists would be paid at the same rate as clinical social workers (75% of the psychologists rate) for mental health services already covered by Medicare, which the MFT is legally authorized to provide in the state in which the service was delivered.  

The importance of increasing the number of qualified Medicare mental health professionals by including MFTs is supported by many health organizations, including but not limited to the Depression and Bipolar Support Alliance, the National Council for Community Behavioral Healthcare, the National Rural Health Association and the California Primary Care Association.  

Recommendation  

Improve access to Medicare-covered mental health services by including marriage and family therapists among the list of providers who can deliver covered mental health services and pay for those services at the same rate as clinical social workers.  

If you have any questions or need additional information, please contact: 
Brian Rasmussen or Melissa Stamps
AAMFT Government Affairs Managers
112 S. Alfred St .
Alexandria , VA   22314
703-253-0463 / 703-253-0445

THE BILL ITSELF: 

109TH CONGRESS

1ST SESSION H. R. 1447

To amend title XVIII of the Social Security Act to provide for the coverage

of marriage and family therapist services under part B of the Medicare

Program, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

MARCH 17, 2005

Mr. STRICKLAND (for himself, Ms. ROS-LEHTINEN, Mr. WILSON of South

Carolina, Mr. WESTMORELAND, Mr. TOWNS, and Mr. WAXMAN) introduced

the following bill; which was referred to the Committee on Energy

and Commerce, and in addition to the Committee on Ways and Means,

for a period to be subsequently determined by the Speaker, in each case

for consideration of such provisions as fall within the jurisdiction of the

committee concerned

To amend title XVIII of the Social Security Act to provide

for the coverage of marriage and family therapist services

under part B of the Medicare Program, and for other

purposes.

Be it enacted by the Senate and House of Representa- 1

tives of the United States of America in Congress assembled, 2

SECTION 1. SHORT TITLE. 3

This Act may be cited as the ‘‘Seniors Mental Health 4

Access Improvement Act of 2005’’. 5

2

•HR 1447 IH

SEC. 2. COVERAGE OF MARRIAGE AND FAMILY THERAPIST 1

SERVICES UNDER PART B. 2

(a) COVERAGE OF SERVICES.—Section 1861(s)(2) of 3

the Social Security Act (42 U.S.C. 1395x(s)(2)) is amend- 4

ed— 5

(1) in subparagraph (Y), by striking ‘‘and’’ at 6

the end; 7

(2) in subparagraph (Z), by striking the period 8

at the end and inserting ‘‘; and’’; and 9

(3) by adding at the end the following new sub- 10

paragraph: 11

‘‘(AA) marriage and family therapist serv- 12

ices (as defined in subsection (bbb)(1));’’. 13

(b) DEFINITION.—Section 1861 of such Act (42 14

U.S.C. 1395x) is amended by adding at the end thereof 15

the following new subsection: 16

‘‘Marriage and Family Therapist Services 17

‘‘(bbb)(1) The term ‘marriage and family therapist 18

services’ means services performed by a marriage and 19

family therapist (as defined in paragraph (2)) for the diag- 20

nosis and treatment of mental illnesses, which the mar- 21

riage and family therapist is legally authorized to perform 22

under State law (or the State regulatory mechanism pro- 23

vided by State law) of the State in which such services 24

are performed, as would otherwise be covered if furnished 25

by a physician or as an incident to a physician’s profes- 26

3

•HR 1447 IH

sional service, but only if no facility or other provider 1

charges or is paid any amounts with respect to the fur- 2

nishing of such services. 3

‘‘(2) The term ‘marriage and family therapist’ means 4

an individual who— 5

‘‘(A) possesses a master’s or doctoral degree 6

which qualifies for licensure or certification as a 7

marriage and family therapist pursuant to State 8

law; 9

‘‘(B) after obtaining such degree has performed 10

at least two years of clinical supervised experience in 11

marriage and family therapy; and 12

‘‘(C) in the case of an individual performing 13

services in a State that provides for licensure or cer- 14

tification of marriage or family therapists, is li- 15

censed or certified as a marriage and family thera- 16

pist in such State.’’. 17

(c) PROVISION FOR PAYMENT UNDER PART B.—Sec- 18

tion 1832(a)(2)(B) of such Act (42 U.S.C. 19

1395k(a)(2)(B)) is amended by adding at the end the fol- 20

lowing new clause: 21

‘‘(v) marriage and family therapist 22

services;’’. 23

(d) AMOUNT OF PAYMENT.—Section 1833(a)(1) of 24

such Act (42 U.S.C. 13951(a)(1)) is amended— 25

4

•HR 1447 IH

(1) by striking ‘‘and (V)’’ and inserting ‘‘(V)’’; 1

and 2

(2) by inserting before the semicolon at the end 3

the following: ‘‘, and (W) with respect to marriage 4

and family therapist services under section 5

1861(s)(2)(AA), the amounts paid shall be 80 per- 6

cent of the lesser of the actual charge for the serv- 7

ices or 75 percent of the amount determined for 8

payment of a psychologist under clause (L)’’. 9

(e) EXCLUSION OF MARRIAGE AND FAMILY THERA- 10

PIST SERVICES FROM SKILLED NURSING FACILITY PRO- 11

SPECTIVE PAYMENT SYSTEM.—Section 1888(e)(2)(A)(ii) 12

of such Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended 13

by inserting ‘‘marriage and family therapist services,’’ 14

after ‘‘qualified psychologist services,’’. 15

(f) INCLUSION OF MARRIAGE AND FAMILY THERA- 16

PISTS AS PRACTITIONERS FOR ASSIGNMENT OF 17

CLAIMS.—Section 1842(b)(18)(C) of such Act (42 U.S.C. 18

1395u(b)(18)(C)) is amended by adding at the end the 19

following new clause: 20

‘‘(vii) A marriage and family therapist (as de- 21

fined in section 1861(bbb)(2)).’’. 22

5

•HR 1447 IH

SEC. 3. COVERAGE OF MARRIAGE AND FAMILY THERAPIST 1

SERVICES PROVIDED IN CERTAIN SETTINGS. 2

(a) RURAL HEALTH CLINICS.—Section 3

1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 4

1395x(aa)(1)(B)) is amended by inserting ‘‘, by a mar- 5

riage and family therapist (as defined in subsection 6

(bbb)(2)),’’ after ‘‘by a clinical psychologist (as defined by 7

the Secretary)’’. 8

(b) HOSPICE PROGRAMS.—Section 9

1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 10

1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or mar- 11

riage and family therapist (as defined in subsection 12

(bbb)(2))’’ after ‘‘social worker’’. 13

SEC. 4. AUTHORIZATION OF MARRIAGE AND FAMILY 14

THERAPISTS TO DEVELOP DISCHARGE PLANS 15

FOR POST-HOSPITAL SERVICES. 16

Section 1861(ee)(2)(G) of the Social Security Act (42 17

U.S.C. 1395x(ee)(2)(G)) is amended by inserting ‘‘mar- 18

riage and family therapist (as defined in subsection 19

(bbb)(2)),’’ after ‘‘social worker,’’. 20

SEC. 5. EFFECTIVE DATE. 21

The amendments made by this Act apply with respect 22

to services furnished on or after January 1, 2006. 23

Æ