Medicare Mental Health Workforce Coalition

• #UpdateMedicare
• #SeniorMentalHealth
• #MedicareMentalHealth

Fast and impactful, a tweet to a member of Congress shows that Medicare mental health access is an issue that is at the forefront of your mind. This can be completed on your own or by registering for NBCC’s Grassroots Action Center.

Examples:

@__________ I’m a constituent from [city]. Studies show that over 500,000 seniors on Medicare are receiving high amounts of opioids, and almost 90,000 beneficiaries are at serious risk of opioid misuse or overdose. We need mental health counselors to be able to accept Medicare clients in order to address this crisis directly. Please support S. 828/H.R. 432. #UpdateMedicare #SeniorMentalHealth #MedicareMentalHealth

• #UpdateMedicare
• #SeniorMentalHealth
• #MedicareMentalHealth

Quick and efficient, a Facebook post to a congressional member allows you to describe how you, your clients, and your practice are impacted by the restricted access to mental health services. Do you have to turn seniors away? They should know.

Examples:

@___________, I am a constituent from [City] and a mental health counselor. There’s a shortage of mental health and substance abuse providers in the Medicare system, despite an increase in mental health and addiction disorders amongst seniors. Please sign on to the Mental Health Access Improvement Act to increase seniors’ access to cost-effective mental health counselors and save lives. #SeniorMentalHealth #MedicareMentalHealth

An email to a member of Congress allows you to truly highlight your passion for this issue as well as your experiences with the potential impact that this legislation could have for your family, your clients, and your practice. This can be completed on your own or by registering for NBCC’s Grassroots Action Center.

Example:

Subject: Please Support Medicare Coverage for Mental Health Counselors and Marriage and Family Therapists

Dear Senator or Representative _______:

I am a constituent, (licensed mental health counselor or marriage and family therapist), and a National Certified Counselor. I strongly urge you to co-sponsor the Mental Health Access Improvement Act (S.828/H.R. 432). This bipartisan legislation is co-sponsored by Sens. John Barrasso and Debbie Stabenow, and Reps. Mike Thompson and John Katko. The bill would authorize Medicare payment for outpatient psychotherapy services provided by mental health counselors and marriage and family therapists. This bill has twice passed the House and the Senate, though not simultaneously.

The current exclusion of mental health counselors and marriage and family therapists from treating Medicare beneficiaries often results in denial of vital mental health services to those in desperate need. Although some beneficiaries are fortunate and find a Medicare-eligible provider, many never receive needed care, driving up costs and tragically increasing morbidity and mortality among beneficiaries in need of mental health or addiction services.

Medicare provider eligibility for mental health counselors and marriage and family therapists is long overdue. These two professions represent 40% of today’s licensed mental health practitioners. Unfortunately, Medicare has not been modernized to recognize their essential contribution in today’s health delivery system. Congressional scoring rules obscure the dollars saved by utilizing their services to treat mental health conditions before they escalate into more serious mental and physical disorders. Benefits of this bill include:

• Improved mental health access for rural and underserved populations.
• Earlier and more efficient use of Medicare mental health benefits.
• Better integration of mental health and physical health care.
• Reduced cost of physical health care, particularly for chronic conditions.

I urge you to become a co-sponsor of the Mental Health Access Improvement Act to help ensure Medicare beneficiaries obtain needed and timely mental health care.

Sincerely,

Are you more of a spoken word person? Great! Take some time to call the office of a member of Congress and express your concerns in person. You do not have to be an expert on this proposed legislation in order to effectively communicate the impact that this has on you, your family, your clients, or your practice. This can be completed on your own or by registering for NBCC’s Grassroots Action Center.

Example:

I am (your name) with the (practice/employer) here in (location) and a National Certified Counselor. Together we are working with the Medicare Mental Health Workforce Coalition.

The coalition supports the passage of the Mental Health Access Improvement Act in Congress, which would recognize mental health counselors and marriage and family therapists as Medicare providers and would increase the pool of eligible mental health professionals by over 200,000 licensed practitioners.

Medicare presently recognizes psychiatrists, psychologists, clinical social workers, and psychiatric nurses to provide covered mental health services to Medicare beneficiaries; however, mental health counselors and marriage and family therapists are not eligible.

Medicare beneficiaries need more mental health services, particularly in rural and underserved areas. Mental health counselors and marriage and family therapists are trained to serve these populations and are geographically accessible. The time has come to give all Medicare beneficiaries access to a qualified professional by recognizing mental health counselors and marriage and family therapists in the Medicare program. I urge you to join us and support the Mental Health Access Improvement Act, Senate Bill 828/House Resolution 432.

Conversation points:

• Elderly Mental Health Problems – Several recent reports have indicated that limited access to mental health services is a serious problem in the Medicare program. According to a recent Surgeon General’s report, 37% of seniors display symptoms of depression when evaluated in a primary care practice environment.
• Comparable Education – The covered mental health professionals recognized by Medicare presently include psychiatrists, psychologists, mental health clinical nurse specialists, and clinical social workers. Mental health counselors and marriage and family therapists are not listed as Medicare-covered providers despite the fact that both groups have education, training, and practice rights equivalent to or greater than existing covered providers.
• Lack of Access – Approximately 77 million people live in 3,000 mental health professional shortage areas. Fully 50% of rural counties in America have no practicing psychiatrists, psychologists, or social workers. Research shows that mental health counselors and marriage and family therapists are located in many rural and underserved areas that do not have any of the current Medicare providers.
• Medicare Inefficiency – Inpatient psychiatric hospital utilization by elderly Medicare recipients is extraordinarily high when compared to psychiatric hospitalization rates for patients covered by Medicaid, VA, TRICARE, and private health insurers. One-third of these expensive inpatient placements are due to clinical depression and addiction disorders, which can be treated for much lower costs when detected early through the outpatient mental health services of mental health counselors and marriage and family therapists. Studies conducted by the Centers for Medicare & Medicare Services show that Medicare is spending on average $9,000 per inpatient mental health claimant and only $400 per outpatient mental health claimant. Medicare’s greater ratio of spending on inpatient mental health versus outpatient mental health is the inverse of mental health payments by other insurers, including Medicaid and private insurers.
• Costs – The addition of mental health counselors and marriage and family therapists should save money over time. Our proposal suggests paying mental health counselors and marriage and family therapists only 75% of the psychologist’s rate for mental health services, thereby saving money when the lower-cost provider is accessed. This legislation would not change the Medicare mental health benefit.

Writing an op-ed piece for your local newspaper can not only gain the attention of congressional leaders, but it also brings much needed attention to issues surrounding the current limitations of services for seniors. If you are interested in writing an op-ed, contact govtaffairs@nbcc.org. We will help get you started by providing a draft for you to edit with your experiences, creating a unique article highlighting your personal impact.

Email Us

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Example:

Medicare Is in Desperate Need of Mental Health Providers

Older adults in America are facing a crisis. The Centers for Disease Control and Prevention estimates that 20% of adults over the age of 55 are suffering from mental health issues. These disorders include anxiety, depression, and substance use disorder. Millions more likely go undiagnosed, as the National Academy of Medicine has found that less than 40% of older adults with mental and/or substance use disorders receive treatment. The ongoing opioid crisis has only contributed to this trend, and it is estimated that 5.7 million adults over the age of 50 will require treatment for a substance use disorder this year. Medicare enrollment is expected to skyrocket in the coming years, with 80 million Americans projected to be on the program by 2030. This growth will further burden an already overtaxed system that is failing to provide mental health services to its beneficiaries.

At a time when Medicare-eligible individuals are suffering from mental health challenges more than ever, we should implement an “all hands on deck” approach, with access to all mental health providers being expanded. However, Medicare does not reimburse for talk therapy services provided by mental health counselors or marriage and family therapists. These two professions make up approximately 40% of the licensed behavioral health workforce in the United States. They are covered by all other insurance providers, both public and private, aside from Medicare. With these two professions shut out of the largest insurer in the country, Medicare beneficiaries do not have sufficient access to mental health treatment.

Mental health counselors and marriage and family therapists are qualified to provide counseling services and are already an integral part of the mental health care delivery system in the United States. They are required to obtain a minimum of a master’s degree, perform two years of postgraduate clinical supervised experience, and pass a national exam to practice independently. These requirements mirror those of current Medicare mental health providers, such as licensed clinical social workers. Mental health counselors and marriage and family therapists provide services in all settings, ranging from private practice to hospitals and everything in between. The fact that these providers are currently covered by all other insurance sources and work in a variety of settings means that people can access their services up until they go onto Medicare, at which point access to these providers is lost. Medicare beneficiaries across the country have had to discontinue treatment with a mental health counselor or marriage and family therapist they have been seeing for years through no fault or choice of their own.

Access to mental health treatment for Medicare beneficiaries in rural areas is especially lacking. As of 2019, over 77 million people in the United States live in Mental Health Professional Shortage Areas, according to the Health Resources and Services Administration. Fifty percent of rural counties in America have no practicing psychiatrists, psychologists, or social workers. Research shows that mental health counselors and marriage and family therapists are much more likely to be in these rural areas than any other practitioner. There are twice as many mental health counselors and marriage and family therapists in rural counties as social workers, six times the number of psychologists, and 13 times the number of psychiatrists. Nearly a quarter of Medicare beneficiaries currently live in rural areas, and the lack of access to mental health providers is leaving them with nowhere to turn for treatment. Mental health counselors and marriage and family therapists who are already located in these areas are unable to assist and provide treatment that is desperately needed.

The opioid crisis has resulted in a steep increase in the number of Medicare beneficiaries suffering from substance use disorder. When we think of the opioid epidemic, we typically don’t imagine seniors over the age of 65 as the primary victims. However, Medicare currently pays for one-third of all opioid-related hospitalizations in the United States, making them the largest single payer for these incidents.8 This research shows that not only are Medicare beneficiaries at a high risk for opioid misuse and addiction, they are not receiving adequate treatment and, as a result, overdose and end up in the hospital. If these patients had access to mental health counselors and marriage and family therapists, they could have received outpatient talk therapy services for their addiction and avoided a trip to the hospital, which is the most expensive and inefficient setting for substance use disorder and mental health treatment.

The Mental Health Access Improvement Act is legislation currently being considered by Congress that would allow mental health counselors and marriage and family therapists to bill Medicare for counseling services. This legislation would make over 225,000 licensed professionals available to Medicare beneficiaries. It would go a long way in both addressing the lack of mental health services currently available to Medicare beneficiaries as well as preparing the program for the increasing demand for these services in the future. It is imperative that Congress pass this legislation and help provide seniors with the mental health services they deserve.

Each member of Congress has multiple district offices in the area they represent. Staff members in these offices are tasked with gathering information from constituents and conveying it to legislators. These staff members want to hear from you, and you can reach out to these offices to arrange a meeting to talk with them about the Mental Health Access Improvement Act. This is one of the most effective advocacy methods.

If you are interested in arranging a meeting with district staff, email govtaffairs@nbcc.org, and we can help you get in touch! We have prepared some draft talking points for you to share with staff, and we also have the Medicare Access Coalition Handout that has all of the information about this legislation. Feel free to print it out and bring it along to give to the staff!

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Talking points:

• During the next 10 years, the number of Medicare beneficiaries with mental health conditions, including substance use disorders, will nearly double from about 8 million to 15 million people. Older Americans have high rates of mental illness and suicide yet have significantly lower rates of treatment than others. Recent data show that upwards of 500,000 people on Medicare Part D are prescribed high amounts of opioids, and almost 90,000 beneficiaries are at serious risk of opioid misuse or overdose. Many older adults will go untreated.
• Approximately 200,000 marriage and family therapists and mental health counselors who serve on the frontlines of our mental health delivery system are armed and ready to provide needed care to elderly adults with mental health conditions—especially key prevalent conditions such as depression and severe anxiety disorders.
• So, the workforce capacity is in place, but Medicare does not include mental health counselors and marriage and family therapists as recognized providers for reimbursement. It is an outdated policy given the new demands for mental health services among older adults. All other public and private health plans reimburse mental health counselors and marriage and family therapists for needed services.
• Moreover, marriage and family therapists and mental health counselors practice in several rural and frontier areas where no other mental health providers practice, and they are prepared to treat the substance use disorders—a growing problem among the rural elderly because of the opioid crisis. We have an under-utilized workforce, not a workforce shortage.
• Two identical bills in Congress—the Mental Health Access Improvement Act (Senate Bill 828 and House Resolution 432)—would fix these problems and increase the Medicare workforce capacity in a single, swift action. Expanding the workforce pool would increase Medicare beneficiary access to treatments.