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AMHCA/ACA Update: Medicare Legislation Passes Without Counselor Coverage

The fight for Medicare reimbursement of licensed professional counselors is over for the calendar year. We were closer to achieving our objective than ever before in the American Mental Health Counselor’s Association and the American Counseling Association’s 15-year fight for Medicare recognition of LPCs. Last week, that goal slipped out of reach as the Medicare conference committee, which wrote the final version of the Medicare prescription drug legislation, excluded the provision establishing reimbursement of licensed professional counselors and marriage and family therapists. The loss delays by another year the full recognition of licensed professional counselors under the nation’s largest public health insurance program. 

The counselor coverage provision, which was originally sponsored by Senators Craig Thomas (R-WY) and Blanche Lincoln (D-AR), was one of the last provisions to be decided by the conference committee. Senator Thomas, who made the counselor provision his top priority in the Medicare bill, and his staff worked closely with the Senate members of the conference committee to fight for inclusion of the provision. The coverage of counselors and marriage and family therapists was opposed by some House conferees, including Chairman of the House Ways and Means Committee Bill Thomas (R-CA), who objected to the provision’s costs. 

The overall Medicare prescription drug and payment reform bill would implement the biggest changes in the program and disabled since it began in 1965. For the first time, Medicare would make prescription drugs available to its beneficiaries, as well as introduce competition in Medicare, in the form of a demonstration project in several cities. Under the bill, the new prescription drug benefit would start in 2006, but would implement a drug discount card in the spring of 2004. Each prescription drug benefit plan would have a $275 annual deductible and a $35 monthly premium. Coverage would be for 75 percent of drug costs up to $2,000. Catastrophic coverage would go into effect once annual costs exceed $3,600. For low-income beneficiaries, those below 135 percent of poverty) there are protections that would either eliminate or severely limit co-payments above the catastrophic limit. The conference agreement does include specific protections for Medicare beneficiaries dually eligible for both Medicare and Medicaid. Provisions would include an allowance for states to use their Medicare programs to cover gaps in the new Medicare drug benefit – including all deductibles and cost sharing, as well as the gap in coverage between $2,200 and $3,600 of costs. Cost sharing for those below 100 percent of poverty would be strictly limited.

The Medicare legislation, without the mental health counselor coverage provision, passed the House of Representatives near dawn on the morning of Saturday, November 22nd. Although originally scheduled for defeat by a vote of 218-216, pressure from the White House forced enough Republicans to change their vote to give the Medicare bill passage by a vote of 220-215. The Senate debated and voted on the identical bill on Monday, November 24th. Although Senator Edward Kennedy (D-MA) led a filibuster effort to block the vote, there was not enough support to maintain the 41 votes needed to delay a vote. The Medicare bill passed the Senate by a vote of 54 to 44.

This setback is disappointing for AMHCA and ACA and all counselors who have been fighting for equal recognition of the profession. It appeared that the Medicare prescription drug bill was our best bet to get coverage of counselors passed this year. While the issue is over for the calendar year, it is not dead altogether. AMHCA and ACA will continue to work with Senators Thomas and Lincoln to find windows of opportunity to gaining passage of their bill. Recognition of counselors is long overdue, and AMHCA and ACA will pick up the flag in the next session of Congress. 

Please feel free to contact Beth Powell with AMHCA (800-326-2642, ext. 105; e-mail: bpowell@amhca.org) or Dara Alpert of ACA (800-347-6647, ext. 242, e-mail: dalpert@counseling,org) should you have any questions or concerns on this issue.