Congress Includes Focused Health Spending as Part of Recession Aid, Defers Action on Medicare

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1 Advocacy Congress Includes Focused Health Spending as Part of Recession Aid, Defers Action on Medicare Amid increasing concerns about the growing financial crisis, Congress has begun to act on recession aid that includes spending on certain health programs. At press time, the House had passed, and the Senate was considering, the $819 billion American Recovery and Reinvestment Act (HR 1), which includes three major health provisions. This bill would increase the federal portion of Medicaid spending by $89 billion over the next two years, so that cash-strapped states would not need to cut benefits to the poor and medically needy, a provision that the AAMFT strongly supports. MFTs provide Medicaid-paid, facility-based services in most states, and independent-practice Medicaid services in approximately 24 states. The House bill also would provide $20 billion over the next two years to certain types of healthcare facilities and practitioners who adopted electronic health records (EHR) systems to replace paper-based records. But little if any of this $20 billion would be available to non-physician practitioners, a limitation opposed by the AAMFT and other groups, such as the American Psychological Association and the National Association of Social Workers. The pending Senate bill would use the Medicare and Medicaid systems for allocating a total of $20 billion in bonuses to providers that adopted electronic health records, so that Senate bill also would severely limit MFTs ability to obtain such funding. Nevertheless, this issue s non-physician coalition, which includes the AAMFT, has received assurance from a key House committee member that EHR funding for non-physician practitioners will be considered later in The House and Senate bills also include a federal subsidy of 65% of the cost of continuation health plan coverage for certain unemployed persons and their families who otherwise would lose employer-sponsored health insurance. The rules for this subsidy would be as now permitted (if the unemployed person paid 102% of the full insurance premium) under the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA, Public Law ). Under COBRA continuation coverage, the affected health plan enrollee(s) receive the same subsidized benefit coverage as if the covered person continued to be employed. The proposal would provide a 65% premium subsidy until either the covered person obtained a new job with employer-sponsored health coverage or a certain number of months elapsed (12 months in House bill, 9 in Senate bill). Meanwhile, on February 4 th, Congress passed and President Obama signed into law a bill (HR 2) that would re-authorize and expand the State Children s Health Insurance Program (SCHIP), increasing enrollment by 4 million persons from the

2 current seven million figure. This new law includes a provision requiring mentalhealth parity, that is, any SCHIP plan s mental-health benefits could not be more financially or clinically restrictive than the plan s coverage for physical-health services, which the AAMFT supports. On Medicare, Congress must act this year to avoid a scheduled 2010 across-theboard cut of 20% in Part B payments for professional (non-institutional, non-rx) services. But action on that has been deferred as a result of the economic crisis. In the meantime, the AAMFT is working to obtain new chief sponsors for Medicare standalone bills that would cover MFTs and LPCs as independent practitioners (not requiring professional supervision) under Medicare Part B. This bill s chief Senate sponsor in the prior Congress (Sen. Thomas for S 921) died in 2007, while the chief House sponsor (Rep. Cubin for HR 1588) retired at the end of At press time, expected new chief sponsors had been identified, but they had not yet formally introduced bills. When that occurs, the AAMFT will all U.S. members, urging them to contact their Congress Members to request them to cosponsor this bill. We also expect that Medicare MFT coverage will again be included in larger bills, such as those to increase rural beneficiaries access to a wide array of services. At press time, none of those bills had yet been introduced. Once the recession-aid and Fiscal Year 2010 Appropriations ( discretionary spending) bills are enacted, it is possible that Congress will begin considering systemic healthcare reform, including broad changes to Medicare, as President Obama has urged. State Advocacy Ohio MFT Scope of Practice Bill Enacted into Law The Ohio Division was successful in its efforts to strengthen the MFT licensure law. This new law adds the word diagnosis to the MFT scope of practice, and makes several other important changes to the Ohio MFT licensure law. Enacting the scope of practice legislation into law is a tremendous accomplishment for the division. Since having the word diagnosis in the scope of practice is necessary for recognition by the state Medicaid plan, this legislation has been the primary advocacy goal for the division. With the enactment of this legislation, the OAMFT will be working with the state Medicaid agency on new regulations that will allow MFTs to become Medicaid providers. Additionally, OAMFT will work with the licensure board on rules that will implement the new law.

3 Proposed Initiatives for 2009 Division Initiatives Alabama Licensure Sunset Alaska Alberta Arizona Licensure Regulations Arkansas British Columbia California Licensure Regulations & State Job Classification Colorado Continuing Education Connecticut issues Florida & State Job Classification Georgia & Title Protection Hawaii Child Abuse Reporting Idaho Illinois Indiana Licensure law amendment Iowa Kansas Kentucky Louisiana Licensure Regulations & Medicaid Maine Licensure Law Amendment Manitoba Massachusetts & Medicaid Michigan Scope of Practice Mid-Atlantic Minnesota Provider tax Mississippi Medicaid Missouri Montana Licensure Nebraska Mental Health Boards Nevada New Hampshire Licensure Regulations New Jersey State Job Classification New Mexico New York North Carolina Associate Licensure North Dakota Licensure Regulations Ohio Licensure Regulations & Medicaid Oklahoma Medicaid & State Job Classification Ontario Title Protection Oregon Pennsylvania Licensure Law Amendment & Medicaid Quebec

4 Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Virginia Washington West Virginia Wisconsin Wyoming Licensure Regulations State Job Classification Scope of Practice MFTs as Commitment Evaluators Privilege and Confidentiality Licensure This table is based on information provided by division leaders to the AAMFT. This table does not include all of the advocacy initiatives that divisions are pursuing in Note that a Division s agenda might change during the course of the year due to unexpected opportunities to pursue a long-term agenda item or to an unexpected challenge to the MFT profession.

5 VA Update In mid-february, the Department of Veterans Affairs (VA) approved the establishment of a new occupational category for MFTs. This is an important victory, as the MFT profession now has a clearer vision of its role within the agency. Despite the uncertain timeframe for necessary next steps within the VA, the AAMFT will continue to advocate on behalf of the MFT profession to see that there is swift and fair resolution to final VA implementation. At the behest of VA human resources, the AAMFT will be working with their office to formalize the establishment of new qualification standards for the emerging VA MFT positions. They have indicated they will seek counsel with our professional organization moving forward as an MFT subject matter expert for the actual development of these classification standards. Launch of Family Therapist Policy Connector In late February, AAMFT Government Affair launched its first-ever issue of the Family Therapist Policy Connector e-newsletter. This quarterly publication has the intent of providing motivated members with insight into the inner-workings of AAMFT advocacy and policy activities. To begin with, its distribution list has been limited to just Family Therapist Education and Advocacy Movement (Family T.E.A.M.) members, Division Leaders, and those whom Opted-in when the birth of this newsletter was advertised in a past issue of Family Therapy Magazine. Some highlights of the Family Therapist Policy Connector content include: federal policy updates, Tales of An AAMFT Advocate featuring Q & A with exemplary AAMFT activists, listings of AAMFT resources to aid members in conducting grassroots advocacy, factoids on policy and politics to help make things even more relevant and/or interesting to MFTs, to name a few. To Opt-in for the Spring 2009 issue, please your request to

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