Bill Would Add Therapists to Medicare
November 14, 2005

WASHINGTON (Associated Press) -- In rural states, older residents often have a hard time finding care for mental health problems. Wyoming, for instance, has 200 square miles for every Medicare provider eligible to treat mental illness.

Sen. Craig Thomas, R-Wyo., wants to improve that ratio. He has sponsored legislation that would bring marriage and family therapists and licensed counselors into the health insurance program. As a result, Wyoming's elderly and disabled would have access to 1,063 mental health professionals instead of 474.

But the proposal has drawn strong opposition from the American Psychiatric Association, which says it would waste government money. The inclusion of the new providers would increase spending for marriage counseling or family troubles without improving care for more serious problems like schizophrenia, the group contends.

"These are the wrong services to cover at the wrong time. There's a huge resource issue," said Tom Leibfried, the association's lobbyist. "Congress is finding it hard to provide new money for services, and the first thing to fund would not be these."

Thomas' proposal became an amendment to legislation designed to cut federal spending by $36 billion over 10 years. The legislation passed the Senate last week, but it would have to survive negotiations with the House before being sent to President Bush.

Many states prohibit professionals with a Masters'-level education from diagnosing and treating serious mental illnesses such as bipolar disorder or schizophrenia, Leibfried said.

Thus, he said, when brought into to Medicare, they would primarily bill for services they are allowed to diagnose, such as marriage counseling or family breakdowns.

"That's a worthwhile thing," Liebfried said. "But if you're going to fix something first, let's make sure we're opening access to people with more serious conditions."

Thomas promoted his plan in a press release that noted one-fifth of all rural counties have no mental health service of any kind. He said the health care professionals he wants to add to Medicare's list of providers are often the only mental health professionals available.

"Folks in Wyoming's small towns already travel long distances to receive care," Thomas said. "With additional practitioners available, access should be a little closer to home."

Congress examined the issue in 2000, asking the Medicare Payment Advisory Commission whether it should allow Medicare to cover "nonphysician providers of health mental health services." The panel concluded, by a 12-2 vote, that it should not.

It said the major roadblock for Medicare beneficiaries needing mental health services was the program's co-payment, which requires patients to foot half the bill.

"Expanding the list of covered providers would likely increase costs to the Medicare program without improving access proportionately in problem areas," the commission concluded.

Congress relies on the panel for advice on Medicare issues.

However, the secretary for health and human services also has various advisory boards. A 21-member panel with expertise in rural health issues said last year that Medicare should include licensed marriage and family therapists and professional counselors.

It noted that those providers argue that they "could actually reduce costs by reducing emergency room visits and encouraging more judicious use of mental health services."

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Medicare Payment Advisory Commission 2002 report: http://www.medpac.gov

National Advisory Committee on Rural Health and Human Services 2004 report: http://www.ruralhealth.ca.gov/pdf/20..._secretary.pdf