Attention Associate License MFTs and MFTs in the School Candidates – 2/16/2016

Hope you’re all staying warm with all this chilly weather. Brrrr!

We have some exciting news!  We now have confirmation of the Public Health Committee raising the MFT Associate License bill at this Tuesday’s (2/16/2016) meeting.  We have requested that the Committee introduce the version of the bill that passed out of the Committee last year.  Below is a provided link to last year’s language for your information.

Is anyone available to testify?  We are also accepting electronic testimonials if you cannot attend. Task force Chair Jes Joseff will be there along with a couple of others.  The bill:
1.) Allows recent graduates to be eligible for 3rd-party reimbursement, which would make them more marketable for jobs
2.) Closes the gap between graduation and becoming eligible to be certified by the state Dept. of Ed for school-based MFT certification
3.) Creates parity with social workers.

When this bill passes, with an associate license you can be hired right out of school for a school-based position, without waiting for full licensure.  It means that schools can now be in a position to hire MFT clinicians if they have been a good match during their internships.  We have been overdue for this adjustment to the law.

Special thank you to Dr. Laundy and Dr. Cohen for writing testimony as they are the original advocates for the MFTs in Schools law from 2007.  Now we need certified MFTs, “almost graduated” MFTs (please send to students) who need the jobs they have trained for, as well as those of senior clinicians who saw the original bill pass.  Please come and be a representative at the capital TOMORROW.

Special areas of interest are New Britain and Hartford, the districts of the Co-Chairs.

Link to last year’s bill: https://www.cga.ct.gov/2015/TOB/h/pdf/2015HB-06861-R02-HB.pdf

Please pass this along to others!

Legislative Update 12/2014

Contact at legislation@ctamft.org

Our legislative path for this year includes a grassroots lobbying campaign about a provisional license for new graduates as well as supporting MFTs in the schools, Medicaid/Medicare initiatives and advocating for MFTs in mental health settings.

Please keep an eye out for e-mails from our legislative Board representatives, Maryann LaBella or Roxanne Pomeroy, about contacting your legislators to make this happen. We are getting good feedback about the new options for Medicare reimbursement for private practitioners as well.

Please see the website for more ways to access this information.

Legislative Update, January 2014

Susan Boritz, MA, LMFT
CTAMFT Legislative Liaison (legislation@ctamft.org)

Mental Health Parity, Affordable Care Act and Access to Treatment

MHPAEA Update
On November 8, 2013, the Obama Administration issued a news release announcing the final regulations/rules for implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA), which was originally enacted in 2008 and implemented under interim rules in July 2010.

By way of background, the purpose of the MHPAEA is to reduce misinformation and stigma about mental illness and addiction, as well as increase access to affordable mental health and addiction services. It’s designed to establish “parity,” or equivalence, between mental health/addiction services and medical/surgical treatment.

Specifically, if a group health plan includes mental health and addiction coverage; out-of-pocket costs, including deductibles, coinsurance and copayments must be the same. If the plan has out-of network benefits for medical/surgical treatment, it must provide equivalent out-of-network benefits for mental health/substance abuse treatment. For a full overview of the MHPAEA, please link here.

MHPAEA Final Regulations/Timing
The final regulations have taken into account research, as well as public input throughout the interim period. These rules prevent most group insurance plans from establishing reduced benefit coverage for mental health and addiction services than other kinds of health care services.

Link here to view the final regulations. Please note these final regulations were effective on January 13, 2014 (except some technical amendments – see rules for details). The mental health parity provisions of these final regulations apply to group health plans and health insurance issuers for plan years (or, in the individual market, policy years) beginning on or after July 1, 2014.

Affordable Care Act Expands on MHPAEA
The Affordable Care Act (ACA) expands on the MHPAEA by considering mental health and substance abuse treatment as one of its 10 essential health benefits categories, thereby requiring that it be included in all health insurance plans sold on the exchanges/marketplace.

In Connecticut, as most Marriage and Family Therapists (MFTs) reading this are no doubt aware, laws governing the sale of commercial insurance are made at the state level and vary considerably from state to state. This is particularly true with respect to mental health and substance abuse benefits.

Connecticut law provides for mandatory coverage for the “diagnosis and treatment of mental or nervous conditions, including alcoholism and drug addiction.” Policies cannot be sold without their inclusion. Information about state health insurance mandates and the ACA essential benefits provisions can be found here.

Despite the fact that Connecticut has among the most progressive laws in the country, Connecticut residents have nevertheless faced roadblocks when they have attempted to access care. In the aftermath of the Sandy Hook shootings, such problems in the system have received considerable attention and criticism. In response, representatives from the insurance industry have teamed up with experts from the UConn Health Center to produce a “Tool Kit” to help consumers navigate the system.

Written in clear and accessible language, the toolkit guides the consumer through the process from contacting his/her insurance company, obtaining pre-authorization, and determining their out-of-pocket expenses. The Behavioral Healthcare Claims Toolkit is available here.

If you have any questions, or would like further information, please contact us at legislation@ctamft.org.

Resources:
• November 8, 2013 News Release Announcing Final Mental Health and Substance Use Disorder Parity Rule

• Mental Health Parity and Addiction Equity Act (MHPAEA)

• MHPAEA Final Regulations/Timing

• ACA 10 Essential Health Benefits

• State Health Insurance Mandates & ACA Essential Benefits Provisions

• Connecticut Insurance Department Behavioral Health Consumer Tool Kit

Medicare Update

As we have welcomed 2014, CTAMFT has received several inquiries about Medicare reimbursement.

Please note that MFTs unfortunately still are not eligible to receive reimbursement for services for clients on Medicare under federal law.

By law (Sec. 1861(s) of the Social Security Act), specific types of clinicians may be determined eligible for Medicare Part B coverage only upon statutory (Congressional) enactment of an amendment to that law Section. Medicare Part B coverage for independent-practice MFTs passed the US Senate in 2003 and 2005, and the US House in 2007 and 2009 – but not the other Chamber at those times.

This has been an important issue for both AAMFT and CTAMFT for years.

We have received positive news that the Department of Social Services (DSS) is considering adding MFT reimbursement to more of their Medicaid plans, aimed at increasing access to quality mental health providers for their clients. This helps to support our goal of eventually achieving Medicare reimbursement.

AAMFT is working diligently to push forward a Medicare MFT coverage bill (S-562), which has 11 bipartisan sponsors. Representative Gibson (R-NY), along with some Democratic cosponsors plan to introduce a House “companion” to this bill.

You can help! Please urge your members of Congress to support S-562, Medicare MFT coverage. It’s simple! Just click here.

Legislative Update

by Susan Boritz, MA, LMFT
CTAMFT Legislative Liaison (legislative@ctamft.org)

CTAMFT’s Legislative Committee continues to make headway on several legislative fronts, including obtaining approval for an Associate License (LMFTA) for new grads working toward their independent license, as well as pushing forward a Medicare MFT coverage bill (S-562).

LMFT “A” Update
CTAMFT is continuing efforts to enhance its licensing structure. Our goal is to create a formal title designation (LMFTA – Licensed Marriage and Family Therapist Associate) for graduates after they’ve passed the national exam, and while they work under supervision (1,000 clinical hours and 100 hours of supervision) toward their independent license.

This summer, Denise Parent and I submitted a “Scope of Practice” proposal to the Department of Public Health (DPH), launching the review process toward a new license designation. We are pleased to share a show of support by CT-NASW’s Executive Director, Steve Carp, who has written backing this effort, as CT-NASW is seeking a similar license designation.

We have since learned that DPH has delayed our request. Let’s make this a priority! We are looking for legislators (particularly on the Public Health and Appropriations Committees) to support a bill we’d like reintroduced in the next session. Schools and students have the most to benefit from this initiative, and it’s important that we all step up our efforts to rally support as we move forward.

You can help by reaching out to your local legislators encouraging them to advocate for this proposal during the upcoming session. To assist you, our lobbying firm, Murtha Cullina, has drafted a “script” with talking points that we can all use with our legislators to gather support for the LMFTA. Click here for a talking points script.

Medicare Update
MFTs are not eligible to receive reimbursement for services for clients on Medicare under federal law. By law (Sec. 1861(s) of the Social Security Act), specific types of clinicians may be determined eligible for Medicare Part B coverage only upon statutory (Congressional) enactment of an amendment to that law Section. Medicare Part B coverage for independent-practice MFTs passed the US Senate in 2003 and 2005, and the US House in 2007 and 2009 – but not the other Chamber at those times. This has been an important issue for both AAMFT and CTAMFT for years. Our entire field stands to benefit from this initiative.

We have received positive news that the Department of Social Services (DSS) is considering adding MFT reimbursement to more of their Medicaid plans, aimed at increasing access to quality mental health providers for their clients. This helps to support our goal of eventually achieving Medicare reimbursement.

AAMFT is working diligently to push forward a Medicare MFT coverage bill (S-562), which has 11 bipartisan sponsors. Representative Gibson (R-NY), along with some Democratic cosponsors plan to introduce a House “companion” to this bill.

You can help!
Please urge your members of Congress to support S-562, Medicare MFT coverage. It’s simple! Just click here. To help with legislative efforts, please contact Susan Boritz via e-mail.

Legislative Update

AAMFT is working to push forward a Medicare MFT coverage bill (S-562) and needs your help.

Please visit http://www.congressweb.com/aamft/5 to easily contact members of our Congress and urge support for this bill.

And as always, please feel free to contact the CTAMFT Legislative Committee at legislation@ctamft.org with questions.

2013 Advocacy Report

Creating a bridge from graduation to independent licensure

CTAMFT recognizes the difficult and unclear road through graduation and the “Pre-Clinical Fellow” membership category where new graduates need to provide 1000 hours of service under supervision. Many agencies require a license for fee-for-service positions, and the majority of insurance panels will not consider practitioners who have not had three years of licensed practice. CTAMFT Board voted in 2009 to pursue legislation for an “Associate License” or “LMFTA” to provide Public Health recognition/regulation of MFTs professional status after they have passed the national exam and while they are still working under supervision. Difficult state budget conditions have repeatedly stalled this bill, which was requested in 2010, as DPH requires funding to support any change in their procedure. Because of this, social workers, who passed a similar bill in 2010 have also continued to wait to implement their bill. This January, the legislative committee, headed by Susan Boritz met with the co-chairs of the Public Health committee to formally request the LMFTA again. The co-chairs agreed to introduce a bill, but the language for it was again dropped before the public hearing. Susan Boritz and President-Elect Denise Parent testified, asking for the language about the LMFTA to be included in another bill raised about accreditation, #6646. While #6646 moved forward, the LMFTA language was referred to DPH for questions and revisions. We are proceeding to work through the “scope of practice” questions with the Department of Public Health regarding the associate or provisional license or LMFTA this summer. We hope to get the LMFTA legislation in next session.

Technical Fix around COAMFTE accreditation, Bill #6646

CTAMFT and all divisions were asked by AAMFT/COAMFTE to remove the requirement for the US Department of Education accreditation from our statute. The old language required MFT programs to be accredited through COAMFTE and the USDE, and dated back to the days when programs were not housed in USDE accredited universities or colleges. Currently, without a statute change, MFT programs go through accreditation with the USDE twice, once through their parent universities/colleges and also when COAMFTE is required to submit accreditation materials to USDE. Bill #6646 eliminates this duplication. The technical fix around COAMFTE accreditation is passing through the legislature in this year’s session.

Raising Family Systems thinking and intervention in the wake of Sandy Hook

CT became the epicenter of debate on mental health and gun control following the excruciatingly painful events of December 14, 2012. By January 2013, a rush of mental health bill proposals were flooding into the capital, covering a wide array of case management and peer support services for the severely mentally ill, services for young adults 18-26, requirements for mental health first-aid training for school professionals as well as reporting requirements for suicidal/homicidal ideation. Noticeably absent were holistic, family-centered prevention and intervention alternatives, plans for coordinated community based multi-disciplinary crisis approaches, and fully considered ways to prevent a mass shooter in the making. Mental health legislative initiatives already underway include the forming of a task force to consider how to serve the severely mentally ill and address a gap in services for 18-26 year olds. The results of the CT Sandy Hook task force meetings and criminal investigation will be completed and presented in/around June 2013.

One of our valued CTAMFT members, Nelba L. Márquez-Greene, suffered the loss of her daughter and became an impassioned advocate on behalf of Sandy Hook families asking for reasonable bipartisan action regarding gun control and mental health. She has also been actively involved in the development of an organization called The Sandy Hook Promise. CTAMFT Board discussed the need to keep a rational, steady and strong presence in the dialogue about mental health and are using their contacts to be a voice at the interdisciplinary tables discussing mental health initiatives. Susan Boritz, our board Legislative Liaison, and a resident of Sandy Hook, testified at the Newtown Public hearing about the need for organized community and family-based, trauma-informed services. Many CTAMFT members contributed testimony, crisis support and advocacy during this difficult time in our state, and the CTAMFT Board cannot be more proud and thankful for the deep commitment of our membership at this time.

MFT and the Schools

CTAMFT continues to support the implementation of the recently passed MFT In The Schools bill in spite of resistance from some individual school systems and the Department of Education’s concerns about the ability of MFTs to work with individual “students.” CTAMFT members and University Professors Kathie Laundy and Ralph Cohen, as well as Laura McBride continue to clarify this point with the help of Senator Andy Fleischman. President Dorothy Timmermann and President-Elect Denise Parent met with NASW-CT Executive Director Steve Karp to discuss concerns about MFTs “taking social work positions,” and to further develop the understanding of the MFT in the school role.

At this time, MFTs frequently work with students and their families outside of schools, often from private practices, school-based health centers or youth service bureaus. The MFT In The School role allows a Superintendent to define and hire their mental health team with a school based MFT on their payroll to address the larger family issues that accompany students to school. There has often been confusion even in our own membership about whether MFTs can be hired in positions defined as “school social worker,” “school counselor,” or “school psychologist.” Interchangeable job description is not the intent of the legislation. Our lobbying firm has discovered that School Psychologists have had similar confusion about this issue, and we hope to have the same conversation with their representatives as we did with Steve Karp.

Advocating for treatment niches for MFTs

CTAMFT Board has recently begun discussing the possibility of staking a greater claim to the provision of couple and family work as a treatment niche for MFTs. MFTs have spent long years breaking into the traditional mental health system and there is strong evidence based research supporting family systems approaches to mental health intervention and prevention. Recent rumours that MFTs were being “locked out” of state jobs were a reason behind CTAMFT’s meeting with NASW-CT in addition to MFT in the schools. We were told that social workers have worked over twenty years to have social workers hired in positions that are defined as “social work” positions. The majority, if not all, social work positions at the Department of Social Services and Department of Children and Families are not designed to provide therapy, but instead provide information, resources, referral, crisis investigation and case management, many of which are Bachelor level positions.

While there is some overlap in MFT and social work roles, many (or all?) of us chose MFT training to provide clinical treatment to individuals, couples and families from a systemic perspective. It occurs to us, as a Board, that we can choose to shift our advocacy and legislative effort in the future to carve out space and funding for the treatment modalities we are deeply committed to, and highlight the expertise of MFTs to fill those roles. This does not mean that CTAMFT will not continue to review and advocate on parity issues and continue to ensure that we have equal opportunity to jobs that MFTs are qualified for, particularly in terms of Medicaid and Medicare reimbursement, Clinical roles and School-Based Health Centers. What it does mean, is that as a Board, we hope to spend more time defining our valuable role as interdisciplinary teammates and the best qualified providers of couple and family treatment. This may or may not include legislative effort, but will absolutely require advocacy and the use of our entire membership as ambassadors and leaders in developing funding streams and relationships within and outside the existing mental health system.

Summer projects involve making connections on the many task forces related to mental health, identifying procedures and contacts to further research how contracts with the state are being decided, and our Board will be doing some strategic planning around advocacy in the fall.

Legislative Committee Seeking Member Involvement

The Legislative Committee of the Board is looking to grow itself by encouraging interested members to get involved and speak up about the policy and regulatory issues that are important to all CT practioners in one way or another. You will NOT be expected to attend regular meetings. Your name will be added to our list of engaged members so that we can keep you informed about the issue/s you are most concerned about and so that we will be able to call on you to use your voice when it can make the greatest difference in the coming months.

Please contact Susan Boritz with interest.