Legislation

YOUR VOICE MATTERS

To support legislation that will move our profession forward, it is important for all of us to contact our Representatives and Senators to let them know how important these initiatives are to the counseling profession and the people we serve. Unsure who represents you, use the links below. 

Find your Representative:  https://setrc.us/resources/florida/

Find your Senators:  https://www.senate.gov/senators/senators-contact.htm

State Legislation

U.S. States and Territories Modifying Requirements for Telehealth in Response to COVID-19

License Portability

AMHCA supports the Counselor Licensure Interstate Portability Endorsement and Reciprocity (CLIPER) Plan – which endorses both portability by endorsement and reciprocity.  Council of State Governments (CSG) requires that 10 states must first pass the compact legislation – which is a reciprocity arrangement — in order for the compact to become in effect.

Endorsement vs Reciprocity

Endorsement:  Any counselor licensed as a mental health counselor or licensed professional counselor for independent practice available in his or her state may obtain licensure in any other state or territory of the U.S.

Reciprocity:  Provides provisions for states to make legislative law changes that comply with a proposed interstate compact that would allow LMHC’s to practice in other states that have passed the compact legislation without having to be licensed in these other states.

Supervised License Practice:  The intent of this section is to ensure that documented supervision practice hours from the originating state are transferred to the receiving state.

 To review the AMHCA’s position paper, see the link below:

https://www.amhca.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=87e738c6-22b4-a81f-7d6c-cf82a05751a6&forceDialog=0


Effective Date: July 1, 2021:  (HB 241) Parents Bill of Rights

The bill creates the “Parents’ Bill of Rights,” which states that licensed health care providers and facilities cannot provide services, prescribe medicine, or perform any procedure without first obtaining written parental consent unless otherwise authorized by law.

The bill requires a health care practitioner, or his or her employees, to obtain parental consent before performing health care services on a minor child and subjects health care practitioners and health care facilities to disciplinary action for violation of these parental consent requirements in certain instances. The bill includes criminal penalties as well as providing grounds for disciplinary action.

Telehealth

With the expiration of the Florida State of Emergency DOH No.20-002, counselors must return to state regulations and boundary jurisdictions.  For a complete explanation, please see the following link: Emergency Order Relaxes Florida Licensure

Federal Legislation

Medicare Parity (HR 945)

September 9, 2020:  House Committee Passes Mental Health Counselor Medicare Legislation

The House Energy and Commerce Committee approved HR 945 in an historic vote supporting Medicare coverage for the counseling profession. While this legislation has passed both the House and Senate twice over the years, never before has the bill been voted on as a standalone measure rather than part of a broader package.

While we did not get the President’s signature in 116th Congress, this historic vote shouldn’t be underestimated. The Committee approval strengthens the chance for approval in the next Congress when mental health legislation is anticipated.

Mental Health Access Improvement Act (2019)

The American Counseling Association is seeking Republican members of the Senate Finance Committee to help push our Medicare bill forward. Currently, the Mental Health Access Improvement Act of 2019 has 109 cosponsors in the House of Representatives (H.R. 945) and 30 cosponsors in the Senate (S. 286). If your legislator is not a cosponsor of the Mental Health Access Improvement Act of 2019, please contact their office to let them know that their support is vital to the success of this important legislation. What You Should Know

Due to outdated Medicare rules, licensed professional counselors (LPCs) are still being denied access to Medicare reimbursements. However, due in part to ACA’s advocacy efforts, the Support for Patients and Communities Act (H.R. 6), commonly referred to as “The Support Act,” has expanded the definition of allowable mental health care services under Provision B to include LPCs operating within certified Opioid Treatment Programs (OTP) for the purpose of Opioid Use Disorder (OUD) treatment. The work of licensed professional counselors in opioid treatment programs certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) was eligible for Medicare reimbursement as of Jan. 1, 2020. This reimbursement will be made only to the opioid treatment programs and not to individuals.

Your clients are depending on you!

Additional facts to use when contacting your Members of Congress: • Licensed professional counselors account for one-third of the mental health care workforce, according to the Health Resources and Services Administration (HRSA). Once their clients reach age 65, however, these licensed providers may be unable to assist them due to outdated mental health care policies. • Every eight seconds, a person in the U.S. turns 65—more than 10,000 people each day. Twenty-six (26) percent of Medicare beneficiaries are dealing with a mental health condition. • The United States has a mental-health-professional shortage, according to HRSA. LPCs are ready to serve, but in underserved urban and rural communities where proper access to mental health services are most needed, those services cannot be provided due to barriers to care. • Seniors and veterans often lose coverage for treatment by mental health counselors at the age of 65, when they must transition from Medicaid or other insurance to Medicare, which does not cover mental health treatment by licensed professional counselors, but does provide coverage for other mental health treatment providers. • Current Medicare regulations only allow psychiatrists, psychologists, clinical social workers and psychiatric nurses to provide mental health services. These provider options were last updated in 1989 by the Center for Medicare and Medicaid Services. • Please remember to make it personal. Share a story of how you and your clients have been affected by this outdated policy. Need more information? Contact: The American Counseling Association Phone: 703-823-9800 E-Mail: advocacy@counseling.org

Legislative Update SB 1418 - Confidentiality & Duty to Warn

The Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling is dedicated to ensuring our licensees have the most current regulatory information related to licensure.

Senate Bill 1418 (SB 1418) adds additional circumstances when information from the confidential clinical record may be released to ensure that communication of a specific threat to cause bodily injury or death is timely reported to law enforcement. It further requires that when a patient communicates a specific threat against an identifiable individual to a mental health service provider, the provider must notify law enforcement of the potential threat. The language provides that the disclosure of the threatening confidential communications may not be the basis of civil and criminal legal action.  To assist with understanding the changes in law, words stricken are deletions; words underlined are additions. The law is effective July 1, 2019.

More specifically, SB 1418 amended section 394.4615, F.S., to provide additional confidential records release circumstances and section 491.0147, F.S., to require persons licensed or certified under chapter 491, F.S., to notify law enforcement if a patient or client communicates a specific threat to cause serious bodily injury or death.

Florida: 2019 Legislative Session

Florida:  2019 Legislative Session

The legislative session begins in the state capitol, Tallahassee on March 5, 2019 and is expected to end May 3, 2019. Up to the start of the regular session committee weeks begin the process of moving bills through the legislature.

Senate President: Bill Galvano (R)
House Speaker: Jose Oliva (R)
Majority Leader: Senate: Kathleen Passidomo (R)
House: Dane Eagle (R)
Minority Leader: Senate: Audrey Gibson(D)
House: Kionne McGhee (D)

According to an op- ed in “Naples Daily News” on February 3, 2019 by Michel V. Reagen, Ph.D. a past  Iowa Commissioner of Human Services, Director of Missouri Department of Social Services and CEO of the Greater Naples Chamber of Commerce, Florida ranks 50th among states in per-capita spending on mental health services and substance abuse.

A few bills to follow……

HB 307: Insurance Coverage Parity for Mental Health and Substance Use Disorders

GENERAL BILL by Silvers ; (CO-INTRODUCERS) Jenne

Insurance Coverage Parity for Mental Health and Substance Use Disorders; Requires managed care plans to submit annual report to AHCA relating to parity in mental health & substance use disorder benefits; requires certain insurers, HMOs, & nonprofit hospital & medical service plan corporations to comply with specified requirements for mental health & substance use disorder benefits; requires such entities to submit annual report to OIR containing specified information; requires OIR to issue report to Legislature; repeals provisions relating to optional coverage required for substance abuse impaired persons.

Effective Date: 7/1/2019
Last Action: 1/23/2019 House – Referred to Health Market Reform Subcommittee; Appropriations Committee; Health and Human Services Committee

 

HB 2045: School Based Mental Health Pilot Project

APPROPRIATIONS PROJECT by Silvers

School Based Mental Health Pilot Project; Provides an appropriation for the School Based Mental Health Pilot Project. APPROPRIATION: $973,099.00

Effective Date: 7/1/2019
Last Action: 1/23/2019 House – Referred to PreK-12 Appropriations Subcommittee; Appropriations Committee
Bill Text: PDF 

Additional information is available at myfloridahouse.gov.

HB 361: Admission to Mental Health Facilities

GENERAL BILL by Silvers ; (CO-INTRODUCERS) Webb

Admission to Mental Health Facilities; Requires receiving facility to refer cases of certain minors admitted for mental health assessment for appointment of public defender within specified timeframe; requires hearings involving children under specified age to be conducted in physical presence of child; requires administrator to petition for voluntary placement within specified timeframe after person under age 18 is admitted for services or transferred to voluntary status; requires hearing within specified timeframe.

Effective Date: 7/1/2019
Last Action: 1/30/2019 House – Referred to Children, Families and Seniors Subcommittee; Appropriations Committee; Health and Human Services Committee
Bill Text: PDF 

Legislative Update as of January 16, 2019

  1. At the FMHCA Conference – there will be a Government Relations Panel Discussion 11:45-1:15 on Friday February 1, 2019
  1. FMHCA Legislatives Days in Tallahassee March 27 and 28th – purpose to meet state legislators during the 2019 Florida Legislative Session to forward LMHC’s legislative agenda
  1. Major FMHCA issue legislative this session (March-May, 2019) is the Licensure Portability Bill – FMHCA is working w/ the LCSW’s and LMFT’s because we all are licensed under the 491 Board.  Until the bill is filed in the House and Senate there won’t be a bill number. Licensure portability is a step in creating national standards which will help move forward our goal of the achieving Medicare Provider Status as Medicare is a federal program.
  1. FMHCA’s lobbyist, Corinne Mixon reported at the 1/16/19 Government Relations Meeting that Psychologists are seeking legislation that will allow them to prescribe medications
491 Board Announces Emergency Rule Affecting Interns: https://fmhca.wildapricot.org/Member-Forum/8843284
DHHS Announces Temporary Discretion to Not Penalize Counselors for Using Non-HIPPA-Compliant Telehealth Resources During COVID-19 Crisis: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
COVID-19 Resources for Counselors: https://fmhca.wildapricot.org/Member-Forum/8829044
FMHCA Announces Passage of Licensure Portability Bill: https://fmhca.wildapricot.org/Member-Forum/8842508


Medicare Provider Status for Mental Health Counselors

The American Mental Health Counselors Associations Four Part Strategy to

Gain Medicare Provider Status for Clinical Mental Health Counselors through the

Seniors Mental Health Access Improvement Act (H.R. 3032 and S. 1879) new bill

numbers will be assigned when the bills are re-introduced in the 2019 Congress.

  1. Increase legislators awareness of CHMC’s role/and ability to help their constituents through strategic meetings
  2. Modify messaging to legislators – tell legislators why CHMC provider status is vital to their constituents for their wellbeing and as a significant way to save dollars
  3. Utilize legislative alternatives – for example adding Medicare provider status as an amendment to a bill related to the opioid crisis
  4. Grassroots Activities

AMHCA organizes “Call Your Congressman/woman Days

AMHCA is a coalition partner working with the following groups to promote Medicare Provider Status:

National Board of Certified Counselors (NBCC), the American Counseling Association(ACA), the American Association for Marriage and Family Therapists (AAMFT), the National Council for Behavioral Health (NCBH) and the Association for Behavioral Health and Wellness (ABHW)

Source “The Advocate Magazine” Fall 2018

APA Division 44 Opposes Anti-Transgender Ban and Encourages Challenging Stigma

APA Division 44, The Society for the Psychology of Sexual Orientation and Gender Diversity, is opposed to the March 23rd, 2018, White House memorandum disqualifying transgender persons from service who have received a gender dysphoria diagnosis.

Division 44, The Society for the Psychology of Sexual Orientation and Gender Diversity affirms the American Psychological Association’s opposition to this ban:

“The American Psychological Association is alarmed by the administration’s misuse of psychological science to stigmatize transgender Americans and justify limiting their ability to serve in uniform and access medically necessary health care….

No scientific evidence has shown that allowing transgender people to serve in the armed forces has an adverse impact on readiness or unit cohesion. What research does show is that discrimination and stigma undermine morale and readiness by creating a significant source of stress for sexual minorities that can harm their health and well-being.”

The memorandum reinforces mental health stigma and transphobia. The order detailed in this memorandum is discriminatory.

In recognition that such acts of discrimination and the perpetuation of stigma can be harmful to our community members (e.g., Barry, 2009), we encourage Division 44 members to take this opportunity to confront and challenge transphobia (prejudice against transgender people) and cissexism (a bias for cis-gender people, or those whose gender identity corresponds with their assigned sex at birth).

What can I do to take positive action?

Transphobia and cissexism are social toxins. In addition to practicing respectful communication, busting myths, and learning about gender diversity from organizations like the National Center for Transgender Equality, we encourage seeking out personal connections with transgender people and those closest with transgender people and amplifying their personal stories. Consider the power of contact (e.g., Allport, 1954, Pettigrew & Tropp, 2006, 2008) and personal stories (e.g., Brookman & Kalla, 2016). Division 44 members are also encouraged to educate others, including friends, students, colleagues, and representatives. Education – including sharing the ways you are impacted by transphobia and cissexism – can have positive ripple effects.

OERA  Summary/Outline

Sec. 1 – Opioid Emergency Response Act)/Table of Contents

Sec. 2 – Alternatives to Opioids Prescribing Act, introduced by Buchanan

  • This section will create a Medicare demonstration program to evaluate the benefits of using alternatives to opioids (ALTOs) in emergency departments. Hospital emergency departments will voluntarily apply to participate (thirty to fifty will be selected). They will have the opportunity to earn bonus payments based on their ability to reduce their use of opioids and increase their use of alternatives (such as nerve blockers or laughing gas) to treat specific conditions.

Sec. 3 – H.R. 4733, the Opioids and STOP Pain Initiative Act, Rep. Peter Welch (D-VT)

  • This section of the bill will provide $500 million to the National Institutes of Health (NIH) over five years to increase their ability to research the science behind pain and addiction as well as new non-opioid treatments for these medical conditions.

Sec. 4 – S. 788, the Veteran Overmedication Prevention Act, Sen. John McCain (R-AZ)

  • This section of the bill requires the Department of Veterans Affairs to work with the National Academies of Sciences, Engineering and Medicine to conduct a review of all veterans who died by suicide in the last five years. The report will look at the correlations between suicide and use of medications, including legal and illegal opioids.

Sec. 5 – Extension of the grants created in the 21st Century Cures Act

  • This section of the bill will continue the Congressionally-passed CARA grants for an additional five years at the current funding level of $500 million per year.

Sec. 6 – H.R. 3032, the Mental Health Access Improvement Act, Rep. John Katko (R-NY)

  • This section of the bill will allow mental health counselors and marriage and family therapists to participate in the Medicare program. These master’s level providers are currently excluded from Medicare, even though they are the most common types of providers in many rural areas.

Sec. 7 – S. 372, the STOP Act, Sen. Rob Portman (R-OH)

  • This section of the bill will require the postal service to provide advanced electronic data to U.S. Customs and Boarder Protection (CBP) on all international packages. Under current law, private carriers (FedEx, UPS) are already required to submit this data, but USPS is not. This change will make it easier for CBP to flag and inspect packages that may contain illicit drugs, especially fentanyl and other synthetic opioids coming primarily from China.

Sec. 8 – H.R. 2851, the SITSA Act, Rep. John Katko (R-NY)

  • This section of the bill will make it easier for law enforcement and prosecutors to keep drugs off our streets. It allows the DEA to temporarily outlaw drugs chemically similar to fentanyl, and gives prosecutors new sentencing guidelines for convicted dealers. Charges of simple possession are explicitly excluded.

  • Summary/Outline

  • Sec. 1 – Short title (Opioid Emergency Response Act)/Table of Contents

  • Sec. 2 – Alternatives to Opioids Prescribing Act, introduced by Buchanan

  • This section will create a Medicare demonstration program to evaluate the benefits of using alternatives to opioids (ALTOs) in emergency departments. Hospital emergency departments will voluntarily apply to participate (thirty to fifty will be selected). They will have the opportunity to earn bonus payments based on their ability to reduce their use of opioids and increase their use of alternatives (such as nerve blockers or laughing gas) to treat specific conditions.

  • Sec. 3 – H.R. 4733, the Opioids and STOP Pain Initiative Act, Rep. Peter Welch (D-VT)

  • This section of the bill will provide $500 million to the National Institutes of Health (NIH) over five years to increase their ability to research the science behind pain and addiction as well as new non-opioid treatments for these medical conditions.

  • Sec. 4 – S. 788, the Veteran Overmedication Prevention Act, Sen. John McCain (R-AZ)

  • This section of the bill requires the Department of Veterans Affairs to work with the National Academies of Sciences, Engineering and Medicine to conduct a review of all veterans who died by suicide in the last five years. The report will look at the correlations between suicide and use of medications, including legal and illegal opioids.

  • Sec. 5 – Extension of the grants created in the 21st Century Cures Act

  • This section of the bill will continue the Congressionally-passed CARA grants for an additional five years at the current funding level of $500 million per year.

  • Sec. 6 – H.R. 3032, the Mental Health Access Improvement Act, Rep. John Katko (R-NY)

  • This section of the bill will allow mental health counselors and marriage and family therapists to participate in the Medicare program. These master’s level providers are currently excluded from Medicare, even though they are the most common types of providers in many rural areas.

  • Sec. 7 – S. 372, the STOP Act, Sen. Rob Portman (R-OH)

  • This section of the bill will require the postal service to provide advanced electronic data to U.S. Customs and Boarder Protection (CBP) on all international packages. Under current law, private carriers (FedEx, UPS) are already required to submit this data, but USPS is not. This change will make it easier for CBP to flag and inspect packages that may contain illicit drugs, especially fentanyl and other synthetic opioids coming primarily from China.

  • Sec. 8 – H.R. 2851, the SITSA Act, Rep. John Katko (R-NY)

  • This section of the bill will make it easier for law enforcement and prosecutors to keep drugs off our streets. It allows the DEA to temporarily outlaw drugs chemically similar to fentanyl, and gives prosecutors new sentencing guidelines for convicted dealers. Charges of simple possession are explicitly excluded.

Medicare language fails to be included in the omni-budget

But, The Good News is This:

While the language to Amend Title XVIII (Inclusion of MH Counselors and MFTS) failed to make the cut, the following was included with the report that accompanied the release of the Omni-Budget of 2018.

Mental Health Providers:  The agreement is aware that Medicare beneficiaries have limited access to substance use disorder and mental health services, particularly in rural and underserved areas. The agreement notes concern about the shortage of eligible mental health providers for the Medicare population and supports efforts to explore the expansion of the mental and behavioral health workforce.  (Division H – L-HHS-ED p. 50)

According to Jordan Hayman of the House Budget Office:

Report language [such as this] is generally the first step in calling attention to a problem and the beginning of further discussions.

In my email exchange with Jacob Jackson, Legislative Assistant with NBCC, we can see this as a victory in that such a statement serves to buttress our efforts to persist in Washington.

 . . . it sets us up well for an opioid package that Congress is preparing currently. This package will be included an array of opioid bills that lawmakers have prepared and will either be one large piece of legislation with several provisions, or a series of smaller bills. Either way, we are working to have our Medicare bill be made one of the provisions. The language included in the spending bill is a step in that direction.

Louise will clarify with AMHCA and NBCC as to how we are to specifically move in getting our own legislators to step up and make this happen.

The FMHCA membership will be fully informed as information and actions are presented.

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