The AAMFT Blog

AAMFT Statement on Anti-Transgender Legislation

As an association, the American Association for Marriage and Family Therapy’s primary goal is to advocate for the profession of marriage and family therapy. We are also extremely sensitive to policies affecting individuals and families spanning a wide range of issues.  

AAMFT strives to be clear and vocal in its position that as an association, discrimination will not be tolerated on any basis. AAMFT finds the volume and increasingly extreme anti-transgender legislation efforts across the country alarming. We reiterate our global commitment to diversity, equity, inclusivity, and a fundamental belief in the power of relationships upon which our profession is built. We recognize the adverse effects of anti-transgender legislation on the livelihood of the transgender and gender-diverse community, including depression, increased suicide and attempted suicide, and fewer safe, inclusive spaces to thrive. AAMFT opposes legislation that discriminates against the LGBTQIA+ population and legislation that seeks to limit MFTs’ ability to provide gender-affirmative care.  

Many marriage and family therapists currently have an active and affirming role with transgender and gender-diverse clients, supporting them throughout their journey of self-discovery, self-acceptance, and transition. Further, MFTs have occupied an integral role in supporting these individuals within their family systems, facilitating enriching, stable relationships that are fundamental to their well-being.  We honor the contributions and influence on our field and within our own community by systemic therapists who identify as transgender or gender diverse.

"We are seeing a frightening pattern of anti-transgender measures being passed across the country. This assault on gender-affirming care is staggering. AAMFT remains steadfast that evidence-based gender-affirming care is essential and provides critical health benefits to the transgender community. We hope the resources on our new Transgender Resources for MFTs page will provide helpful information to our MFT community and the clients they serve. Furthermore, to increase AAMFT’s LGBTQIA+ advocacy influence, we have created a work group that will evolve into a Family Team in 2024. AAMFT is proud to support the Queer & Trans Advocacy Network (QTAN), a topical interest network that among its many goals is to increase professional competency to better serve all sexual and gender minority (SGM) clients and to advocate for SGM health and well-being stated”, Chris Michaels, CEO of AAMFT.

This new resource page, developed in collaboration with QTAN, will be updated with new resources as they become available.

Then why is AAMFT still holding the 2024 Systemic Family Therapy Conference (SFTC) in Orlando, Florida, where anti-transgender legislation and other harmful legislative actions have passed against marginalized communities?

Historically, AAMFT has never shied away from the responsibility we carry into the states where we hold conferences. Unfortunately, Florida is not the first state that has enacted discriminatory legislation over the years where we were hosting an event. Each time, AAMFT committed to hold the event and implemented efforts to push back. Efforts have included reach outs to legislative decision-makers in the areas, educational sessions, as well as efforts such as the implementation of AAMFT's attendee inclusivity statement, gender-neutral bathrooms, pronoun stickers, and more. Holding the conference in Florida sends a powerful message of support to our members, other systemic therapists, and our clients residing and practicing in the state and who are facing these challenges head-on.

Further, in-person event logistics necessitate conference location decisions being made many years in advance. The decision to have the conference in Orlando was made before COVID-19, with the original conference scheduled for 2020. Of course, the COVID-19 worldwide pandemic forced organizations to cancel many events over the past three years. The Walt Disney World Swan and Dolphin Hotel without hesitation, allowed AAMFT to shift our event from 2020 to 2024 without incurring the $500,000 in cancellation penalties. Canceling this time would result in the activation of the cancellation fee. Spending half of a million dollars of member funds with no demonstrable return on investment is not fiscally responsible and would be a significant loss on many levels for the association, the profession, and the many marginalized communities that rely heavily on the tourism industry and who are still recovering from the impact of Covid-19.

Instead, by holding the conference, we can ensure our presence has a positive impact as we work to raise awareness by inviting local community groups to exhibit at the conference for free, allowing them to educate attendees on the issues they are facing, and the helpful action attendees can take to help drive change in the community.

AAMFT is working closely with Disney, the Walt Disney World Swan and Dolphin Hotel, and the Orlando Convention and Visitors Bureau, prioritizing the safety and well-being of conference attendees and implementing measures to ensure an environment free from discrimination. In addition, AAMFT is collaborating with its topical interest networks, including the Queer and Trans Advocacy Network and Margins to Center: Cultural Connections Among C/MFTs, to find ways to create a welcoming and safe space for our attendees and to bring awareness to these issues.

This event in Florida is still over a year and a half away. Between now and then, much can – and likely will – change politically and practically. While AAMFT will share the early stages of our plans this summer (2023) so attendees have adequate time to discuss and share concerns and ideas, we anticipate adding and refining our plans until the 2024 event. To this end, AAMFT is monitoring all events being held in the area this year to understand the challenges they encounter, as well as gather new information and ideas about how we can continue to hold a safe and inclusive event.

Also, the 2023, 2025, and 2026 events will be held virtually, allowing for alternative training and networking opportunities. These virtual events provide vital systemic training to our global systemic therapists who cannot afford to attend in-person events. As we have done for the past three virtual SFTC events, all AAMFT student members will be able to attend for free. 

While we regret that some may be unable or choose not to attend our event in 2024, we hope that you will understand and join us in fully supporting our AAMFT members, systemic therapists, and clients in Florida as they navigate these troubling discriminatory attacks.

Pride 2024 – Pride, Advocacy, and Dancing!

 

When asked to write a blog post for Pride, I was preparing to travel to Wilton Manors, Florida, a historic LGBTQIA community. I set the intention to keep the topic for the blog post, the importance of Pride Month and the advocacy for all members of the LGBTQIA community, in mind as I was enjoying my “gaycation.” The use of “gaycation” is intentional. I live in a small city, so I try to take vacations that focus on visiting predominately queer areas and areas where I am least likely to run into any current or future therapy clients. As I have returned and settled back into navigating the heteronormative community I live in, here are some of my takeaways: 

 

1. Being surrounded by the queer community is powerful. As someone who lives in a smaller city, there is nothing quite like being surrounded by queer-owned shops, restaurants, bars, and lots and lots of pride flags and support of the queer community. To walk around an entire gay neighborhood is something I never could have imagined as a kid growing up in rural Appalachia. To see everyone being their authentic self is adrenaline-charged. It is extremely powerful and essential for these spaces to continue to exist, especially in states that are actively passing laws that negatively impact the LGBTQIA community.  

 

1. The power of seeing and listening to queer elders. One of my favorite things that I experienced was seeing so much diversity in queer love and joy, and especially seeing older adult queer individuals and couples. I was reminded of the importance of listening to our LGBTQIA elders and learning from them about what they have fought for. I left reflecting on how I want to continue to age as a queer person and what I hope to accomplish, and what I hope to see our community achieve.  

 

1. The Queer Community is resilient and vibrant. The complexity of walking around a queer neighborhood in Florida was evident. As we know, Florida has been a leader when it comes to States passing anti-gay and transgender bills. Yet, there we were. Thriving. Proud. Dancing! We need to remember this when we discuss boycotting similar areas. The LGBTQIA community is there, on the ground, doing the work. Any support provided is helpful.   

 

This trip was vital in reminding me of the importance of advocacy for the LGBTQIA community. Advocacy that will allow us to maintain our space in this world that we have fought hard to have. When I think about advocacy, I think about how broad this term can be and how it can mean something different to everyone. I want to share some advocacy tips to start the conversation and provide guidance:  

 

1. Advocacy can be small or big and should be authentic to you. For example, my most extensive form of advocacy is being authentically queer in South Carolina and bringing that identity into the classroom as a program director for a COAMFTE MFT Master’s Program. I hope that I make a positive impact on my students and that this leads them to create change in the multiple systems that they are involved in. I hope it models for them how to be their authentic selves.  

 

1. Advocacy requires you to stay informed and build community. Policies and information move fast, requiring energy, time, and focus. I have found that creating a community of support with friends that I can “kiki” (a hangout with friends) about the current state of politics and policies helps with burnout and my mental health. Advocating in isolation can be scary, but working in a community and a support system is energizing.  

 

1. Find Your Rhythm. Advocacy can happen in many ways. Find what works for you and be okay with that. Allow others to find what works for them. For example, I plan to attend the 2024 Systemic Conference in Orlando, Florida, this November. My choice to do so is because I feel attending is vital for the Queer and Trans Advocacy Network (QTAN) community, and showing up as a queer person is a core value of mine. With that, I understand other’s hesitations and concerns. Do what is best for you and allow others to do the same. Decide with your community and support systems, and maybe travel with them. I know you will have a community via QTAN leadership in attendance.  

 

Lastly, I cannot talk about advocacy without discussing the Queer and Trans Advocacy Network. As the 2023-2025 Chair, I am proud of the work the leadership team has been doing over the past two years, and I’m thankful to those who have come before us to help build the network. Here are some ways to get involved and advocate via QTAN: 

 

1. Join the QTAN 2024 Virtual Conference, July 26th – 28th. 
2. Please attend one of the many QTAN events! 
3. Volunteer to help with social media, event planning, or running for an upcoming elected position. Reach out to leadership at [email protected] to see how you can get involved.  
4. Connect with QTAN Leadership at the 2024 Systemic Conference in Florida. We have sponsored a track of QTAN-focused presentations that will help bring awareness to and advocate for the LGBTQIA community.  

 

Stay Proud,  

Evan 

 

AAMFT Statement on University of Las Vegas

The devastating impact of senseless gun violence has once again shaken a community, claiming the lives of three faculty members and injuring a fourth at the University of Nevada, Las Vegas (UNLV). Our thoughts are with the students, faculty, and staff of the marriage and family therapy program, as well as the entire UNLV community, as they confront the challenges ahead and start to cope with this devastating tragedy.

Adrian Blow, AAMFT President-Elect, states, “Having experienced a similar ordeal a little over six months ago at Michigan State University, we understand firsthand the arduous journey of recovery following such traumatic events. We recognize the resilience required to navigate through these difficult times, especially considering Las Vegas has unfortunately endured similar incidents in the past.”

To address the pervasive issue of gun violence in the United States, The Violence Prevention Project has committed itself to reducing such tragedies through extensive research. Driven by a desire for tangible change, Dr. Jill Peterson and Dr. James Densley founded the project and created a comprehensive database of mass shooters. Their groundbreaking work was shared at the virtual 2023 Systemic Family Therapy Conference, sponsored by the American Association for Marriage and Family Therapy. The pivotal insights from their comprehensive mass shooter database, publicly accessible on their website, are a crucial tool in understanding and addressing the pressing national crisis of gun violence.

“Meaningful action is needed to prevent more senseless mass shootings. Policymakers need to address this urgent national crisis by working together and finding meaningful solutions and putting an end to these devasting tragedies that happen in communities far too frequently”, stated AAMFT CEO Chris Michaels.

For those on the UNLV campus, Student Counseling & Psychological Services (CAPS) will provide crisis support services in person and via telehealth.

Helpful Resources:

AAMFT:

School Shootings and Family Therapy: Where Do We Go From Here?

Post Traumatic Stress Disorder Therapy Topic

Tips for Parenting During Times of Crisis

AAMFT Blog: Statement on Gun Violence Crisis

Other Resources:

Doing What Matters in Times of Stress: An Illustrated Guide 

What to say to kids when the news is scary

https://firstrespondertoolkit.com/

To share a resource with our community of MFTs, please contact us.

AAMFT and Medicare Mental Health Workforce Coalition Celebrate Passage of Medicare Coverage of MFTs and Counselors

AAMFT and the Medicare Mental Health Workforce Coalition honored key leaders involved in the passage of Medicare Part B Coverage of Marriage and Family Therapists at a special event and reception in Washington, DC on September 12.

The Mental Health Access Improvement Act, which was passed last year, will enable MFTs and MHCs to begin treating Medicare beneficiaries for their mental health conditions and bill for those services beginning January 1, 2024. This action was a major milestone for the advocacy and public policy efforts of AAMFT and our members around the country who have fought hard for inclusion in the Medicare program.

The event was held on Capitol Hill and attended by many representatives of the Medicare Mental Health Workforce Coalition, the key alliance supporting Medicare recognition of MFTs and MHCs, to honor key legislative sponsors of our Medicare bill. AAMFT is a key participant and founding member of the coalition.

Chris Michaels, CEO of AAMFT, said at the reception, “Tonight, I am again reminded of the many therapists, counselors, Medicare enrollees, association staff members, healthcare advocates, and Members of Congress and their staffs who worked so hard for so many years in order to ensure that Seniors have access to the valuable services that counselors and therapists provide.”

At the reception, Senator Debbie Stabenow (D-MI) was honored for her long commitment to securing Medicare Part B Coverage for MFTs and MHCs. Senator Stabenow was a lead sponsor of the Mental Health Access Improvement Act for several years. In accepting the award, Senator Stabenow highlighted the challenges of passing any kind of health-related legislation, especially during tough federal budget times.

She said, “Sometimes it takes a focusing event like a disaster or crisis which in this case was the Covid-19 pandemic to bring significant attention to the problem of mental health workforce shortages in Medicare.”  “Fortunately, we had the solution in hand through the Mental Health Access Improvement Act that had bipartisan support,” the senator said proudly. 

Senator John Barrasso (R-WY) was honored alongside Senator Stabenow at the event. Senator Barrasso was also a lead sponsor of the Mental Health Access Improvement over the last decade. He struck a similar tone as Senator Stabenow, saying “We know the public mood, comments from constituents and the like, and widespread media attention during the pandemic reinforced what we knew before the pandemic about mental health workforce shortages. The early warning signals were there before the crisis and we needed to take action.” Senator Barrasso said that significant mental health workforce shortages in Wyoming prevented people from seeking care and he is hopeful that the Mental Health Access Improvement Act will address the current situation in Wyoming.

Both Senator Barrasso and Senator Stabenow highlighted that we need to do more to improve access to mental health care for older adults. “More work needs to be done to address our workforce issues”, Stabenow said. Barrasso agreed, “We need to increase access to mental health, especially in underserved areas.”

For more information about Medicare and the resources available to prepare for its implementation, please visit the AAMFT Medicare Coverage of Marriage and Family Therapists page.

 

Foundation for the Advancement of Human Systems

Allow us to reintroduce ourselves! Have you heard of the the launch for Foundation for the Advancement of Human Systems (FAHS), formally AAMFT Foundation? Join the party by connecting with FAHS! Follow the FAHS on Twitter/IG (@Advancehumansys, and check out our website for impact (www.humansyst.org)

 

With a new mission and vision the Foundation for the Advancement of Human Systems is poised to advance healthy relationships for individuals, couples, families, and communities!

 

Mission: The Foundation for the Advancement of Human Systems (FAHS) exists to fund research focusing on healthy and strong human systems – individuals, couples, families, and communities.

Vision: Advancing healthy relationships for individuals, couples, families, and communities

 

Download FAHS Video

Breaking News on MFTs in Medicare!

AAMFT is thrilled to announce that the Mental Health Access Improvement Act (S. 828/H.R. 432), legislation that would allow MFTs, as well as MHCs, to serve as Medicare-eligible providers, has been included in the proposed omnibus package currently making its way through Congress. It is heavily anticipated that both houses of Congress will take action on this proposed legislation within the coming days.

As stated in the AAMFT Blog post from December 15, AAMFT and its allies have been advocating that Congress include the language from the Mental Health Access Improvement Act into the end of year omnibus spending package that Congress has been developing. We are pleased to report that the language from the Mental Health Access Improvement Act was included in the omnibus bill!

At over 4,100 pages, this massive omnibus bill will fund the federal government through the end of the current fiscal year, which ends on September 30, 2023. In addition to funding the federal government, this legislation also includes many policy provisions that change federal law. One of several changes to Medicare would finally allow MFTs and MHCs to serve as recognized providers under Medicare. This legislation would allow MFTs in private practice or other settings to become Medicare-eligible providers. The effective date for allowing MFTs to start serving as Medicare providers is a year from now – January 1, 2024.

 Below are a few FAQs concerning this legislation:

• Has this omnibus package been signed into law? - No, it has not. The Senate will first vote on this legislation. If it passes the Senate, the House of Representatives must vote on it, then it would be presented to President Biden for his signature.

• When should Congress pass this omnibus package? - Congress is expected to vote and send this legislation to the President by Friday, December 23. As of Tuesday afternoon, the Senate is expected to vote on this legislation on Wednesday, with the House voting on the legislation about a day after the Senate approves the package. Funding for the federal government will end on Friday evening if Congress does not act. Therefore, there is some pressure on Congress to act this week to prevent a government shutdown.

• Is passage of this omnibus package guaranteed?  -  No. Although a majority of Members of Congress are believed to support the omnibus package as it is now, passage of any legislation is not guaranteed.

• If this legislation is signed into law, when can I enroll as a Medicare provider and start providing services to Medicare beneficiaries? - Under this legislation, MFTs and MHCs would not be able to serve as Medicare-eligible providers and bill Medicare until January 1, 2024.  This delay is needed so that the federal government can make arrangements for MFTs and MHCs to serve as Medicare providers.

Please follow AAMFT through our social media pages and the AAMFT Blog to stay informed of the progress of this legislation. Please also consider sending a grassroots message to your Members of Congress urging them to pass the omnibus package as introduced.

Thank you in advance for advocating for MFTs as Medicare providers. Your messages and outreach to Congress in support of the Mental Health Improvement Act made the difference! Please contact us at [email protected] if you have any questions. 

Additional information:

Statement of Support from Finance Committee Chair Senator Ron Wyden (D-OR) for Mental Health Provisions in Omnibus Package

Statement from Energy and Commerce Committee Chair Frank Pallone, Jr. (D-NJ) and Health Subcommittee Chair Anna G. Eshoo (D-CA)  in Support of Healthcare Provisions in Omnibus Package

Description of Medicare Policy Changes in the Omnibus Package

Urgent: Please Contact Congress Now to Advocate for MFTs as Medicare Providers

This week, Congress is drafting a large end of year package that will fund the federal government through September 2023, as well as make some helpful changes to federal law. MFT advocates are pushing Congress to include in this package the Mental Health Access Improvement Act (S. 828/H.R. 432), legislation that would allow MFTs and MHCs to serve as Medicare-eligible providers. We need this package to include the MFTs in Medicare legislation. Please contact your Members of Congress today to advocate for MFTs as Medicare providers. 

Contact Congress Now 

As of December 15, high-level negotiations are taking place on Capitol Hill as to how to fund the government for the rest of fiscal year 2023. These negotiations will wrap up soon. If Congress decides to pass an end of year package, also known as an Omnibus funding bill, as opposed to a Continuing Resolution which simply continues funding levels from already passed bills, Congress COULD include other policy initiatives, such as the Mental Health Access Improvement Act. For this reason, we urge you to contact your Senators and Representative in Congress NOW and urge them to include MFTs in Medicare as part of the end of the year funding legislation.  

    

Background and Progress 

Introduced in 2021 as H.R. 432 by Rep. Mike Thompson (D-CA) and Rep. John Katko (R-NY) and as S. 828 by Sen. John Barrasso (R-WY) and Sen. Debbie Stabenow (D-MI), the Mental Health Access Improvement Act is a bill that would finally allow both  Marriage and Family Therapists and Mental Health Counselors to serve as independent Medicare Part B practitioners. This legislation would allow MFTs and MHCs to bill Medicare for providing covered mental health and substance use services to older adults and other Medicare beneficiaries.   

Since this legislation was introduced in early 2021, AAMFT and its allies in the Medicare Mental Health Workforce Coalition, who also advocate for passage of the Mental Health Access Improvement Act, have made substantial progress in advancing this legislation so that it could be eligible for inclusion in the end of year package: 

Support in the House of Representatives: Currently, 97 Members in the House of Representatives are cosponsoring H.R. 432, with strong bipartisan support. Earlier this year, the Mental Health Access Improvement Act was passed by a key House committee with jurisdiction over Medicare. On September 21, the House Ways and Means Committee met to discuss and vote to move several bills to the full House of Representatives, a process known as a committee markup. At this markup, the Ways and Means committee unanimously voted to move to the full House for consideration the Mental Health Access Improvement Act (H.R. 432). This vote was an important step in the process of moving this legislation forward. Legislation that has been approved by a committee is more likely to be considered in a larger package than bills that have not been considered by a committee. 

Support in the Senate: In the Senate, 34 Senators are cosponsoring S. 828, which is a record amount of support for any MFTs and MHCs in Medicare legislation in the Senate. In September, the Senate Finance Committee, which has jurisdiction over Medicare in the Senate, released a discussion draft of legislation to address mental health workforce needs and challenges. This draft includes legislation to add MFTs and MHCs as Medicare providers (S. 828), along with many other provisions to expand the behavioral health workforce. The release of this draft represents the most important action by the Senate in twelve years pertaining to adding MFTs and MHCs as Medicare providers. Please see this AAMFT Blog for additional information on the committee actions from September.   

Support from AAMFT Members and Allies: MFTs, as well as MHCs, other mental health providers, and allies, have been active and engaged in reaching out to their Members of Congress to advocate for the Mental Health Access Improvement Act. Thousands of email messages in support of this legislation have been sent by MFTs and MHCs to Congress. AAMFT members and other mental health providers have met with the offices of Members of Congress to advocate for this issue as well as AAMFT and its allies in the Medicare Mental Health Workforce Coalition. 

In addition, inclusion of the Mental Health Access Improvement Act in the end of year package is supported by a wide number of organizations besides associations representing MFTs and MHCs. Congress has received letters of support for including this legislation in the end of year package from groups as diverse as the Mental Health Liaison Group and the American Hospital Association. 

 

What You Can Do   

 Negotiations are occurring now to determine which bills make it into the omnibus, and it is unknown which bills would be included. These negotiations will end very soon, and a vote on the end of year package will occur next week. This is the best opportunity for passage of the MFTs in Medicare legislation in over twelve years. Therefore, it is imperative to contact your Members of Congress NOW to let them know that you want Congress to include the Mental Health Access Improvement Act in the end of year package.   

Finally, you can advocate for MFTs in Medicare by sending a message to your Members of Congress through AAMFT’s grassroots advocacy platform. If you have friends, family or colleagues who are also constituents of your Member of Congress, they can use this grassroots advocacy platform to send a message advocating for MFTs in Medicare. If you wish to send a more personalized message to your Members of Congress, use this link to find your Members of Congress and click on their profiles to find their D.C. office contact information.  

 

Thank you in advance for advocating for MFTs as Medicare providers. Please contact us at [email protected] if you have any questions.   

The Respect for Marriage Act – The MFT Perspective

Just last week, the Respect for Marriage Act passed in the House 258-169, marking an incredibly historic moment for not only the country, but also for marriage and family therapists. The first version of this bill was originally introduced back in 2009 and was reintroduced into Congress this past summer. The revised version still included protections for same-sex marriages, but now extends protections to interracial couples. The Senate previously passed the bill in November. 

The bill is on its way to Biden’s desk, which he says upon House passage of the bill, President Biden said he “looks forward to signing into law” this landmark legislation. Biden writes, “The House’s bipartisan passage of the Respect for Marriage Act—by a significant margin—will give peace of mind to millions of LGBTQI+ and interracial couples who are now guaranteed the rights and protections to which they and their children are entitled.” Biden signed the bill yesterday afternoon during a large celebration at the White House, marking a huge step forward for the field of marriage and family therapy.  

This past year, the Journal of Marital and Family Therapy (JMFT) released its Decade In Review– a special issue released every ten years that reviews what the past 10 years of systemic therapy research has to say about various topics within the field. This review included a special article on how couple and family therapy research can reduce mental health disparities for racially and ethnically diverse populations. The article reviewed research surrounding minority, interracial and LGBTQI+ couples, advocating for their inclusion in systemic therapy research and studies in order to advance the field.  

LGBTQI+ individuals are already more likely to struggle with issues like depression and anxiety, due to the stigmas and discrimination they face. Similarly, interracial couples face issues with stereotyping, isolation, negative comments, and rejection, which can often lead and contribute to mental health issues. These mental health concerns impact more than just the individual– they affect the entire family, marriage, and relationship structure. Thus, marriage and family therapy can help address and resolve these issues from a systemic perspective, mitigating any stressors or implications they may cause in marriages.  

JMFT’s Decade in Review article on mental health disparities noted that only 68 of the 271 (25%) articles they examined included predominantly racial/ethnic minority samples or globally underserved populations. Among the 60 relevant articles examined, there was a pattern of inattention to methodological considerations relevant to diverse populations. LGBTQI+ and interracial couples deserve to have the mental health and marriage therapy resources they need to maintain healthy relationships. The passing of this bill is just the first step towards including, accepting, and appreciating LGBTQI and interracial couples, both inside and outside the therapy room. 

Significant MFTs in Medicare Action by Congress This Week

This week, both the U.S. House of Representatives and the Senate have moved forward with legislation to add MFTs, as well as counselors, as Medicare-eligible providers!

House of Representatives: On Wednesday, the House Ways and Means Committee met to discuss and vote to move several bills to the full House of Representatives, a process known as a committee markup. At this markup, the Ways and Means committee unanimously voted to move to the full House for consideration the Mental Health Access Improvement Act (H.R. 432) – legislation that would add MFTs and MHCs as Medicare providers.

This vote is an important step in the process of moving the Mental Health Access Improvement Act through Congress. AAMFT would like to thank Representatives Mike Thompson (D-CA) and John Katko (R-NY) for sponsoring H.R.432. In addition, we greatly appreciate Representative Thompson’s efforts, as a member of the Ways and Means Committee, to move this legislation forward and to speak so strongly in support of H.R. 432 during Wednesday’s hearing. In this markup on Wednesday, the legislation to add LMFTs and LMHCs as Medicare providers (H.R. 432) passed in a package along with four other bills related to mental health and substance use disorder treatment.

Senate: In addition to action by the House Ways and Means Committee this week, the Senate also took action in support of S. 828, the Senate version of the Mental Health Access Improvement Act. On Thursday, four members of the Senate Finance Committee released a discussion draft of legislation to address mental health workforce needs and challenges.  Released by Committee Chair Ron Wyden (D-OR), Ranking Member Mike Crapo (R-ID), Senator Debbie Stabenow (D-MI) and Senator Steve Daines (R-MT), this draft includes legislation to add LMFTs and LMHCs as Medicare providers (S. 828), along with many other provisions to expand the behavioral health workforce.

The release of this draft represents the most important action by the Senate in twelve years pertaining to adding LMFTs and LMHCs as Medicare providers. AAMFT would like to thank Senator John Barrasso (R-WY) and Senator Stabenow for sponsoring S. 828. We would also like to thank Senator Stabenow and the other three Senators for all of their work on this discussion draft.

This is the third discussion draft released by the Finance Committee, as the Committee previously released drafts pertaining to telehealth and youth mental health. As mentioned in an AAMFT Blog article earlier this year, the Finance Committee started soliciting comments a year ago from stakeholders to gather information on legislative proposals that will improve access to healthcare services for Americans with behavioral health disorders.  AAMFT and many other organizations submitted comments.

In addition to the inclusion of MFTs and MHCs as Medicare providers, this discussion draft, known as the Behavioral Health Workforce of the Future Act, would make many other significant changes to enhance the mental health workforce, such as funding 400 additional Graduate Medical Education slots for psychiatry residencies, updating Medicare coverage for licensed clinical social workers, and allowing psychologist trainees to provide services under the general supervision, as opposed to the direct supervision, of a licensed clinical psychologist. Of particular note, this draft would expand the current Medicare Health Professional Shortage Area bonus program to increase bonus payments for psychiatrists who practice in shortage areas, as well as for the first time allow for MFTs, MHCs, psychologists, clinical social workers, and other non-physician providers to receive bonuses when they provide services to Medicare enrollees while practicing in health professional shortage areas. This provision is the first legislative text ever introduced that would allow LMFTs and LMHCs to receive these particular bonus payments when providing those services.

Next Steps:

The next step for this legislation in the House of Representatives would be to have a vote by the full House to pass H.R. 432. Since Congress is not in session for much of October, any such vote would likely not occur until after the midterm elections on November 8. AAMFT and its allies will be encouraging the Senate to move forward on this discussion draft and other behavioral health proposals.

AAMFT would like to thank all Family TEAM members, other AAMFT members, and their allies and friends who have submitted grassroots messages to Members of Congress in support of the MFTs in Medicare legislation in both the House and Senate. These messages have led to Members of Congress supporting this important legislation.

Do you want to help continue the momentum? Please thank your Members of Congress in the House and Senate who have supported adding MFTs as Medicare providers. If you have not already done so, you can advocate for MFTs as Medicare providers by sending a message to your Members of Congress through AAMFT’s grassroots portal urging your Members of Congress to support MFTs as Medicare providers. AAMFT has also created a special grassroots message that friends and family of AAMFT members can send to their Members of Congress to advocate for this vital legislation. Please contact us at [email protected] if you have any questions.

House Ways and Means Committee’s press release on passage of H.R. 432 and other healthcare bills

Representative Mike Thompson’s press release on H.R. 432

Senate Finance Committee’s press release on mental health workforce discussion draft that includes S. 828.

Summary of the Behavioral Health Workforce of the Future Act Senate Finance Committee draft.

Proposed Rule Allows MFTs Greater Flexibility in Providing Care to Medicare Beneficiaries Under Supervision

On July 7, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for changes starting in 2023 that would expand access to behavioral health services and allow some LMFTs more flexibility in treating Medicare enrollees. Every year, CMS releases a rule, known as the physician fee schedule (PFS), which makes changes to fees CMS pays to Medicare providers and other administrative changes through rulemaking that CMS is proposing for the coming year.

Change to the Medicare “incident to” rule

CMS is proposing several changes to Medicare’s rules pertaining to behavioral health, including one major change pertaining to providing incident to services that impacts MFTs. Under current regulation , an LMFT or LMHC could provide services to Medicare beneficiaries “incident to” the services provided by a physician or other qualified supervising provider (usually a psychologist) if the LMFT or LMHC is under the direct supervision of the supervising physician or other supervising provider. Under Medicare’s current rules , “direct supervision” means that the physician or other supervising provider must be in the same office suite and be immediately available to furnish assistance and direction when the LMFT is providing services to a Medicare beneficiary.

Under the proposed rule, CMS would allow LMFTs and other qualified professionals to provide behavioral health services under the “general supervision” of a physician or other qualified supervising provider. Under the general supervision standards , an LMFT’s incident to services to a Medicare enrollee would be under the overall direction and control of the physician or other supervising provider. However, the general supervision requirements do not require the supervising practitioner to be in the same office suite as an LMFT when the LMFT is providing behavioral health services to Medicare beneficiaries. CMS believes that removing the direct supervision requirement will allow an increase in the utilization of behavioral health services by older adults and other Medicare beneficiaries.

This change, if adopted, will result in additional services to Medicare enrollees starting in 2023. However, due to overall restrictions in federal statute preventing the full and proper utilization of MFTs and MHCs as eligible providers, this change will likely not have a significant impact on the ability of Medicare enrollees to receive necessary behavioral health services or result in a significant increase in the number of LMFTs providing incident to services As most licensed behavioral health providers practice in settings where they are not employed by or working directly with physicians or other qualified supervisors, most LMFTs will not have an opportunity to utilize these new flexibilities. Many potential supervisors might not have the time or the ability to provide general supervision under the incident to standard. Other restrictions also make it difficult for this change in the incident to rule to have a significant impact on behavioral health access for most Medicare beneficiaries. The proposed rule would still not allow Medicare to directly reimburse LMFTs and would still not allow LMFTs to directly bill Medicare for services provided to Medicare enrollees.

Impact of the “incident to” rule change

AAMFT supports the expansion of the overall ability of MFTs and other behavioral health providers to provide incident to services to Medicare enrollees under the general supervision standard. The federal government’s support for expanded access to behavioral health services is reflected in President Biden’s budget for Fiscal Year 2023 , which, if adopted, would provide the largest amount of federal financial support in history for mental health services, and would modernize Medicare mental health benefits by allowing LMFTs and LMHCs to serve as Medicare eligible providers. Under the current CMS Behavioral Health Strategy , one goal is to improve access to and quality of mental health care and services.

AAMFT applauds CMS for doing as much as this agency can under federal law to improve access to behavioral health services for Medicare beneficiaries. In the proposed rule, CMS is doing all that can be done under current federal law to allow MFTs to provide services to Medicare beneficiaries, as CMS clearly states that it does not have the authority to add LMFTs and LMHCs as Medicare billable providers. Since only Congress can change federal statute to add LMFTs as providers eligible for direct reimbursement by Medicare, it is critically important that Congress pass the Mental Health Improvement Act of 2021 (S. 828/H.R. 432). If you have not already done so, please contact your Members of Congress now to urge them to pass the Mental Health Access Improvement Act.

The full text of the proposed rule can be found here . AAMFT will be providing public comments by September 6 to CMS regarding this proposed rule. Please contact AAMFT at [email protected] if you have any questions.

Advocating for MFTs as Medicare Providers: Spring 2022

In recent weeks, many members may have noticed an increase in communications from AAMFT encouraging MFTs to contact their Members of Congress and post on social media in support of legislation that would allow MFTs and MHCs to finally become Medicare-eligible providers. During the week of May 16^th, AAMFT will be engaging in the third Virtual Action Week since February to provide a coordinated effort for MFTs and their friends, family and allies to contact their Members of Congress to support the Mental Health Access Improvement Act (S. 828 and H.R. 432). AAMFT is participating in this Virtual Action Week campaign with other associations who are also members of the Medicare Mental Health Workforce Coalition, the coalition that advocates for passage of this important legislation. 

Members might be wondering why AAMFT and other organizations are engaging in this advocacy push. The answer is that Congress is now focusing on the ongoing behavioral health crisis. There is now some momentum for legislation to add MFTs as Medicare providers: 

• Support: As of May 12, the House version of the Mental Health Access Improvement Act (R. 432) has 74 Members of Congress who are cosponsoring this legislation while the Senate version of this bill (S. 828) has 26 cosponsors. This is a strong level of support. 

• Inclusion in President’s Budget: On March 28, President Biden released his budget for Fiscal Year 2023, which included a recommendation to Congress to include MFTs and MHCs as Medicare-eligible providers. This is a significant development, as the inclusion of this request in President Biden’s budget makes it more likely that some Members of Congress will agree to cosponsor the Mental Health Access Improvement Act. It is also the first time a president’s budget has recommended that Congress add LMFTs as Medicare providers.

• Senate Action: Last fall, the Senate Finance Committee, the committee with jurisdiction over Medicare, solicited comments from stakeholders on legislative proposals that will improve access to healthcare services for Americans with mental health and substance use disorders. AAMFT and many other organizations responded to this request by advocating for the inclusion of MFTs and MHCs as Medicare providers. In March, the Finance Committee released a report summarizing the major findings from these responses and outlining a case for the federal government to address this mental health crisis. This report stated that MFTs and MHCs make up 61% of the total rural mental health workforce yet are not recognized as eligible Medicare providers. The Finance Committee is expected to release a comprehensive behavioral health legislative package for consideration by Congress this summer.
   

In light of this current effort to address national behavioral health challenges through legislation, we urge members to post on social media and email your Members of Congress in support of including MFTs and counselors as Medicare-eligible providers! AAMFT has also created a special grassroots message that friends and family of AAMFT members can use to send to their Members of Congress to advocate for this important information. These efforts increase the likelihood that other Members of Congress will agree to cosponsor the MFTs in Medicare legislation.    

Please contact [email protected] if you have any questions.