by
Joseph Peters
| Sep 22, 2022
Dania Lofton:
Welcome to the Voice of Counseling from the American Counseling Association. Today is a special episode of the podcast. I'm Dania Lofton, Government Affairs specialist with the American Counseling Association. And with me today is Brian Banks, our Chief of Government Affairs and Public Policy officer for the ACA. Here's a little bit of information about Brian. He's not only the Chief of Government Affairs and Public Policy officer for the American Counseling Association, he has over 20 years of Government Affairs experience where he has worked for NGOs, the United States Air Force, Congress, and for-profit organizations.
His resume boasts a variety of experiences, where he has focused on issues ranging from healthcare, education, tax policy and healthy food access and the environment. Brian earned his bachelor's degree in communication studies, where he focused on business communication, and he earned his Master of Arts degree in politics with a focus on congressional studies from the Catholic University of America. Brian is a native of Washington DC, and in his spare time he enjoys traveling, cooking, and spending time with his family. Welcome, Brian.
Brian Banks:
Thank you, Dania. It's awesome to be here.
Dania Lofton:
Can you tell us briefly about the history of the work to get licensed professional counselors, as well as marriage and family therapists approved to be able to see clients who have Medicare health insurance?
Brian Banks:
Absolutely. First, let me tell you this. What we're discussing today is the Mental Health Access Improvement Act. That is H.R. 432 in the House of Representatives, and S.828 in the Senate. When you think about this bill, you really have to look back to the 107th Congress. You'll hear a lot of people say that this bill has been around about a decade. It's really been longer than that. It was first introduced in the 107th Congress. And the reason it was introduced then was that there's outdated language within Medicare coverage that limits access to individuals that need mental health services. These individuals are older Americans, senior citizens, some would say, the disabled. And it also allows a veteran's choice when seeing a mental health professional, such as a licensed professional counselor, as well as a marriage and family therapist. 40% of the mental health workforce are LPCs and MFTs.
That's about 225,000 people across this nation, which includes our US territories. This bill has passed before, but never at the same time in the House and Senate. So in the 108th and 109th Congress, the bill passed the Senate, but not the House. And then the 110th and the 111th, the bill passed the House, but not the Senate. So we've been working very hard to get some things done.
One thing I will tell you, our members, the members of ACA, as well as counselors across the nation, have worked very hard to advocate on this bill. About a year and a half ago, the Support Act was amended, which allowed licensed professional counselors working in federal substance use disorder centers and rural health clinics to provide services to Medicare clients. So the proof is in the pudding. Congress and CMS sees that our counselors are valuable and they are serving Medicare clients, but not at the level they need to.
Dania Lofton:
You spoke on this a little bit already, but can you tell us a little bit more on why this initiative is so important and how has the inability to take Medicare contributed to the provider shortage, as well as the impact on the careers of professional counselors?
Brian Banks:
Okay. Absolutely. Well, first, our country is in a mental health crisis. We were in a mental health crisis prior to COVID and the need has grown ever since. We have people across the nation, whether they're in rural areas, suburban areas, or the city areas, that do not have access to care, simply because there are professionals out there that cannot serve them based on the regulatory language by CMS. Currently, CMS is proposing a rule to change the language. This is at the full authority of CMS, but this change only really... Let me back up. This change will not affect the majority of the counselors in our nation. The majority of our counselors are individuals that practice independently. They're not working in the federal centers or the rural health clinics. Most are in the hospitals. So the incident to change within CMS billing rules will not affect many counselors.
Historically, counselors are highly trained individuals. They're trained very similar to social workers, with the exception of counselors actually who have more clinical training, which allows them to work with clients in a more productive manner when it pertains to talk therapy. When you look at the bills and you look at what we are doing at ACA, we're working with the House Energy and Commerce Committee, the House Ways and Means Committee, House Senate... I'm sorry, excuse me, the Senate Finance Committee, as well, to make sure they are educated and empowered on how this bill will affect their constituents in their states, so they see the benefit to the bill.
ACA has partnered with the Medicare Mental Health Workforce Coalition. There are about 20 groups in there that includes the Center for Medicare Advocacy, the American Association of Marriage and Family Therapists, Centerstone, American Mental Health Counselors Association, and the Michael J. Fox Foundation, to name a few, were strategically working together to push this bill forward.
What we're doing different over the past two years is making sure that constituents of members on Capitol Hill are meeting with their Congress people, they're meeting with the health staff, to really explain to them why this bill is important. If this bill passes today, we can expect in a year or two, 115,000 estimated counselors to actually become Medicare providers. The majority of these counselors are in rural areas. The rural areas of our country lack access, but where access lacks, there are counselors there. So it would make a huge impact in the rural areas, as well as the suburban areas across our country.
Dania Lofton:
That's great. And you talked about us moving this bill forward and earlier you said that it was first introduced during the 107th Congress. And right now we're currently in the 117th Congress. Can you tell us where we are in the process of having Congress pass the law to allow LPCs and MFTs to enroll as Medicare providers?
Brian Banks:
Awesome question. Well, let me tell you this. In the House of Representatives we currently have 93 co-sponsors. In the Senate we have 31 co-sponsors. For this particular bill to pass in the Senate, we're going to need 60 senators to vote yes. In the house, we're going to need 218 representatives to vote yes. We are in the process now of working with Congress to ensure that they can vote right. What does that really mean? What has ACA done?
Well, in August of 2021, Congress came to us and said, "Hey, we don't have any information on the impact of beneficiaries. What can you tell us? What statistics are out there?" And the answer was, "Mr. and Mrs. Congressman, there are no statistics because the LPCs are not included, but we can show you exactly how this would work." So we did a brief for Congress, which focused on the impact of beneficiaries, the experience of counselors, as well as make policy recommendations to Congress.
It was well received and allowed us to bring on more sponsors. This year, Congress said to us, "Hey, this is great. We have a lot of good information, but can you tell us how many LPCs will actually enroll in the program? And also tell us how many LPCs and MFTs will not enroll in the program?" Again, we don't have that information. So ACA took it amongst ourself to do a national survey. We reached all 50 states, as well as three territories, US territories, to receive information. And we determined that we would have 115,000 people that are counselors enroll in the program. This means there's a huge chunk of people that will not enroll in the program as Medicare providers. It's not necessarily because they don't want to be Medicare providers, but in some cases they're not trained to work with the older population. It's not what they do.
In some cases, they look at the reimbursement rate and say, "Hey, it's too low so I don't want to enroll in the program." And there's other reasons out there, as well. But we know from the work that we've done at ACA, that we can expect 115,000 people to enroll as Medicare providers. That's a huge, huge number. So where are we now with getting this bill passed? That's the question everyone wants to know. I don't have a crystal ball, but what I tell you is that we're looking at Congress, in September or October of this year, to really take a hard look at these bills, to discuss them within committees and hopefully pass them out of committees to a full Senate and House vote. If the bill passes out of the committees and it goes to a full vote and it passes, it goes to the President's desk and the White House administration can sign... The President of the United States can sign the bill. And all of a sudden, yes, we have a law. Counselors and marriage and family therapists are now eligible providers within Medicare if they enroll into the program.
Now, that sounds pretty simple, maybe, but once this bill passes, and it will pass eventually, hopefully in this Congress, when this bill passes, it's going to be a year and a half, two year wait before people can actually enroll into the program, because there's a lot of technical issues that CMS and the federal government have to take care of in order for people to effectively enroll and serve consumers. We're getting close. ACA is doing our best effort to get there, but we need counselors to stay involved, to work with us, not just with us, but to work with their Congress people, to work with their legislators at home and on Capitol Hill to ensure we can move this bill to passage.
Dania Lofton:
That's exactly right. We do need our members and supporters of the counseling community to speak with those members of Congress, state legislators, and really and truly anyone who'll listen. What are some resources that the ACA provides to help counselors and other supporters do this, advocate for this bill and other pieces of legislation that the ACA may be working on?
Brian Banks:
Another great question. And Dania, you know this all too well. We have a ton of resources on our website. We reach members through the Counseling Today magazine. We have social media. But the reality is we understand at ACA that sometimes you may not have time to read the Counseling Today or to view our social media. The good part is we have an awesome website, the Government Affairs portion of our website, where we provide a lot of resources, and Dania, I want you to help me with this list that I'm going to give out today, because you may have some to add.
Within our website on the Government Affairs section, we have talking points to legislators. We have an awesome advocacy tool kit that explains the why's and how's of advocacy. So it's pretty much a step-by-step guide on how to work with your legislators, not just on Congress, but in state legislatures as well. You can see a list about federal bills of interest. We focus on more than just Medicare so it's really important to look at that list, to see that we're working with everything from the VA to school counselors, to rehab counselors, to counselor educators. The list goes on, career counselors. So you can see all of that information there and see exactly where bills are.
We have links that go to our federal issues and our state issues and you can go there and you can see just about everything that we're doing and the progress that we're making. Also, extremely important. All those resources are great, but you may get in and it may be overwhelming at times. Give us a call, reach out to us, email us at advocacy@counseling.org, let us know what's on your mind and we'll get back to you so we can help support your needs and the needs of this profession. So those are some are our resources. Dania, did you have any that you want to share with the listeners?
Dania Lofton:
Listen, I echo everything you just said. I want to make sure that that advocacy update that's in every CT, Counseling Today, magazine that comes out every month, make sure that our members are reading it, share that information. We've also got LinkedIn, our social media channels, Facebook. That will also provide tips and really direct you back to our website, which has all the information you just listed.
Brian Banks:
Can I add one more in there?
Dania Lofton:
Mm-hmm.
Brian Banks:
Because you reminded me, the YouTube channel Counseling Views. People should check that out. You can go on our YouTube channel. You can see our congressional briefing that took place this year on Medicare. It was an awesome briefing with great experts from Capitol Hill, as well as we had one senior, Ms. Darla York from Miami of Ohio, Miami County of Ohio, Miami of Ohio is a university, that spoke on the importance of Medicare reimbursement. We need more people like Darla York to speak up, to speak out and to tell their stories to the legislators.
The biggest resource we have is your story. So please help us in telling your story. And if you do not know how to reach your member of Congress, you just call on the members of the Government Affairs team, email us at advocacy@counseling.org, or just call us, 1-800-347-6647, ask for a member of the team and we'll be happy to help you.
Dania Lofton:
What we're talking about right now is the power of grassroots advocacy, how that will help us to move this legislation and other pieces of legislation and policies across the finish line. So what are some other ways that people can join in on ACA's grass root efforts to get the Medicare bill passed, and again, any other piece of legislation that we're focusing on?
Brian Banks:
A very simple way is to, again, go through our website and look at our action alerts on voter voice. You can just go to the website, click on our action alert page. The action alerts will pop up and you can literally sign up. So when you sign up, when the action alert is issued, it will come directly to your email and you can go on and take two, three, maybe five minutes at the most and actually respond to an action alert. It's this one letter that you're sending off. It's pre-written. Members can add in their own stories. And when you send that one letter, it goes to three members on the Hill, two representatives, and one senator. We use the same process with our state legislatures, as well. That's one easy way to do it.
On that same page is a story collection where you can skip there, get on and actually tell us your story. How is not being a part of Medicare, or any program, affecting you? What's working and what's not working? We use those stories with legislators so they can get a real view of what, of how, I should say, people are being negatively affected by some of the policies that are not updated within our law.
Dania Lofton:
Now, Brian, when people send these messages to their members of Congress or their state legislators, are they going to hear back from the offices? Are they going to hear back from their member of Congress? Speak a little bit more about that, please.
Brian Banks:
Yeah. Yeah. Here's what I want you to understand. When you write a member of Congress, as a constituent, you're going to hear back. Now, some members of Congress have a very generic form letter that they send you. Others will actually have their health LA's or the person working on the issue that you care about draft a letter to you to answer specific questions. When you send a letter to Capitol Hill, they are reviewed.
Now, here's what I'm going to tell you. I want to be completely honest with the listeners. They may not read every letter line by line, but they're going to look at the topic that you're writing on, they're going to look at if your four or against it, and they're going to put a checkbox and continue to track that and they're going to file your letter away. So they're going to have it to go back and to refer to, and if something stands out within that letter, within your story, there's a great chance that sooner or later they're going to contact you for more information.
I would say this. When you send a letter, you're going to receive a response which you should always follow up. Give them a call, find out who the health legislative assistant is. ACA can help you find that person within a matter of seconds. Get in contact with that person, have a conversation with them, let them hear your voice and let them know that you're a real person that is in need. It's extremely important when we advocate in our issues that we just don't make it about the counselor. We make it about the constituents. There's more constituents than counselors.
So if we can show a vast amount of people that need help and assistance, the light bulb will go on to the health LA's, that it's not just about a person and their job and making more money. That's a big part of it. No doubt about it. But it's also about helping some of the most vulnerable people in our country that just want to live productive lives and that need a little extra help.
I think, personally and professionally, I think that's okay. And I think that we have the ability to make change with our advocacy. This team at ACA can help you, but we definitely need your help. So always rely on us because we definitely will rely on you, and calling you for helping assistance.
Dania Lofton:
Just want to go back and kind of hone in on this a little bit more. When I send a message to my member of Congress, my member of Congress is going to specifically... Am I going to speak to that member of Congress or is it going to be somebody in their office, and does it matter who I speak to? What's more important?
Brian Banks:
Good question. Awesome. When you send a letter, here's what's going to happen. Brian Banks sends a letter to Congresswoman Lofton. Congresswoman Lofton's letter goes into her office and there's going to be Health Legislative assistant that is responsible for my issue who will review that letter, or the letters that come in. That person will then make sure that you receive a response. It may be this person directly responding to you. It could be a correspondence director or coordinator within an office that will respond to you.
But at the end of every week, or whenever the congressperson decides, they're meeting with their staff and their staff are talking about these issues and they're going to give account of, "Okay, this is the Mental Health Access Improvement Act." Maybe it's on the Senate side, so it's 828. "We've had 30 letters this week and here's what people are saying and here's what the theme is. We really need to look into this." So when you hear back, it's going to be from the office. The letters going to be addressed from the member that is in that office. That member may not enter to get it to you, but they are aware of what's happening. They're meeting with their health LA's and other people in the office to get the education and empowerment they need to make informed decisions on these bills.
Now, the reality of it is, the person that you're going to meet with if you make a phone call or schedule a meeting's, it's going to be the person that's responsible with that issue. There's a chance that the congressperson will be available to sit in that meeting, but they're very busy so they rely on their staff to guide them. You really want to speak to the staff members.
But I'll say this, congresspeople, the majority of them, they go home on the weekend. They have events. Find out where those events are in your community. Attend those events, ask a question, ask any question, make yourself known that they stay behind when the event's over to shake hands and to meet their constituents. Talk to them. Allow them to get to know you. So when an issue comes up, they can go, "Oh, I know this expert. Let me call on person X. They can help me." Make yourself known, become a friend of that member as much as possible so they know that they have an expert in their community that can help them with the issues that matter most to their constituents.
Dania Lofton:
Thanks. A lot of times what we'll see is that members, ACA members, will send those messages to their members of Congress. And like you said, you're going to get that letter back and it's going to request a meeting. So it's either going to say, "Hey, let's meet to talk about whatever your issue is virtually or in person." Are all of these meetings going to always be in Washington, DC. Tell me a little bit more about that.
Brian Banks:
Great question. The answer to that is, no, all the meetings will not be in DC. You do not have to put on your Sundays best and hop on and plane and come to the nation's capital. The members of Capitol Hill and their staff are accessible by email and by phone. And they're happy to speak to you, especially by phone. And they'll do Zooms as well, on occasion, where they can actually see your face and have an opportunity to speak with you. So you don't have to do it in person at all.
They understand that their constituents are back home. They can be in Wyoming or California or Hawaii or Guam or Puerto Rico. And it's not that easy to just hop on a plane and have a 15 minute conversation. And keep in mind, when you are meeting in person, your conversation could be limited to just 10 or 15 minutes. So you want to make sure that you're organized. You want to make sure you let them know what the issue is, why it's important to the constituents. You want to let them know how this is going to benefit the district.
And before you leave, you need to ask them. Ask them. Tell them exactly what you need them to do, and then follow up with them with a thank you letter and then follow up with them again, maybe 30 to 45 days later to check to see what the status of the bill is or if they need anything else from you. Is that the answer to your question?
Dania Lofton:
You said that occasionally the members will come back to their districts. Are there district offices as well as the Washington DC office?
Brian Banks:
Yes. Yes. Here's the thing. The district office, it's not always accessible, as well. Some states are very large, like Texas or Alaska's large and rural. So the district office is there. So you may not always to get there, but you can always develop a relationship with the district office. Go into the member's webpage. The content information to the district office is there. Side for alerts from the member, whether it's through social media or email and you'll receive information on what's happening in the district office, as well as the Capitol Hill office.
The district office primarily is there to focus on the local issues at home, not necessarily the federal issues. However, it's important to develop that relationship, express concerns with federal issues with the district office, because they will communicate to the office on Capitol Hill to make the member aware of what's going on. Because when that member goes home, he or she, they want to hear from their constituents, and it's very, very important that they understand the issues and so they'll reach out to you.
There could be all kind of opportunities to speak to your member, whether it's just a fireside chat or whatever it may be. Opportunities are out there to speak to your members. Call them, talk to them. When I say them, I'm talking about the district office and the Capital Hill office. Build those relationships, make your name known, make your background known and make yourself available to the people within those offices because they will call on you for support on issues when they come up. Trust and believe they will call on you.
Dania Lofton:
Thank you. So look, it's not possible for us to talk about all of the functions of Congress and all of the pieces of Medicare and all the other pieces of legislation that ACA's currently working on. I do want people to know where they can learn more or how ACA members can get in touch with our Government Affairs team if they want to have that full-on conversation.
Brian Banks:
Yeah, yeah. So to get in touch with us, it's advocacy@counseling.org, that's A-D-V-O-C-A-C-Y @counseling.org. You can give us a call. 1-800-347-6647. And I'll repeat that. The number is 1-800-347-6647. That's how you reach us. We'll help you get in touch with your members on Capitol Hill, as well as your state legislators if you need that help. If you just have questions for us, that's how you reach us. We're happy to answer your questions.
We receive a lot of emails from our members and counselors across the country, so the only thing I ask of members is just to give us about a couple days, 48 hours, to give back to you. If it is urgent and you need to speak to us, give us a call. There's five members of our team. We're available to help you. When you look at resources, again, the website is there. Navigate to the Government Affairs website and you'll find just about everything that you need, from the toolkit to state issues and federal issues.
We have a page dedicated to Medicare reimbursement that you can review all of the resources there, everything from our briefing materials, sorry, to the issues that we have on our YouTube page. When you meet with your members, this is a reminder, you're the expert so tell them your story. Relate it to your district and state, make an ask, and explain the benefit of the ask. It's extremely important that you do that. And back to YouTube, very important. You can find us on Counseling Views, and to receive YouTube information on the latest briefing that we had on Medicare reimbursement.
Dania Lofton:
All right. So listen, this wouldn't be a true Government Affairs conversation about advocacy if we did not end it with a call to action. Brian, please give us a call to action.
Brian Banks:
Awesome. Dania, you're doing an awesome job. So listen, everyone that is listening to this, whether you're an ACA member or not, go to www.counseling.org. Go to our website, the ACA website. When you get to the website, click on the Government Affairs tab, go to our Action Alerts, Voter Voice, sign up, sign up today. After you sign up, there may be five or six action alerts there, complete every single one of them. All right? One of those action alerts is going to be on Medicare reimbursement. Another that is there is going to ask you to tell us your story.
Take advantage of that. If you don't want to go through the process of writing out your story, give us a call. We'll listen to you. We'll draft your story. We'll make sure members on Capitol Hill receive your story. When you go online to Voter Voice, through our Action Alert, Mental Health Access Improvement Act, H.R. 432, S. 828, respond to that alert today. We need people to respond.
The month of September is extremely important. The more people that we can get to respond will help our bills move to the finish line and become law and allow counselors to become Medicare providers. The time is now, the stove is hot, and so we need to make sure that we take action as soon as possible. If you have questions, call us. We're here to help you.
Dania Lofton:
All right. Listen, this legislation is critical to getting more people the care they need and every voice, every email, every phone call makes a difference. Please join us as we make a strong push for allowing professional counselors and marriage and family therapists to work with clients who have Medicare insurance. Be sure, again, to subscribe to the Voice of Counseling on Apple and Google Podcasts and follow ACA on social media to stay up to date on advocacy alerts and updates to Medicare progress. To join the ACA and get exclusive access to the member benefits, check out counseling.org. Thank you, Brian, for joining us today.
Brian Banks:
Thank you, Dania.
Audio:
And thank you all for listening with us today. We hope everyone has a great day.
Dania Lofton:
ACA provides these podcasts solely for informational and educational purposes. Opinions expressed in these podcasts do not necessarily reflect the view of ACA. ACA is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information and resources provided in this program. This program is copyright 2022 by the American Counseling Association. All rights reserved.