THE SENIORS MENTAL HEALTH ACCESS IMPROVEMENT ACT OF 1999 -- HON. NATHAN DEAL (Extensions of Remarks - September 24, 1999)

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HON. NATHAN DEAL OF GEORGIA IN THE HOUSE OF REPRESENTATIVES FRIDAY, SEPTEMBER 24, 1999

Mr. DEAL of Georgia. Mr. Speaker, I rise today to introduce Seniors Mental Health Access Improvement Act of 1999. I urge support of this important legislation to address the mental health needs of our nation's elderly population.

According to the National Institute of Mental Health (NIMH), nearly 2 million Americans over the age of 65 suffer from depression. Timely and appropriate access to mental health services is a critical component in depression treatment and suicide prevention. Unfortunately, many of those two million older Americans do not have access to appropriate mental health services or, if they do have access, the mental health provider available to them is not covered by the Medicare program.

Failure to treat depression has devastating consequences. It is a national tragedy that one of the highest rates of suicide in the United States is found in white males over the age of 85. Depression is treatable and suicide preventable if we make mental health services more readily available to the Medicare population. The legislation Representative STRICKLAND and I introduce today is an important step in the battle to improve mental health services access for older Americans.

The Seniors Mental Health Access Improvement Act would authorize Medicare Part B coverage of marriage and family therapists (MFTs). For many years, the Federal Government has recognized a core group of mental health providers. The five groups of professionals are: psychiatrists, psychologists, social workers, psychiatric nurses, and marriage and family therapists.

When assessing the availability of mental health services, the Federal Office of Shortage Designation (OSD) determines the availability of each one of these health professionals when determining whether a community should be considered a Mental Health Professional Shortage Area. According to OSD, nearly 50 million Americans currently reside in areas designated by the Federal Government as a Mental Health Professional Shortage Area.

Unfortunately, while many older Americans may live in an area the Federal Government has determined to have an adequate supply of mental health professionals, the reality may be something quite different. You see, Mr. Speaker, of the five core mental professionals I mentioned earlier, all but one are covered by the Medicare program. Marriage and family therapists are the only mental health professional not recognized by Medicare.

The Seniors Mental Health Access and Improvement Act seeks to correct this oversight Many may hold a common misconception that marriage and family therapists only deal with marital strife or family communication problems. In fact, like psychologists and social workers, marriage and family therapists provide a full range of mental health services. When you examine the state laws governing social workers and marriage and family therapists, my colleagues will find that the education and training criteria for licensure as a social worker is often identical to the requirements for licensure and certification as a marriage and family therapist. In other words, like social workers, marriage and family therapists are educated and trained to diagnose and treat those mental disorders and services currently covered by the Medical program.

Currently, 42 states license or certify marriage and family therapists, and legislation is either pending or anticipated in the remaining 8 states. In each of these states, the standards of licensure or certification are virtually identical to the standards for licensure or certification as a social worker: possession of a Master's degree or Ph.D. from a recognized program for marriage and family therapy or a related field and at least two years of supervised clinical experience in marriage and family therapy. In the 8 states where licensure or certification has not been achieved. MFTs are able to practice if they are eligible for clinical membership in the American Association for Marriage and Family Therapy which is the national certifying body for marriage and family therapists.

Although the name might suggest that the scope of services MFTs provide would be limited to problems arising due to marriage, their title merely refers to the context in which they treat common mental disorders. For example, research has shown that one of the greatest risk factors for depression is family stressors. In addition, the likelihood of relapse is more likely when family stressors are not addressed in treatment. MFTs treat the individual in the context of their spousal and family relationships. Such as approach not only affords the provider a better context in which to deal with the underlying problem, but increases the likelihood for a successful outcome.

I want to make it clear to my colleagues that the proposal we are putting forward today does not expand the scope of mental health services currently available to Medicare beneficiaries. Our proposal would simply state that when a marriage and family therapist providers a mental health service to a Medicare
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beneficiary that is covered by Medicare when provided by a psychiatrist, psychologist, social worker or psychiatric nurse, then the same service is covered if provided by a marriage and family therapist. Equally important, when the marriage and family therapist provides a covered service to a Medicare beneficiary, the fee paid shall be 75% of what has been paid by Medicare had the service been provided by a psychiatrist or psychologist.

Our proposal, Mr. Speaker, is modeled after earlier laws passed by Congress relating to Medicare coverage of mental health services provided by psychologists and social workers. Individuals must meet certain minimum educational standards, as well as compete clinical experience requirements and be licensed or certified by the state as a marriage and family therapist. In the event the individual provides services in a state that does not license MFTs, the therapist would be required to meet equal education and experience qualifications, adhere to standards determined by the Secretary of Health and Human Services, and be eligible for clinical membership in the American Association for Marriage and Family Therapy.

Mr. Speaker, I suspect that many of my colleagues would be surprised to learn that much of their Congressional Districts may be considered Mental Health Professional Shortage Areas by the federal government. Indeed, in my own rural district, all 20 counties are considered Mental Health Professional Shortage Areas.

The time has come to correct the oversight in the Medicare law and treat marriage and family therapists the same way we treat other mental health professionals. Millions of Medicare beneficiaries could benefit from being able to receive their covered mental health services from a marriage and family therapist. Equally important, I believe the Medicare program could benefit by covering these individuals. We have an opportunity to make an investment to improve access to mental health services for the Medicare population. Failure to make this investment now could result in far higher Medicare expenditures in the future, but more importantly, many mental disordered that could have been successfully handled by a marriage and family therapist will go untreated. If this is allowed to happen, the human toll, as well as the financial toll, will steadily increase.

I welcome my colleagues' support for this important legislation, and I look forward to working with both the Commerce and Way and Means Committees to secure the bills' adoption.
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