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The American Counseling Association’s lobbying efforts for Congress to pass the Mental Health Access Improvement Act (H.R. 432) may garner success before the new year.

As of this morning, the House version of H.R. 432 has been included in Section 4121 of the Omnibus released by the Senate, says Brian D. Banks, ACA’s chief government affairs and public policy officer. “This means the House and Senate have worked together to include our bill in the final vote to become law,” he explains. “Both the House and Senate have to vote yes for the bill to pass and make its way to the President’s desk for signature. We can expect a vote by the 23rd of this [week].”

If passed, H.R. 432 and S. 828, its companion bill, will allow licensed professional counselors and licensed marriage and family therapists to get reimbursed for providing mental health services to adults age 65 and older who access their health care through Medicare. This includes clients who are disabled and veterans.

This latest development is proof of ACA’s ongoing progress to make the bill a law. Earlier in the month, ACA was successful in its work with the Centers for Medicare and Medicaid Services (CMS) to help lower the cost of the bill to $902 million over a 10-year period.

“This is a big deal. Many Republicans were hesitant to support [the bill] because of the $1 billion plus price tag,” Banks says. “This gives us more momentum, right when we need it.”

Banks also notes that mental health is a “hot topic on the Hill.” ACA was competing for a vote on Congress’ legislative calendar, which is scheduled to end on December 21. Now it appears the House and Senate will vote on the bill before the start of the new 118th Congress in January.

The decadelong push of ACA and its stakeholders to bring a Medicare reimbursement bill this far on the Hill is bearing fruit, says Banks, who has focused on the effort for three years.

“This bill passing is a hand up to people in need, and that is bigger and better than any impact on the Hill,” he continues. “I will share this. Congress will look to ACA more when this bill passes because we will become equals with our needed colleagues in the social work and psychology professions.”

According to the national study ““Counselors’ Interest in Working With Medicare Beneficiaries: A Survey of Licensed Professional Mental Health Counselors,” conducted by ACA in April, an estimated 115,000 current licensed professional counselors would enroll in the Medicare program with the passage of this legislation, including counselors in the CMS Medicare Program. The ability for licensed professional counselors to treat Medicare clients also provides them with a way to earn additional income.

Danielle Monroe, a licensed mental health counselor at Southwestern Behavioral Healthcare in Indiana, has been helping with lobbying efforts in her state. “There is a lot of excitement and anticipation amongst counselors to finally have access to this population and to provide services to meet their needs,” she says.

The passage of the bill is necessary because licensed professional counselors and licensed marriage and family therapists can only provide mental health services to clients up to age 65, when they become eligible to enroll in Medicare. Older Americans on Medicare who are working with these counseling professionals must then find a new provider who accepts Medicare so they can continue their treatment.

According to Banks, passage of the Mental Health Access Improvement Act will help older adults who must often wait as long as three to four months for an appointment with other mental health providers who accept Medicare, such as social workers or psychologists.

As of now, Monroe explains, older adults must decide whether to pay out of pocket for care, which is an added burden since many live on a fixed income, or to discontinue treatment because they don’t want to start over with a new provider who takes Medicare.

“Passage of this legislation means that older Americans will be able to keep working with providers that they connect with and trust regardless of their age,” notes Monroe, an ACA member. “This seamlessness of treatment makes completion of treatment more likely.” Making it possible for older adults to continue mental health services with licensed professional counselors is an important preventative measure against future negative outcomes.

If older clients don’t receive consistent clinical help, they may begin to rely on medication to treat their mental health symptoms, Banks adds. “Some of the medications contain opioids, which can be addictive and lead to substance use issues, or worse,” he says. This includes suicide attempts, thoughts of suicide and self-harm. Many psychologists and social workers are not accepting Medicare, which, as Banks notes, gives licensed professional counselors the opportunity to treat these clients.

Monroe says that there is an important lesson to be learned in the dedicated effort to pass the Mental Health Access Improvement Act. “We have to continue to be organized and to have our voices heard,” she stresses.


Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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