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Obamacare Mental Health Benefit Extended to 62 Million Americans

February 22, 2013 – Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced on Wednesday final rule for the Accountable Care Act that will make purchasing health coverage easier for consumers. The policies give consumers a consistent way to compare and enroll in health coverage in the individual and small group markets. The rule outlines health insurance issuer standards for a core package of benefits, called "Essential Health Benefits," which health insurance issuers must cover both inside and outside the health insurance "Exchanges." The standards for essential health benefits greatly expand the availability of coverage for mental health and substance use disorder services. HHS projects the rules will eventually expand mental health and substance use disorder benefits and federal parity protections to 62 million more Americans. For more information on the rule, see: Essential Health Benefit Rule

The Obamacare statute does not enumerate detailed benefit levels, but requires that all plans covering essential health benefits include mental health and substance use disorder benefits with services at parity levels. Until Obamacare, nearly 20 percent of individuals purchasing insurance have not had access to mental health services, and nearly one third have no coverage for substance use disorder services. The new rule will bridge this huge gap by expanding benefits coverage in three ways:

  • Mental health and substance use disorder benefits are included as Essential Health Benefits
  • Federal parity protections are applied to mental health and substance use disorder benefits in the individual and small group markets
  • Mandated parity for mental health and substance use disorder benefits in the individual and small group market will expand benefits availability to 62 million more Americans

All states have been given the opportunity to define essential health benefits in a way that would best meet the needs of their residents. Most have elected to establish their own benchmark-based plan approach, including selecting a benchmark plan from options offered in their current state market. Benchmark plan benefits must be equal in scope to a typical employer plan. Twenty-six states have already selected a benchmark plan for their state, and the largest small business plan in each state will be the benchmark for the rest. States that decline this option will have their benchmark plan defined by the federal government. More information on health care reform and the state “Exchanges” or “Marketplaces” may be viewed here: Health Insurance Marketplaces

On Feb. 14 Valentine’s Day

DCMHCA participated in the E3 Initiative’s Global Summit on Issues Affecting Women and Girls Worldwide at George Washington University. Organized by Stacey Karpen and Kathleen Smith Counseling graduate students at GWU, this two-part effort was exceptional. The first part of the event consisted exhibits and information-sharing by organizations concerned with the state of women and girls. Among the groups represented were The Women’s Center Women Thrive Worldwide, Whitman-Walker Health, DC Rape Crisis Center, The Project to End Human Trafficking, GWU Global Women’s Institute, Coalition to Abolish Modern Day Slavery in Asia and the Rebecca Project for Human Rights with whom we shared a table. In the second part, Zainab Hawa Bangura UN Special Representative to the Secretary General on Sexual Violence in Conflict; Sabrina Hersi Issa, Digital Director of Be Bold Media and Imani Walker, Co-Founder and Executive Director of the Rebecca Project spoke. Their presentations about the work they were doing on behalf of women and girls in the world were engaging, enlightening and moving. It seemed everyone in attendance felt it was well worth being there.

DCMHCA Survey Results

  1. 78% were licensed (29/37); 51% of those for 10 yrs or more

  2. 49% belong to AMHCA; 57% to ACA;

  3. 64% were current DCMHCA members; 33% were past members

  4. Respondents want the chapter to provide credit hour opportunities 88%; Advocacy for licensure 55%; Networking Opportunities 55%; Community awareness/mental health 54%; Continuous contact with AMHCA 46%; Advocacy re Insurance Companies. 40%

  5. Committee interests were Professional Dev 48%; Comm. Awareness 35%; Networking 29%; Membership 19% and Grad students 19% ; Newsletter and Fund-raising 0%

  6. Credit hour activity likely to participate: Annual half day conf. 83%;; 2-4hr wkshps 63%; Webinars 44%; regional con 42%; National conf 25%

  7. Dues....83% wanted them to stay the same; 14% wanted to raise them

  8. 56% said yes or maybe to becoming part of the leadership.

  9. Most said website and list serve met their needs. Some had specific problems with paypal link or find a therapist section.

  10. 51% were interested in offering group or indiv supervision

ACA/AMHCA/NBCC Update: Senate Bill Introduced on TRICARE Independent Practice Authority

The counseling profession took a significant step forward with the introduction of Senate legislation (S. 3371) that will make it easier for TRICARE beneficiaries to see a professional mental health counselor. TRICARE is the health care system for service members and their dependents, and licensed professional counselors are the only mental health professionals still required by law to see beneficiaries following physician referral and under physician supervision.

Senators Joseph Lieberman (I-CT), Claire McCaskill (D-MO) and Susan Collins (R-ME) jointly introduced the “TRICARE Mental Health Care Access Act,” S. 3371 to allow licensed professional counselors to independently treat and diagnose TRICARE beneficiaries.  The American Mental Health Counselors Association, the American Counseling Association and the National Board for Certified Counselors applaud the senators for sponsoring this legislation, as it is a much-needed step forward in giving  TRICARE beneficiaries better access to highly skilled outpatient mental health professionals.  Our three organizations are working closely together to gain the enactment of legislative language providing counselors independent practice rights as part of this year’s National DefenseAuthorization Act (NDAA).

Introduction of S. 3371 comes on the heels of a recently released Institute of Medicine (IOM) report that recommends independent practice of mental health counselors in TRICARE.  The Institute of Medicine’s report, titled “Provision of Mental Health Counseling Services under TRICARE,” was conducted pursuant to a request by Congress contained in the National Defense Authorization Act for Fiscal Year 2008.  The IOM panel recommended granting independent practice authority for counselors who have:

  1. A master’s (or higher) degree in mental health counseling from a program accredited by the Council for Accreditation of Counseling and Related EducationPrograms (CACREP);
  2. Obtained state licensure in mental health counseling at the “clinical” or highest level available;
  3. Passed the National Clinical Mental Health Counselor Examination (NCMHCE); and
  4. Have a well-defined scope of practice sufficient to permit a counselor to see TRICARE beneficiaries absent primary care physician supervision and referral.
Representatives Tom Rooney (R-FL) and Mike McMahon (D-NY) introduced a similar bill, H.R. 3839, last October.  The Rooney-McMahon legislation would let any counselor participating in the TRICARE program practice independently, just like clinical social workers and marriage and family therapists have done for years.  The legislation is currently being cosponsored by Reps. Bordallo (GU), Courtney (CT), Israel (NY), Jones (NC), Kilpatrick (MI), McMorris Rodgers (WA), Rodriguez (TX) and Shuster (PA).
AMHCA, ACA, and NBCC are working with members of the House and Senate Armed Services Committees to gain adoption of legislative language based on H.R. 3839 and S. 3371 as part of the defense authorization legislation being considered over the coming weeks.  We urge counselors to contact their representatives to ask them to cosponsor H.R. 3839, and to contact senators to ask for cosponsorship of S. 3371.  The more cosponsors we have on the legislation, the greater our chances of establishing independent practice authority for as many counselors as possible within the TRICARE system.

For more information, contact Scott Barstow with ACA’s public policy office, at 800-347-6647 x234, email:

Synopsis of IOM Panel LMHC TRICARE Recommendations

On Friday, February 12, 2010, the Institutes of Medicine (IOM) released its final report titled Provision of Mental Health Counseling Services under Tricare. The IOM made the following recommendations, with the first one being to eliminate the supervision and referral requirement currently defining LMHCs’ practice under TRICARE, and the second one being directed to all cadres of licensed mental health professionals currently practicing under TRICARE.     

Below are the recommendations and attached is an IOM report brief summary.  The report itself is not yet law. However, recommendations arising from IOM panels commissioned by Congress and the Department of Defense usually receive deference by Congress and the Department of Defense, thus inspiring changes to existing laws which will parallel the IOM studies’ recommendations to Congress and the Department of Defense. To link to the full report, click on the following link:


1) Independent practice of LMHCs in TRICARE in the circumstances in which their education, licensure, and clinical experience have helped prepare them to diagnose, and where appropriate, treat conditions in the beneficiary population. These circumstances include:

-A master’s or higher level degree in counseling from a program in mental health counseling or clinical mental health counseling that is accredited by the Council for Accreditation of Counseling and Related Educational Programs.

-A state license in mental health counseling at the "clinical" or the higher or highest level available in states that have tiered licensing schemes (community counseling programs won’t suffice)

-Passage of the National Clinical Mental Health Counseling Examination (passage of the NCE alone won’t suffice)

-A well-defined scope of practice for practitioners.

*The Committee found that LMHCs who do not meet these proposed requirements may still practice within the system of TRICARE but will be supervised with the opportunity to acquire greater levels of independent practice as their experience and demonstrated competence increase.

2. A comprehensive quality management system for all mental health professionals, with this system including:

-Well-defined scopes of practice and clinical privileging of all TRICARE mental health providers consistent with their professional education, training, and experience.

-Promotion of evidence-based practices for treatment of conditions and monitoring of results.

-Focused training in the particular mental and  related general medical conditions that are present in the TRICARE beneficiary population, and in military cultural competence.

-A systematic process for continued professional education and training to ensure continuing improvement in the clinical evidence base and accommodation of the changing needs of the TRICARE population.

-Development and application of quality measures to assess the performance of providers.

-Systematic monitoring of the process and outcomes of care at all levels of the health care system and application of effective quality improvement strategies.

*The IOM panel determined that the coursework required by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) helps prepare counselors to serve as independent practitioners. It also found the National Clinical Mental Health Counselor Examination (the NCMHCE) best tests the experiences and competencies of mental health counselors to practice independently.

*The TRICARE IOM panel could not find any evidence distinguishing LMHCs from other cadres of licensed mental health professionals in their ability to serve in an independent capacity or provide high quality care. The panel’s research pointed to the need for a quality management system to ensure that all mental health professionals serving TRICARE beneficiaries provide care so TRICARE beneficiaries receive the “proper diagnosis and treatment for disorders.”

***Please call AMHCA Director of Legislative Affairs, Julie A. Clements, J.D. (Phone: 800-326-2642 x 105), if you have any particular questions about the report’s content and applicability. The above brief is meant to provide you with some of the nuances in the IOM recommendations.***

AMHCA Haiti Relief Efforts

Reach Out to Aid Workers in Haiti
through AMHCA's Partnership with Give an Hour Network

Dear Chapter Leaders and Members,

As you may be aware, AMHCA has partnered with Give an HourTM (, a national nonprofit organization providing free counseling and other mental health services to members of the military, veterans of Iraq and Afghanistan, their families, and their communities.

In response to the tragedy in Haiti, Give an HourTM will also be offering free mental health services to all volunteers serving in Haiti, including civilians, military personnel, and loved ones of those who volunteer. Thousands of military personnel and civilian aid workers are responding to the crisis, and many will face psychological effects from dealing with such horrific circumstances. Moreover, these personnel left their families and their lives at home quickly and so families may be having a difficult time adjusting to the separation as well.

While there are more than 4,600 mental health professionals on the network nationwide, there is a critical shortage in many areas, particularly in the communities surrounding our military installations. As we raise awareness about the psychological issues surrounding combat and deployment, more people are seeking services through Give an HourTM.

Give an HourTM is an important and well respected organization, filling a critical need. If you are willing to volunteer one hour a week (for a minimum of one year) to help our military men and women and their families heal from wartime service or to help our fellow citizens who are providing humanitarian relief in Haiti, please join the Give an Hour network.

Registration is quick and easy. Log on to and click on "Providers." Please spread the word to your colleagues.


Linda Barclay, Ph.D. LPCC/S LICDC NCC
AMHCA President

Other News

Occasionally we will also post relevant and important bulletins/newsletters from organizations outside of DCMHCA (such as AMHCA) for our members to access easily. See our selections below.


E-News From Washington (AMHCA - November 2009) - PDF format
Senate Health Reform Package Falters in Enhancing Access; Bill Fails to Recognize LMHCs as Medicare Providers

E-News From Washington (AMHCA - July 2007) - PDF format
Gene Variant May Increase Risk For Alcoholism Following Child Abuse

Click here for a printable Petition to the Citizens’ Stamp Advisory Committee to create a Mental Health Awareness commemorative postage stamp. Please feel free to print this petition and distribute it at your board meeting, your regional or other meetings.


Contacting Us

District of Columbia Mental Health Counselors Association