AARP, Medicare might be negligent in allowing for salient treatment of Mental Health conditions

[GalenS27763]

Medicare does not pay for Mental Health treatment provided by Licensed Professional Counselors (LPC’s). Why not? Or, what is the current rationale supporting this 50 year old decision?

All 50 of the United States provide licensure for LPC’s (or a variation of this title such as LMHC - Licensed Mental Health Counselor, LPCC - Licensed Professional Clinical Counselor; check your state’s licensure). An LPC must undergo 40 - 60 hours of Graduate/Masters level academic education along with 100+ hours of practical (Practicum) experience and 600+ hours Internship experience. LPC’s must then pass their college-developed comprehensive exam and their state-approved — and usually nationally-developed and/or similar — exam to qualify for licensure. Advanced LPC’s must complete an additional 3000 hours of on-the-job, supervised experience and pass an additional, state-approved and nationally developed exam to qualify for the advanced license. The advanced-licensed LPC’s are then licensed to practice mental health counseling/psychotherapy independently and diagnose and treat mental health at the same level as psychiatrists and psychologists. (LPC’s and psychologists do not prescribe medications. If medications are involved in the treatment of a mental health disorder, a person may be prescribed the same medication from their Primary Care Physician — including Physician Assistants and Advanced Practice Nurses — and receive needed mental health treatment from an LPC.)

Psychiatrists are covered by Medicare. Psychologists are covered by Medicare. LPC’s are not covered, yet their costs for treatment are much lower. A patient will receive a greater quantity of treatment — and, quite realistically, a greater quality of treatment in comparison to a psychiatrist — for the same out of pocket expense.

Finally, what is AARP’s stance on this issue? Throughout the many years I have been an AARP member, I have not heard nor seen them advocate for it’s consumers on this issue. (Also, isn’t there a economic law, model, theory, or hypothesis that proposes that an increase in the number of providers/suppliers/competition leads to a decrease in price of the provided service for the consumer?)

Respectfully,

[GailL1]

I think the reason is that they aren't licensed (at least not in every state) to diagnose mental illness.  This ability to diagnose has to be outlined in the state statue -  they also can't treat it in every scope of the term - they can't diagnosis or prescribe.

Plus, the title of these types of professionals often vary from state to state.  There is no continuity of educational level, advanced training, licensing between the states.

It is the same in other medical providers - like Medicare does not pay for Optometrists either but they can be a great source of beginning a diagnosis of a vision related problem, but they can't treat it or even diagnosis it formally.  Medicare will pay them for a few preventive tests annually as long as the state where they are located describes it in their statue.  

A good resource of where things stand:

National Conference of State Legislatures:  50-STATE SCOPE OF PRACTICE LANDSCAPE

Edited to ask:  Are they covered by MEDICAID?  Everywhere or just in specific states?