There
are several points that you can use in written or verbal correspondence
with your legislators in support of the Coalition's legislative
efforts:
1. LPC's and LMFT's fully qualified.
The
required training for LPCs and LMFTs to acquire and maintain
licensure meets or exceeds that of other professionals in
the state’s mandated provider pool. (See Comparison
of Mental Health Providers).
In addition, the lawful Scopes
of Practice for LPCs and LMFTs include “identification”
and “diagnostic appraisal and assessment” of mental
health conditions and problems.
Finally,
competent practice by LPC's and LMFT's is ensured by the Oregon
Board of Licensed Professional Counselors and Therapists.
2.
Increased consumer access
Every
citizen in the state of Oregon has the right to access confidential
mental health care. Recently, mental health parity
became the law in Oregon, suggesting that consumers should
have as much access to mental health care providers as they
do to physical health care providers. However, current practices
by insurers operating under Oregon statutes significantly
limit access to mental health care providers.
3. Improved consumer protection
The
State of Oregon should verify the qualifications and regulate
the practice of its mental health care providers, including
unlicensed providers. These education
and credentials of unlicensed providers have never been verified
by the Board and, as such, do not operate under the auspices
of the Board whose key regulatory function is to protect the
consumers of mental health services.
4.
Too many restrictions on LPC's and LMFT's.
Despite
their approval by a state licensing board, LPC's and LMFT's
are wrongfully excluded from the state’s mandated provider
pool. This limits the ability of these small businesses to
meet the mental health care needs of Oregonians. Oregon statutes
should be changed to mandate that LPC's and LMFT's be reimbursed
by insurance companies and managed care organizations for
their services.
Current
Oregon law already requires insurers to pay for mental health
services provided by physicians, psychologists, clinical social
workers, and nurse practitioners.
5.
Inadequate service in rural areas.
The
impact of restricting the size of mental health care provider
networks is most noticeable in the rural areas of Oregon where
providers are few and far between. This limits the abilities
of these rural consumers to access mental health care providers.
6.
Supply and demand works.
Increased
access to a larger provider pool will translate to decreased
health care costs. Research suggests that improved access
to mental health care providers results in an additional savings,
a medical cost-offset. (See background material in
Resources.) For example, people
may reduce their use of health care services after individual
psychotherapy, thereby lowering overall health care costs.
A
1985 study by Regence Blue Cross-Blue Shield of the Oregon
law that mandated reimbursement of LCSW's revealed an increase
in service at reduced cost. Why shouldn’t this service-cost
relationship also apply to LPC's and LMFT's?
There's
research evidence to support this. A 2002 economic
impact analysis from the Journal of Health Politics, Policy
and Law. Anne Carroll (Rider University) and Jan M. Ambrose
(La Salle University) examined all states that had "Any
Willing Provider" (AWP) laws on the books. These laws
mandate that all providers of a service (e.g., mental health
care) are eligible for reimbursement from insurers as long
as they adhere to company standards. Their analysis concluded
that
the
impact of both types of AWP laws is such that the profit
margins, or "bottom lines" of HMOs are unaffected
by their presence....[O]ur results robustly indicate that
fears that such laws will adversely affect the profitability
of HMOs are unfounded, at least insofar as these laws are
currently used.
Increasingly,
states are implementing AWP laws (read the Vermont
experience). Here in Oregon, insurance companies such as Regence
Blue Cross/Blue Shield still maintain that expanding provider
pools with LPCs and LMFTs will drive health care costs up.
We think this is "voo-doo" economics.
7.
Insurance company provider "panels" unfair
Insurers
"trump" the State of Oregon and its professional
licensing boards by selecting for their customers, the insured,
which licensed professionals they may see for therapy. At
times, these "selectively contracted" provider panels
may even be closed to new applicants for extended periods
of time. Why must insurers limit access to providers who are
fully qualified to practice and licensed by the State of Oregon?
We believe these companies should not outrank the laws, rules,
and licensing boards that determine who - and who is not -
competent to provide mental health care in Oregon. Moreover,
by restricting access to mental health care via provider panels,
insurers are, in effect, restricting the "supply"
of counselors and therapists. The economic law of supply and
demand suggests that the net effect of restrictive provider
panels is to prop up the price of mental health care.
8.
Utilization reviews invade client privacy
Oregon
law deems that "...a utilization review contractor...shall
have the authority to certify for or to deny level of payment."
While these reviews by insurance companies must be conducted
subject to certain client confidentiality provisions under
Oregon statutes, most therapists feel they must divulge some
confidential therapeutic information to receive reimbursement
from insurance companies or to obtain authorization for an
extension of treatment. Often, they feel "interrogated"
by some insurance personnel who may not have the depth of
training to understand a client's issues.
Licensed
mental health care providers should not have to practice their
profession "between a rock and a hard place." Their
professional ethical codes demand accountability for client
welfare, yet these same codes also hold sacred client confidentiality.
Clients should be able to receive the treatment they need
without fearing that sensitive, confidential information will
be released to their insurance companies.
9.
Bureaucracy costs
Insurance
companies spend a lot of money on a bureaucracy that checks
on authorization, screens therapists for panels, provides
utilization reviews, etc. Why not use this money more productively
elsewhere?
