[Congressional Record (Bound Edition), Volume 145 (1999), Part 16]
[Extensions of Remarks]
[Pages 22630-22631]
[From the U.S. Government Publishing Office, www.gpo.gov]



        THE SENIORS MENTAL HEALTH ACCESS IMPROVEMENT ACT OF 1999

                                 ______
                                 

                            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

[[Page 22631]]

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 an 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 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.

                          ____________________