VTMHCA News Archives

Decmber 18, 2008

Jacqueline S. Weinstock
Associate Professor, Human Development & Family Studies
University of Vermont
C-150 Living & Learning Center
Burlington, VT 05405

Dear Professor Weinstock:

I am pleased to request, on behalf of the Board of Directors of the Vermont Mental Health Counselors Association, that our professional organization be added to supporters of your statement entitled, "Statement by Health Care and Human Service Professionals In Support of Equal Marriage Rights for Same-Sex Couples."

After review of the research and literature, and discussion, our Board unanimously voted to endorse the above-referenced statement. We agree that same-sex couples and their children should be provided with the all the rights, benefits and responsibilities conferred by civil marriage. It is our belief that prejudice and discrimination of same-sex couples impacts the mental health of both in the couple, their extended families, and their children.

For this reason, we are proud to join our professional colleagues as proponents of same-sex civil marriage in Vermont.

Sincerely,

 
Heather F. Pierce, MA, LCMHC
President
Vermont Mental Health Counselors Association

cc: Board of Directors, VTMHCA

VTMHCA's Testimony to State Senate Hearing Committee March 19, 2009 regarding Same Sex Marriage Rights

by Heather Pierce, President

  • The Vermont Mental Health Counselors Association (VTMHCA) represents approximately 140 Licensed Clinical Mental Health Counselors in the State of Vermont.
  • Our professional code of ethics demands that we respect diversity and "do not condone or engage in any discrimination based on age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status or socioeconomic status." (AMHCA Code of Ethics, 2000)
  • VTMHCA’s Board decision to fully support the "Statement by Health Care and Human Service Professionals In Support of Equal Marriage Rights for Same-Sex Couples" was unanimous.
  • Medically, psychologically, psychiatrically, clinically, homosexuality is not a pathology, illness or "problem" that needs to be treated.
  • We want to be very clear that clinically, we do not encounter homosexual clients or their children seeking therapy for "help" with their sexual orientation. More, we are likely to see any range of mental health issues that effect the population at large, no greater or lesser incidences, in our clinical practices.
  • What we do often see, however, complicating or compounding the picture of mental health issues brought to counseling by homosexual clients, is the effects of discrimination. This can be discrimination experienced by them personally, by their friends and loved ones, extended family, partners and children. Complications can range from fear of being "outed" when not wanted (i.e., to an employer), fear of job loss, custody loss, having the love relationship seen as "less than" by society, worry that their children will be teased or picked on by peers, worry about financial security of their partner if death occurs. Many experience an anonymous, pervasive pressure to appear or become heterosexual.
  • We, as mental health clinicians, believe it is detrimental to the psychological welfare of gay and lesbian clients and their families and children to continue to be seen as "less than"; that this status perpetuates discrimination and the issue of same-sex equal marriage is a civil rights issue.
  • What constitutes a "family" is not static; it changes with time. Even just 60 years ago, we rarely saw inter-racial couples, divorce, single (out-of-wedlock) parenting, and grandparents raising grandkids. We all know that what defines a "family" has changed radically in less than a century. We now socially accept unwed parents, single parents, divorced parents, blended families, adoption of children of another race, inter-racial marriage and inter-faith marriages. Same-sex couples should be included.
  • While some may say, "That is exactly the problem! These new definitions and acceptance of "families" are 'wrong'" I would submit to you that this is a judgment that is not for individuals to make. It is a progress in society, a larger movement and evolution. Change is difficult, and it is human nature to avoid change, to stay with what is safe, known. However, a society where change is forbidden or stunted is a stagnant and discriminatory environment.

The New York Times
October 6, 2008

Bailout Provides More Mental Health Coverage

By ROBERT PEAR

WASHINGTON — More than one-third of all Americans will soon receive better insurance coverage for mental health treatments because of a new law that, for the first time, requires equal coverage of mental and physical illnesses.

The requirement, included in the economic bailout bill that President Bush signed on Friday, is the result of 12 years of passionate advocacy by friends and relatives of people with mental illness and addiction disorders. They described the new law as a milestone in the quest for civil rights, an effort to end insurance discrimination and to reduce the stigma of mental illness.

Most employers and group health plans provide less coverage for mental health care than for the treatment of physical conditions like cancer, heart disease or broken bones. They will need to adjust their benefits to comply with the new law, which requires equivalence, or parity, in the coverage.

For decades, insurers have set higher co-payments and deductibles and stricter limits on treatment for addiction and mental illnesses.

By wiping away such restrictions, doctors said, the new law will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse.

Frank B. McArdle, a health policy expert at Hewitt Associates, a benefits consulting firm, said the law would force sweeping changes in the workplace.

“A large majority of health plans currently have limits on hospital inpatient days and outpatient visits for mental health treatments, but not for other treatments,” Mr. McArdle said. “They will have to change their plan design.”

Federal officials said the law would improve coverage for 113 million people, including 82 million in employer-sponsored plans that are not subject to state regulation. The effective date, for most health plans, will be Jan. 1, 2010.

The Congressional Budget Office estimates that the new requirement will increase premiums by an average of about two-tenths of 1 percent. Businesses with 50 or fewer employees are exempt.

The goal of mental health parity once seemed politically unrealistic but gained widespread support for several reasons:

  • Researchers have found biological causes and effective treatments for numerous mental illnesses.
  • A number of companies now specialize in managing mental health benefits, making the costs to insurers and employers more affordable. The law allows these companies to continue managing benefits.
  • Employers have found that productivity tends to increase after workers are treated for mental illnesses and drug or alcohol dependence. Such treatments can reduce the number of lost work days.
  • The stigma of mental illness may have faded as people see members of the armed forces returning from Iraq and Afghanistan with serious mental problems.
  • Parity has proved workable when tried at the state level and in the health insurance program for federal employees, including members of Congress.

Dr. Steven E. Hyman, a former director of the National Institute of Mental Health, said it was impossible to justify insurance discrimination when an overwhelming body of scientific evidence showed that “mental illnesses represent real diseases of the brain.”

“Genetic mutations and unlucky combinations of normal genes contribute to the risk of autism and schizophrenia,” Dr. Hyman said. “There is also strong evidence that people with schizophrenia have thinning of the gray matter in parts of the brain that permit us to control our thoughts and behavior.”

The drive for mental health parity was led by Senator Pete V. Domenici, Republican of New Mexico, who has a daughter with schizophrenia, and Senator Paul Wellstone, the Minnesota Democrat who was killed in a plane crash in 2002. Mr. Wellstone had a brother with severe mental illness.

Prominent members of both parties, including Betty Ford, Rosalynn Carter and Tipper Gore, pleaded with Congress to pass the legislation.

Representatives Patrick J. Kennedy, Democrat of Rhode Island, and Jim Ramstad, Republican of Minnesota, led the fight in the House. Mr. Kennedy has been treated for depression and, by his own account, became “the public face of alcoholism and addiction” after a car crash on Capitol Hill in 2006. Mr. Ramstad traces his zeal to the day in 1981 when he woke up in a jail cell in South Dakota after an alcoholic blackout.

The Senate passed a mental health parity bill in September 2007. The House passed a different version in March of this year.

A breakthrough occurred when sponsors of the House bill agreed to drop a provision that required insurers to cover treatment for any condition listed in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

Employers objected to such a requirement, saying it would have severely limited their discretion over what benefits to provide. Among the conditions in the manual, critics noted, are caffeine intoxication and sleep disorders resulting from jet lag.

Doctors often complain that insurers, especially managed care companies, interfere in their treatment decisions. But doctors and mental health advocates cited the work of such companies in arguing that mental health parity would be affordable, because the benefits could be managed.

Pamela B. Greenberg, president of the Association for Behavioral Health and Wellness, a trade group, said providers of mental health care typically drafted a treatment plan for each person. In complex cases, she said, a case manager or care coordinator monitors the patient’s progress.

A managed care company can refuse to pay for care, on the grounds that it is not medically necessary or “clinically appropriate.” But under the new law, insurers must disclose their criteria for determining medical necessity, as well as the reason for denying any particular claim for mental health services.

Andrew Sperling, a lobbyist at the National Alliance on Mental Illness, an advocacy group, said, “Under the new law, we will probably see more aggressive management of mental health benefits because insurers can no longer impose arbitrary limits.”

The law will also encourage insurers to integrate coverage for mental health care with medical and surgical benefits. Under the law, insurers cannot have separate cost-sharing requirements or treatment limits that apply only to mental illness and addiction disorders.

The law comes just three months after Congress eliminated discriminatory co-payments in Medicare, the program for people who are 65 and older or disabled.

Medicare beneficiaries pay 20 percent of the government-approved amount for most doctors’ services but 50 percent for outpatient mental health services. The co-payment for mental health care will be gradually reduced to 20 percent over six years.

The mental health parity law was forged in a highly unusual consensus-building process. For years, mental health advocates had been lobbying on the issue.

Insurers and employers, which had resisted earlier versions of the legislation, came to the table in 2004 at the request of Mr. Domenici and Senators Edward M. Kennedy, Democrat of Massachusetts, and Michael B. Enzi, Republican of Wyoming.

Each side had, in effect, a veto over the language of any bill. Insurers and employers, seeing broad bipartisan support for the goal in both houses of Congress, decided to work with mental health advocates. Each side gained the other’s trust.

“It was an incredible process,” said E. Neil Trautwein, a vice president of the National Retail Federation, a trade group. “We built the bill piece by piece from the ground up. It’s a good harbinger for future efforts on health care reform.”

E-News from Washington
October 6, 2008

AMHCA Applauds Enactment of Mental Health Parity and Addiction Equity Act

Alexandria, Va., October 6, 2008 – By a vote of 263 to 171, the U.S. House of Representatives, on October 3, 2008, gave final approval to the Paul Wellstone-Pete Domenici Mental Health Parity and Addiction Equity Act, as part of the Emergency Stabilization Act (H.R. 1424). President George W. Bush signed the legislation into law several hours later.

The American Mental Health Counselors Association (AMHCA) applauds the 110th Congress for including the mental health and substance abuse parity language in the economic rescue legislation, and the President for signing this legislation into law. Enactment of the bill ends nearly a decade long effort to require group health plans to cover treatment for mental illness on the same terms and conditions as for all other illnesses.

“AMHCA commends the 110th Congress, particularly sponsors of the parity legislation, Sens. Pete Domenici (R-NM) and Edward Kennedy (D-MA) and Reps. Patrick Kennedy (D-RI) and Jim Ramstad (R-MN), for their tireless efforts to ensure that this legislation was enacted during the remaining hours of the 110th Congress, said AMHCA President Victoria A. Sardi, Ph.D., LPC. As a result of this legislation, Americans who suffer from mental and addiction disorders will now have greater access to the services they need to live more productive and meaningful lives.”

AMHCA also appreciates its members, as well as other mental health and addiction advocates from across the country, who contacted their Senators and House members to push for consideration of this legislation. Without their advocacy on this issue, we would not have seen the ultimate enactment of this landmark bill during the 110th Congress.

 

2008 President's Welcome

I am honored to be serving as the new president for the Vermont Mental Health Counselors Association. The past year as president-elect has presented me with a steep learning curve, but my predecessors and the Board are wonderful support and a wealth of knowledge.

Most recently I represented Vermont at our National level (AMHCA) conference in San Diego over the summer. I truly felt privileged to meet so many other therapists from across the nation, to learn the issues that face each chapter, from licensure, to budgets, to coping in New Orleans after Hurricane Katrina. At a National level, we belong to a strong, determined, skilled and caring group of colleagues.

My foremost goal for my tenure as president is to increase our membership. Currently about 25% of licensed clinical mental health counselors in Vermont belong to their professional organization I would like to be able to tell legislators and other officials that our numbers are strong, and 80-90% all of all the licensed professionals in our field support the work of VTMHCA! I am pleased to say that already our Board has formed a Membership Committee and will be working in earnest on finding out what members need from VTMCHA both professionally and personally. So, don’t be surprised if your phone rings soon with a member of VTMHCA on the other end!

VTMHCA also continues to participate in Council Meetings, which meets monthly and has a representative from each of the disciplines in the mental health field. This is our forum to coordinate legislative advocacy issues and agendas, and also to continue conversations with managed care and insurance companies, advocacy groups and government officials.

Legislatively last year was very busy. I would like to acknowledge all the hard work and time Don Rhoades put in to advance our visibility at the State House. The feedback we got from legislators was that they truly are getting a better feel for the issues facing health care and our professional field.

VTMHCA is proud to have been a part of advocating for further legislation to move toward true mental health parity in coverage for people with mental health or substance abuse issues. Bill S114 was enacted into law and is now known as Act 142, "An Act Relating to Enhancing Regulation for Progress toward Mental Health Parity." It is a long and complicated process to nurture change (as we know; it is what we do!), educate government about the issues, and advocate for people whose voices are often muted. And, the work is far from over and it is far from perfect in fully meeting the needs of people with mental health and substance abuse issues. However, VTMHCA is being articulately represented by Scott Earisman, LCMHC of Burlington in the forum with BISHCA, the State and insurance companies to regulate the details of this Act, along with Act 129, the original parity bill.

Finally, I would like to encourage any Licensed Clinical Mental Health Counselors practicing in Vermont who have not joined VTMHCA already to consider doing so. Along with our National chapter, the American Mental Health Counselors Association (AMHCA), important, if not always visible and tangible, advocacy is being done to progress our professional field and support the clients who need our services. Without active members, it is very difficult to make headway. Feedback, suggestions and questions are always welcomed! We want to hear from our membership about issues, needs and concerns, and how VTMHCA can help to meet your professional needs.

With Best Regards,
Heather Pierce, MA, LCMHC
President, VTMHCA

Vermont AMHCA Chapter Launches
Mental Health Disaster Relief Registry

AMHCA  Director-At-Large, Peter Mahar, has announced the formation of the Vermont Mental Health Disaster Relief Registry. Mahar stated at the launch, "This represents the first step in a multi-faceted campaign designed to both increase disaster relief preparedness and to demonstrate the importance of mental health counseling as a profession." For a start, 550 Vermont Licensed Mental Health Counselors received registration forms.

The purpose of the Registry is to have a system and a resource for referrals from disaster relief agencies in place for disaster survivors, their loved ones and those who provide services in shelters and on site.

AMHCA President-Elect Gary G. Gintner, PhD. has praised the Registry as, "a great initiative and worthy of national notice."  The Registry was launched during Mental Health Counseling Week (May 1-7).

A Note from the President

Don Rhoades, MA LCMHC
Spring 2007

The evidence continues to pile up that our profession is in a crisis. The following appeared online this May in Psychiatryonline.org, the American Psychiatric Association's online journal:

“"It is difficult to overstate the magnitude of the workforce crisis in behavioral health. ... [T]here is substantial and alarming evidence that the current workforce lacks adequate support to function effectively and is largely unable to deliver care of proven effectiveness in partnership with the people who need services. There is equally compelling evidence of an anemic pipeline of new recruits to meet the complex behavioral health needs of the growing and increasingly diverse population in this country. ... Urgent attention to this crisis is essential." Read more...

Living Multicultural Counseling

By Jon Bolaski, EdD, LCMHC, January 2007

I direct a counseling center at a large medical school in the West Indies. The Commonwealth of Dominica is located among the Leeward Islands of the Lesser Antilles. It is 26 miles long and 16 miles wide with a population of about 72,000 people. Dominica has enjoyed 28 years as an independent island nation that has been greatly influenced by British, French, West African, and Carib cultures. For example, while English is the official language, French Creole is widely spoken and while the majority of citizens are of African descent, Dominica maintains the only Carib Indian territory in the world. Read more...

Content with Insurance Reimbursement Rates?

If Not... You Can Make a Difference!

My name is Pam Sweeney, and I am the legislative advocate, better known as a lobbyist, for the Vermont Mental Health Counselors Association during this legislative session, which started in January of this year. It is my job to convince the 130 members of the Vermont House of Representative and the 30 members of the Vermont Senate to pass legislation that is advantageous to mental health counselors in Vermont. In order to be successful in this endeavor I need your help. Read more...

2006 President's Welcome

Don Rhoades, MA LCMHC

VTMHCA's mission in the past 5 years has been to promote our licensure to ensure that we may practice in a free market place. As an organization, we have been busy promoting our work politically, as well as, facilitating important changes. Although we cannot list all of our accomplishments, the Board would like to tell you a little bit about what has been happening this past year. Read more...

December 6, 2005

David Fassler, M.D.
Vermont Psychiatric Association
86 Lake Street
Burlington , Vermont 05401

Dear Dr. Fassler:

In response to your inquiry of November 18 the Department has long held that any reviewer responsible for issuing an adverse determination must be an appropriately licensed professional. That includes requiring that the reviewer be licensed in the State of Vermont. To be specific, our position rests on the following statutory and regulatory language:

I. A review agent must use licensed mental health care providers to conduct review services (section 8, Regulation 95-2);

2. A review agent must use licensed mental health care providers who are licensed in Vermont, unless the reviewing providers are under the supervision and control of a Vermont licensed provider (see definition of provider, 8 VSA 4089a(b)(2).

3. A review agent must use a provider who is licensed in Vermont to discharge the statutory responsibility of making an evaluation, findings and concurrence of a decision to deny coverage or pre- certification as required under 8 VSA 4089(c)(3).

While the number of Vermont licensed providers a mental health review agent engages will depend on its organization and the size of its operation, at least one Vermont licensed provider must be employed, or serving as a consulting physician, who is capable of discharging the responsibility of providing an evaluation, finding and concurrence in the event of a decision to deny coverage for care. In addition, if a review agent uses personnel who are licensed, but not in Vermont , then at least one provider must be engaged who is licensed in Vermont to supervise and direct such personnel. This means, for example, that a psychiatrist licensed in Vermont must be available to conduct reviews, and if screening personnel (typically RN's) are not licensed in Vermont, then there must be direct supervision of such screening personnel by a Vermont licensed mental health care provider.

Further, the Department requires that, consistent with professional standards in the field, the review agency must have a medical director with a direct patient care post-residency who is responsible for oversight of the IJM program, and if the medical director is not a psychiatrist, there must be at least one consulting psychiatrist with board certification in psychiatry who is licensed (in the State of Vermont) readily available to support the clinical review staff.

I hope this addresses your question. Please contact me if you want further clarification.

John P. Crowley
Commissioner

cc: Edward P. Smith, Jr., D.P.M., Chair
Board of Medical Practice
Christopher D. Winters, Director
Office of Professional Regulation