Year: 2007

US House includes counselors in Medicare legislation

This is off the usual topic of this blog, but I want to note it anyway. The following news release just came via email from Beth Powell at AMHCA:

U.S. House Passes “Children’s Health and Medicare Protection Act,” Including Provision Establishing Medicare Coverage of Mental Health Counselors

August 1, 2007, was a historic day for the mental health counseling profession, as for the first time ever, the U.S. House of Representatives passed legislation to establish coverage of state-licensed mental health counselors under Medicare. The Medicare coverage provision was included in H.R. 3162, the “Children’s Health and Medicare Protection Act,” or CHAMP Act, a bill which seeks to increase access to health insurance for uninsured children and strengthen the Medicare program.

Passage of the provision has been a long standing goal of the American Mental Health Counselors Association (AMHCA), the American Counseling Association (ACA) and the National Board for Certified Counselors (NBCC). House passage of the counselor-coverage provision brings us a step closer to achieving this objective. The bill also eliminates the discriminatory 50% co-payment requirement for outpatient mental health services.

The primary focus of the legislation is to reauthorize and strengthen the State Children’s Health Insurance Program (SCHIP), which supports health insurance coverage for more than 6 million children whose families are low income but do not qualify for coverage under Medicaid. Unless legislation is enacted by September 30th to renew SCHIP, it will expire. H.R. 3162 would expand the program to cover 5 million children who would otherwise be uninsured, and allow states to keep pace with health care cost inflation and population growth. H.R. 3162 passed the House by a largely party-line vote of 225 to 204; all but 10 Democrats voted for the bill, and all but five Republicans voted against it.

The Senate is expected to pass their version of the SCHIP reauthorization bill-which does not include Medicare-related provisions-by the end of this week. Following Senate passage, a conference committee will be appointed to reconcile differences in the House and Senate legislation. Congress will then need to negotiate the legislation with President Bush, who has threatened to veto even the Senate’s more modest bill.

Even if the Medicare-related provisions are removed from the SCHIP legislation, Congress is expected to revisit Medicare soon in order to prevent cuts in physician payment rates scheduled to take effect by the end of the year.

I cut my teeth on advocacy for Medicare recognition in the early 90s when I discovered that my clinical counselor’s license in Ohio did not allow for Medicare reimbursement. Despite a similar scope of practice to social workers and clinical psychologists, mental health counselors (and consequently clients who wanted to see counselors) were at a disadvantage without payment recognition from the Medicare program. Through the 1990s, I helped negotiate recognition from private payers (managed care and insurance companies – e.g., Magellan Healthcare) for counselors but the Federal programs have remained difficult to enter. The Senate may yet add the provision or it may be added during conference. We have been close before but I do not think we have been this close.

Is religious belief a choice?

In the ongoing discussion of sexual identity therapy, some have asserted that sexual orientation is not a choice but religion is (“The bottom line is your sexual orientation cannot change and your religion can,” [Wayne] Besen said.”). That struck me as a failure to understand the function and centrality of religious belief for those who are committed to it. On point, a reader and commenter over at ExGayWatch named “jasmine” linked to a blog post by Hugo Schwyzer who in turn linked to an article by ex-LA Times-religion-writer William Lobdell. Mr. Lobdell has experienced a crisis of faith and no longer views himself as a believer.

In his reflections on Mr. Lobdell, Schwyzer notes that his (Schwyzer’s) response to evil in the church has not been to turn away from God. Through this awareness, he wonders if indeed there is something involuntary about belief. Some things just seem right and make sense. I have had a similar sense throughout my adult life. I know there are inconsistencies in my beliefs but I have tried on many other worldviews and have found them full of cognitive inconsistencies as well. It does not seem like my beliefs are chosen as if from a menu. To me, it seems like our brains are wired to believe but not wired well enough to find a system without holes. For folks with religiously based conflicts over sexual behavior, the conflict can be excruciating in that here are two realities, each of which seems given but at odds. The process of resolution for some folks is a dynamic, fluctuating process that may leave some aspects of both worlds intact and others modified. I suspect that the results seem less like a choice and more like a water moving to the lowest level – does water have a choice? For others, the resolution may come in a series of revelations, each with what seems like a new perspective. Sometimes, these moments are so vivid, they seem like the awareness must be the divine intruding and are certainly not experienced as a choice. In any case, I am only scratching the surface and am speaking descriptively and not prescriptively.

Suffice to say, as I experience religious belief and as it has been described to me by numerous clients, friends and colleagues, such beliefs are often not experienced as mutable or negotiable. I do not say this to say, I am comfortable with this. Some religious beliefs are not healthy in my view. However, to trifle with them as if they can be switched on and off is, in my not completely chosen opinion, to misunderstand how the religious mind works.

Sexual identity therapy: What it is and what it isn’t

There is lots of discussion occuring on various blogs/media sources about the sexual identity therapy framework. I want to link to a couple and comment.

Two threads at ExGayWatch involve the framework. One is an open forum triggered by my appearance on CNN with Dr. Benjamin McCommon and the other references Peterson Toscano’s statements about what change is and isn’t. It appears that many observers want to link the framework with reparative therapy which is a clear misunderstanding. I invite you to go on over and read the comments there. However, I will say here that if therapists tell clients why they have same-sex attraction as a precursor to therapy or engages in confirmatory questioning (e.g., “many men who are attracted to the same sex say they were distant from their fathers, what was your relationship with your father like?”), then they are not operating consistently with the framework. Furthermore, we do not focus on change of orientation, but rather living a valued and congruent life. Success is not measured by moment by moment assessments of attractions but rather by satisfaction with the help received. People may indeed change if there are clear links from past experience to present unwanted behavior (ask Joe Kort about this) but that is not initial focus of the framework.

Speaking of Joe Kort, he had a go at the framework as well. Beginning on a positive track, the train derailed quickly when he said:

The problem is that when you read on both Throckmorton and Yarhouse talk about homosexuality as being able to be changed. Like reparative therapy they promise to make straight soldiers out of homosexual men.

and then near the end of the post:

I do wish Throckmorton and Yarhouse would stop promising to change peoples sexual and romantic orientation.

Puzzled, I am. In fact, here is what we say in the framework:

Prior to outlining the recommendations, let us define what they are not. They are not sexual reorientation therapy protocols in disguise. Although some investigators (e.g., Spitzer, 2003) have attempted to examine sexual orientation change, numerous criticisms have been leveled at client self-report as a means of assessing such change. Currently, no other means of sexual orientation assessment has found wide acceptance. A consensus about accurate assessment and measurement of sexual orientation would be required in order to empirically test therapies purporting to produce sexual orientation change. At present, such consensus does not exist (Kinnish, Strassberg & Turner, 2005).

Current assessment methods do allow us to ask clients about their perceptions of sexual identity during psychotherapy. Furthermore, we have tools that assess overall client well-being, mental health and satisfaction with how therapy is conducted. To varying degrees, some clients may come to believe change has occurred in their sexuality while some will believe little or no change has occurred. These perceived changes can be examined but we do not view such change as a determinant for the success or failure of sexual identity therapy. Instead, client satisfaction and overall mental health improvement are more efficiently assessed. In any case, we believe guidelines are needed for therapy with clients who experience sexual identity conflict no matter what their beliefs are about sexual orientation and whether it can be altered.

Joe, you had your wish before you made it.