Monthly Archives: June 2015

TRICARE Congressional Conference Committee MONDAY — Letters Needed

[Posted for LCPCM and Concerned Counselors]

Dear Colleagues:

On Monday, the 22nd, a Congressional Conference Committee will be meeting to decide whether ALL Mental Health Counselors will be able to see TRICARE beneficiaries, irrespective of whether they went to a CACREP School. The American Counseling Association advocated for a special provision in the National Defense Authorization Act that would grandfather ALL Mental Health Counselors as independent providers who possess 5 years of clinical experience. This grandfathering period would last 10 years.

This is a VERY IMPORTANT precedent and I am asking every member to take a moment on Monday to send an email to a specially created listserve below that emails every legislative director involved in the conference committee. I need you to write a brief statement telling Congress why CACREP should not be used as the sole criterion to select providers for TRICARE. I fear if we do not stand strong now, the use of CACREP as a selection criterion for insurance reimbursement will seep into MEDICARE and other insurers.

It is a heavy burden to serve as President of our state association while knowing that many of us could face employment and insurance discrimination in the future if we do not act concertedly now to address this threat. I want to do everything possible on my watch to stand up for our profession in Maryland, but I need your help. Thank you for taking a moment to email these legislative staffers. You could make a difference in securing the profession we love into the future.

tricarecounseling@concernedcounselors.org

Larry Epp, President

Licensed Clinical Professional Counselors of Maryland

PS – I have attached a letter with some language you can borrow for your email. Your email does not have to be long to be effective. Short, passionate statements can be effective.

[Please see the sample letter at the following URL and PLEASE modify it to be personal: http://www.concernedcounselors.org/wp-content/uploads/2015/06/LCPC-letter-to-Congress-6-19-151.docx ]

Letters Needed to Expand TRICARE Eligibility

The House and Senate will meet in conference shortly to work out differences to their versions of the National Defense Authorization Act.

We need language in The Special Rule adopted in H.R. 1735 would allow qualified mental health counselors who hold masters or doctoral degrees in counseling from institutions accredited by other than CACREP to receive TRICARE reimbursement for services provided to veterans and their families through 2027.

This language is not currently in the Senate version.

Letters sent to the following email address will distribute your letter to all the legislative directors serving the Congressmen and Senators involved in this process:

tricarecounseling@concernedcounselors.org

This is not a discussion list – it only exists for a short time in order to email the right Congressional senior staff.

Please consider using elements of the following modified letter which is written to a group rather than to individual members of Congress.

Letter to all legislative directors and their Senators and Congressmen

We strongly recommend that you modify this letter or write your own to include specific examples of how you have served military members, families, and veterans.  Personalize your story.

You are more than welcome to write individual members – please see our last post for the list of names and contacts, as well as an individual member letter format.

Thanks

TRICARE CACREP Advocacy Alert – Highest Importance

Click here for a sample letter in Word .doc format

Click here for where to send letters (.xlsx Excel format)

[Posted for Licensed Clinical Professional Counselors of Maryland and all Concerned Counselors everywhere.]

This is a very urgent request. Please distribute this important information to all LCPC members, Counseling Psychology professors, students, and all interested parties. Thank you!

Even if you do not work with TRICARE beneficiaries, please still advocate for those who do. How the TRICARE eligibility language for LCPCs is written could impact how the MEDICARE eligibility language is written; and this could have a vicious trickle down affect into private plans who follow MEDICARE’s policies, if CACREP restrictions are retained.

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Dear Colleagues:

I hate to ask you second time in a month for your help, but I really need it. As you may have heard, the American Counseling Association lobbied for more inclusive language in the National Defense Authorization Act that would allow all LCPCs with 5 years of experience to be Independent TRICARE providers. This change would lift the CACREP restrictions until 2027.

I need you to email the staffers of the legislators listed below to tell them why CACREP only language excludes highly qualified providers from serving members of the military and their families.

Even if you do not work with TRICARE beneficiaries, please still advocate for those who do. How the TRICARE eligibility language for LCPCs is written could impact how the MEDICARE eligibility language is written; and this could have a vicious trickle down affect into private plans who follow MEDICARE’s policies, if CACREP restrictions are retained.

I can’t overstate enough how important this request is for protecting our practice rights into the future. I have attached model language for your email, provided by our federal lobbyist, Ellin Nolan. Please tweak it as you need to, or simply send an email from the heart. These are usually the most powerful. I also attached a list of the emails of the staffers of the key legislators.

If you only email a couple of staffers, this will make a big difference.

Thank you for your advocacy. Please take a moment to send an email or two, it will make a world of difference to your profession.

Larry Epp, Ed.D., LCPC

President, Licensed Clinical Professional Counselors of Maryland

 

Senator John McCain (R-AZ)—Chairman

Senator Jack Reed (D-RI)-  Ranking Democrat

Senator James Inhofe (R-OK)

Senator Kelly Ayotte (R-NH)

Senator Clair McCaskill (D-MO)

Senator Jeanne Shaheen (D-NH)

Senator Kirsten Gillibrand (D-NY)

Senator Mazie Hirono (D-HI)

 

Congressman Mac Thornberry (R-TX)  Chairman

Congressman Adam Smith (D-WA)

Congressman Rob Bishop (R-UT)

Congressman Jim Langevin (D-RI)

Congresswoman Niki Tsongas (D-MA)

Congressman Seth Moulton (D-MA)

Congressman Donal Norcross (D-NJ)

Congressman Frank Lobiondo (R-NJ)

 
Click here for a sample letter in Word .doc format

Click here for where to send letters (.xlsx Excel format)

CACREP Update–Restricting the Practice of LCPCs

[Posted for Larry Epp — President of Licensed Clinical Professional Counselors of Maryland]

Dear Colleagues,

As President of the Licensed Clinical Professional Counselors of Maryland, I do not usually reach out to you on a professional issue unless it is very important. Some of you may have been following the developments with the accrediting agency, CACREP, whose supporters have been trying to restrict the practice of LCPCs who have not attended their accredited programs in the Commonwealth of Virginia.

Right now, supporters of this organization have instituted a campaign to close practice in Virginia to LCPCs from non-CACREP schools, counseling psychology, school psychology, clinical psychology, art/creative therapy master’s programs in seven years. While veteran LCPCs from Maryland can transfer their license to Virginia as the laws are currently constructed, the underlying concern is that the CACREP restriction will enter insurance regulations such as in Medicaid, Medicare, and private insurance plans, as has already occurred in Tricare, the Veterans Administration, and Department of Defense schools and programs.

Those who believe in the CACREP only standard have an ideological belief in separating psychology from counseling to create a pure and independent “mental health counseling profession.” Whatever the merits or pitfalls of their argument, the fact is that the changes they are promoting could potentially restrict the practice of many Maryland LCPCs in the future, especially if their thinking enters the recently introduced Medicare Bill on Capitol Hill or in the qualifications to practice in a Federally Qualified Behavioral Health Center under the Excellence in Mental Health Act. I do not have a crystal ball to know what will happen precisely, but this movement is certainly concerning and demands a response from those who favor the protection of existing practice rights and greater inclusivity in the future.

I urge you to weigh in on this important issue. I have attached the link below to the Virginia Board of Counseling’s website, who is for 30 days accepting comments on this issue. Virginia is a battle ground state, as it was one of the first to license professional counselors; and it is the headquarters for three national counseling associations. Thank you for considering my suggestion.

Larry

Here is the Virginia Board comment area that can be found online:

http://townhall.virginia.gov/L/comments.cfm?stageid=7071

Virginia Protest Letter Help File and Background

Your assistance is needed to defeat proposed CACREP-only regulations for Virginia licensing.  The Virginia Board has posted a NOIRA (Notice of Intended Regulatory Action) for public comment, after which it will likely issue new CACREP-only license regulations.

The purpose of the proposed regulation states: To require graduation from a clinically-focused counselor preparation program accredited by CACREP or an approved affiliate of CACREP that includes a minimum of 60 semester credits (90 quarter hour credits) of curricular experiences and a practicum of at least 100 hours and an internship of at least 600 hours.  Allow a grandfathering of programs that meet current requirements for seven years from the effective date of the regulations.

Virginia is a particularly vulnerable state because it has far more than usual CACREP accredited programs. There are a few carrots being thrown to the non-CACREP counselors.  One is the 7 year grandfathering period.  After which the doors will be slammed on non-CACREP counselors in the state.  Another is that apparently Virginia does have some sort of process for accepting non-CACREP counselors licensed in other states wishing to move to Virginia.   These carrots are helpful, but really only soften the blow that CACREP is being forced as the superior standard and only standard.  One is also left to wonder at what point the regs allowing out-of-state transfers with non-CACREP backgrounds will be tightened?

Suggested Letter Text:

Please write your own letters, and feel free to cut and paste selections from the suggestions below into your letters.

“Counseling” vs. “Counseling Psychology”

The NOIRA states: “In recent years, the Board of Counseling has worked towards greater professional identity for counseling to help the public understand the clinical services a licensed professional counselor is qualified to provide… the Board continues to review applications for licensure from students whose educational programs are not clearly “counseling” in their identity. The lack of clarity in its regulations has been frustrating for the Board and very problematic for some applicants who have obtained a post-graduate degree that may or may not qualify them for a residency and ultimately licensure”

This innocent-sounding section of the NOIRA appears like it is about professional identity and qualification for licensure.  It would actually seem to be about the ongoing crusade of CACREP advocates to forcibly excommunicate graduates of “counseling psychology” masters programs in favor of “counseling” masters program graduates. One of the primary problems with CACREP is the inability of counseling psychology programs to obtain accreditation under CACREP. The differences, if any, between “counseling psychology” and “counseling” programs quickly fall apart upon examination.  The theories and techniques of “the talking cure” are the same regardless of label.  Most counseling psychology programs utilize the ACA ethics code in coursework (and the APA code is not that different).  There may perhaps be a greater reliance upon testing and medical model in some counseling psychology programs (some would applaud this).  CACREP advocates would like the American Psychological Association (APA) to rescue masters-level counseling psychology graduates (they only license at the Ph.D. level).  Counseling psychology graduates have been licensed as professional counselors and members of the ACA since the beginning.  This is in part a ridiculous petty squabble between Ph.D. level counselor educators versus Ph.D. psychologists dating back decades. Regardless – from the point of view of the public good – this has absolutely nothing to do with competence or public safety, but has great potential to impact the numbers of available counselors.  Booting “counseling psychology” graduates out of the licensing pool for Virginia in no way helps Virginia! (It’s doubtful that even professional identity is seriously different as counseling psychology graduates have always considered themselves professional counselors.)

Factual Corrections to the NOIRA (NOIRA original text in italics.)

“CACREP was established in 1981 to achieve some consistency in counseling educational programs.”

– True.  CACREP spent much of its early history accrediting school counseling (school psychology at one point) and has only accredited larger numbers of mental health counseling programs recently.  In fact CACREP is still in the process of converting even CACREP-accredited 48-credit Community Counseling programs to their newer 60-credit CMHC standard (see http://www.cacrep.org/for-programs/ ).  The point being that when CACREP indirectly gives the impression that they are a very old and very established standard, this is not the case.

“CHEA recognition also assures the public that the programs that achieve CACREP accreditation are legitimate degree programs”

– The majority of non-CACREP programs in this country are also regionally accredited by CHEA and must maintain high quality standards.  This sentence implies that non-CACREP programs are usually not CHEA accredited and are illegitimate.

“One of the goals of CACREP is to establish a uniform set of educational requirements across the United States to facilitate portability of licensure from state to state.”

– True, but other methods of state-to-state portability would include an interstate agreement between the member Boards of AASCB, a simple choice to recognize out-of-state licensed counselors, or even CACREP-equivalent coursework and preparation.

“Three federal agencies have made graduation from a CACREP accredited program a requirement for independent practice in counseling.”

– This is not a reason to make the same mistake elsewhere.  Such requirements place a burden on counseling business owners and on clients who are looking for easy access to counselors in their communities.

“With a large military presence in Virginia, there is a need to equate graduation from a CACREP-accredited program with licensure to avoid public confusion and give licensees access to federal agencies.”

– This is exactly what should NOT happen for the good of both counselors and the public. Thousands of competent seasoned non-CACREP counselors throughout Virginia face increasing public confusion as to their competence.  A public which expects CACREP (despite no evidence of its superior quality) will start demanding CACREP and start discriminating against counselors without this accreditation in their past.  This will result in lack of employment for non-CACREP counselors even in situations where they are licensed and eligible to help with our burgeoning mental health community needs.  The likelihood of public confusion of CACREP with license eligibility and with competence is exactly why grandfathering provisions for non-CACREP counselors fall short of acceptable.

“The Board of Counseling has found that it has neither the resources nor the expertise to examine counseling programs across the country to assess the quality of the education in that program.”

– Plenty of Boards across the country do just this.  They typically require regional CHEA accreditation (for quality) and then require coursework in a variety or required categories.  Sometimes they choose to look for “CACREP-equivalency”.  When state Boards cede control of their standards to an outside entity they lose control over serving the needs of their state constituents.  Furthermore, several professions have two or more recognized accrediting authorities.  With variety comes a greater opportunity for a diversity of training to ensure a flexible and responsive (counseling) workforce for the unique needs of individual clients.  The Virginia Board might also avail itself of discussions amongst the various state Boards at the AASCB association – in which case it could at least have a strong voice in whatever national standards are enacted for standardization and license portability.

“Consistency and quality in educational preparation for professional counselors will provide greater assurance to clients seeking their services that they have been adequately prepared and appropriately licensed to protect public health and safety.”

– CACREP advocates have created a mostly false narrative of a public endangered by poor quality counselor preparation.  No doubt they can find isolated examples of such.  There is no epidemic of poor quality counselor preparation – controls and standards are already in place to protect the public without locking down the profession to one privately controlled gatekeeper.

Requested Public Participation in the NOIRA: The agency is seeking comments on this regulatory action, including but not limited to 1) ideas to be considered in the development of this proposal, 2) the costs and benefits of the alternatives stated in this background document or other alternatives and 3) potential impacts of the regulation. The agency is also seeking information on impacts on small businesses as defined in § 2.2-4007.1 of the Code of Virginia. Information may include 1) projected reporting, recordkeeping and other administrative costs, 2) the probable effect of the regulation on affected small businesses, and 3) the description of less intrusive or costly alternatives for achieving the purpose of the regulation.

Costs of the NOIRA proposal include the nearly $4500 in program application fees, and $2600+ annual maintenance fees charged to each CACREP accredited program (see http://www.cacrep.org/for-programs/cacrep-accreditation-fees/ ) which are paid for in some fashion by state school budgets, counseling students, and ultimately the public. Costs are also paid in terms of flexibility of curriculum in a field with MANY theories of psychology, loss of employment opportunities in CACREP programs for educators with slightly different qualified backgrounds than Ph.D.s in counselor education, and locking counseling psychology graduate students out of future licensure for no discernable reason related to competency to the public good. The future effects of CACREP on small businesses are murky and troubling. Many counselors in private practice are sole proprietors or at small clinics which would qualify as small businesses.  In the short-term under this proposal, these non-CACREP counselors will continue to be licensed and new graduates will be license-eligible until 2022.  However, the CACREP-only push creates a false perception of CACREP quality that is likely to impact these small businesses in the future.  The public may look for CACREP graduates in the false belief that they are more qualified.  Government programs (and private insurers?) may follow the bad TRICARE example and start requiring CACREP for licensure.  Employers may start only hiring CACREP graduates.  There is a potentially devastating longer term effect on small clinics and sole proprietors at risk of being cut out of the market. To the extent that non-CACREP counselors are cut out of the market, the public may experience counselor shortages or have to settle for newer counselors with less experience. Other Points: A careful look at the data will reveal that counselors who have graduated from CACREP programs are not more effective in their work with clients or in their service to their communities. A regulation limiting practice will not serve the people of Virginia well given that a majority of master’s level counselor training programs in the USA are not CACREP-accredited. A regulation limiting practice will not serve clients in Virginia given that the majority of currently practicing counselors graduated from schools free of CACREP accreditation. A restriction such as this would negatively impact current students and alumni from non-CACREP affiliated VA programs; negatively impact the public by reducing access to qualified counselors; negatively impact relocation of qualified and competent counselors from non-CACREP programs; reduce overall services available to VA residents; and increase cost of graduate education. Even the American Counseling Association (ACA), the largest national counseling association, opposes the CACREP-only restrictions highlighted in the rationale for this regulatory change. The people of Virginia need a strong Board that protects their rights to access quality mental health care.

Comments Needed Against Virginia CACREP-Only Regulations for Future Licensed Counselors!

Dear LCPCM Members:

Virginia is about to enact a regulatory change that would only permit CACREP graduates the right practice mental health counseling in the Commonwealth of Virginia. If you disagree with this regulatory change, the Virginia Board of Counseling is accepting comments for 30 days at
http://townhall.virginia.gov/L/comments.cfm?stageid=7071

Veteran practitioners are generally given reciprocity in Virginia after practicing for 5 years in Maryland, but the greater concern is the potential negative perception of non-CACREP and counseling psychology graduates that may follow this change. It seems to emphasize an unproven belief that non-CACREP and counseling psychology graduates are inferior in their educaitonal preparation.
Larry Epp, LCPC

President, LCPCM