Last December, the AMA submitted a statement to the Subcommittee on Health of the House Committee on Ways and Means, opposing H.R. 6092, a proposed bill to expand Medicare and Medicaid benefits to include direct payment for services of “mental health specialists”. The term was defined to include licensed or certified clinical psychologists, clinical social workers, and psychiatric nurse specialists, as well as psychiatrists.
The relevant paragraphs of the AMA statement are as follows:
“The American Medical Association opposes H.R. 6092 as being both unnecessary and inappropriate. Passage of this legislation would allow individuals lacking medical skill and training to serve as the first entry point to care for Medicare and Medicaid beneficiaries with mental or emotional disorders. While individuals trained as ‘mental health specialists’ may perform psychoanalytical functions, all but the physician, frequently a psychiatrist, lack the expertise to identify or treat a mental health problem that is caused by a medical condition. In addition, the medical doctor is the only individual listed among those that the bill would classify as ‘mental health specialists’ who is qualified by training and law to treat a medical condition that is either co-existing or causing the mental or emotional problem.”
Mr. Ross N. Rubin, Director of the AMA's Department of Federal Legislation, stated in response to Newsletter questioning, that although the AMA does not make official policy statements on private insurance coverage, it would be consistent to presume that the principles enunciated regarding H.R. 6092 would be applicable to all insurance coverage. He stated that the AMA would not likely object to coverage for nonphysician services, providing the patient were referred for therapy by a physician and if the treatment were under the supervision of a physician.
Since Medicare, Medicaid, and other Federally financed insurance programs often act as bellwethers for private insurance programs, this publically stated opposition to reimbursement of psychotherapy conducted by nonmedical therapists may have widespread repercussions, if successful. Particularly, it may introduce a new element into our Association's consideration of providing clinical training for nonmedical candidates.