private employers and perform functions similar to those in agency settings. The number of ACA members who identified themselves as working in a school setting declined between 1990 and 2000, from 30 to 23 percent while the number of members who reported themselves to be in private practice increased from 25 to 31 percent over the same time span (Locke, Myers & Herr, 2001). Current Issues License Portability
Although an important issue for all mental health professionals, portability of licensure between states is a particular concern for professional counselors. By portability, we mean the degree to which a professional licensed in one state can move to another state and be eligible for licensure in their new place of residence. According to one source, “credentialing and occupational mobility in the counseling profession are among the most pressing national and international issues facing the growing profession” (Anderson & Swanson, 1994). Counselors face unique challenges to license portability compared to other mental health professionals because of the differences in state certification and licensure requirements across the country (Anderson & Swanson, 1994). As noted above, even the titles that states use to identify professional counselors through the licensing process may differ dramatically between states. Insurance Reimbursement
For professional counselors working in mental health agency settings or in private practice, the ability to secure third-party reimbursement for services is critical. A number of states require that insurance companies must reimburse professional counselors for services that they cover when rendered by other professionals (Remley & Herlihy, 2001; Strosnider & Grad, 1993). However, while these “vendorship” or “freedom of choice” laws are beneficial for professional counselors, their effectiveness can be limited if the plans that cover state residents are from out-of-state or come from self-insured employers (Strosnider & Grad, 1993). In most states insurance companies can decide themselves whether or not they will reimburse professional counselors and, although many choose to cover their services, this is by no means uniform (Remley & Herlihy, 2001).
Scope of practice legislation can affect the ability of professional counselors to gain reimbursement for third party payers. In order to be able to bill an insurance company, a professional counselor needs to be able to submit a diagnosis on the insurance forms (Anderson & Swanson, 1994). As Table 5 indicates, diagnosis is only explicitly defined to fall within the scope of practice for professional counselors in 19 of the 36 states that we reviewed that license them. In some states where diagnosis is not explicitly permitted, professional