misperception, federal law does not recognize marriage and family therapists as qualified professionals for employment in schools (D. M. Bergman, personal communication, March 1, 2001). This perception has implications for reimbursement as well. Reimbursement
According to 42 USC §1395 x (aa)(1), neither Medicare nor Medicaid will reimburse marriage and family therapists in rural health clinics. This federal law, which provides Medicaid and Medicare reimbursement to mental health services in rural health clinics and federally qualified health centers, has a very specific roster as to who will be reimbursed. This exclusion may be a major access barrier for rural residents who are beneficiaries of these public insurance programs. This exclusion also applies to Licensed Counselors. Medicare, in fact, will not directly reimburse these two professions in any setting. This potential access barrier is directly addressed by a bill currently being considered in the U.S. Congress, known as the Seniors Mental Health Access Improvement Act (H.R. 3899, 2002).
In addition to Medicare/Medicaid and the rural health clinic provision, reimbursement from third parties is as a major obstacle for the marriage and family therapist according to Patricia Stevens-Smith. Dr. Smith claims that the majority of third party payment sources base their payment criteria upon the Diagnostic and Statistical Manual of Mental Disorders (DSMIII-R, or DSM IV). Although marriage and family therapists treat many individuals, Dr. Smith explains that this assessment and diagnosis model is individually oriented, and is therefore contrary to the holistic wellness philosophy of the marriage and family theory and a disadvantage for reimbursement for any family therapy (Stevens-Smith, 1993).