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to provide five core mental health services: assessment, diagnosis, treatment planning, individual and group counseling, and psychotherapy. Since prescriptive authority had not been granted to any of these professions at the time of our study, this function was excluded from our analysis.

FINDINGS

  • 1.

    Licensure laws authorize psychologists, social workers, marriage and family therapists and licensed professional counselors to practice assessment, treatment planning, and individual and group counseling independently in most states. Many states do not explicitly grant the authority to social workers, MFTs or LPCs for diagnosis (SW: 10, LPC:14, MFT:9) or psychotherapy (SW:9, LPC:20, MFT: 8), but none explicitly deny it.

  • 2.

    The purpose of state licensure laws is to determine who is qualified to practice, not who is eligible for reimbursement. A few states (e.g. Missouri and North Carolina) explicitly deny the use of scope of practice laws as a mandate for third party reimbursement.

  • 3.

    Laws that require supervision to be performed exclusively by a member of the profession in a face-to face setting may make it difficult for a new graduate to log the number of required hours within the specified time limit to qualify for independent practice.

  • 4.

    A few states explicitly allow supervision that is not face-to-face, such as use of tele-health technologies or telephone (Colorado and Kansas for LPC and MFT; Wyoming for Psychologists). Perhaps more importantly, a few states have recognized the negative effect on access to care of competition among the mental health professions, and have placed explicit language in statutes or rules encouraging collaboration and cooperation among the professions. Most notable are states that have consolidated the oversight of these professions into a single board (NH), or a single mental health practices act (UT). Other policies that may achieve this end include allowing supervision by members of other professions (ID, KY, NC, NH, SD, TN, UT, and WA) and encouraging collaboration with other professionals as part of the continuing education requirements (NH).

RECOMMENDATIONS

  • 1.

    States can simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency. A first step toward this end is either combining Marriage and Family Therapy and Licensed Professional Counseling into a single board, or creating a mental health professional practice act, as Utah has done, that addresses all mental health professions.

  • 2.

    State licensure laws do not support payers who choose not to reimburse Marriage and Family Therapists or Licensed Professional Counselors for essential mental health services. For example, while eight states do not explicitly grant MFTs the right to practice psychotherapy, nine do not explicitly grant that privilege to SWs. Yet Medicare chooses to reimburse SWs but not MFTs. This evidence suggests Medicare should reconsider its

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