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Effects of Scope of Service and Reimbursement on Access to Mental Health Services in Rural Areas
Mental health professionals are differentially distributed in rural and urban areas, with psychiatrists and Ph.D. level psychologists tending to practice in urban and suburban areas, leaving mental health professionals with master's level preparation or less as the most readily available mental health providers in most rural areas. The availability of mental health services is further affected by scope of practice laws and reimbursement rules. Each state determines by statute what services can be provided by each of the five core mental health professions. Within the framework of state scope of practice laws, both public and private insurers have adopted a variety of rules regarding reimbursement for services provided by different types of mental health professionals. This study will investigate how scope of service and reimbursement policies affect the availability of mental health services in rural areas.
We will document which services are included in the scope of practice for each of the five core mental health professions in all states with substantial rural populations. For a subset of these states, we will document the geographic distribution of each of the five core mental health professions and determine which services Medicaid, Medicare and selected commercial insurers will reimburse for each.
Publications
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State Licensure Laws and the Mental Health Professions: Implications for the Rural Mental Health Workforce
Author(s): David Hartley, Erika C. Ziller, David Lambert, Stephenie L. Loux, Donna C. Bird
Report Number: Working Paper No. 29
Date: 05 / 2002
Investigates whether and the extent to which licensure laws that determine the permissible scope of practice for each of these professions may affect the availability of mental health services, particularly in rural communities. Findings: Licensure laws authorize non-physician mental health providers to practice assessment, treatment planning, and individual and group counseling independently in most of the 40 states studied. Many states do not explicitly grant the authority to all of these professions for diagnosis or psychotherapy, but none explicitly deny it. Despite this finding, Medicare and some other payers do not directly reimburse Marriage and Family Therapists or Licensed Professional Counselors. Laws that require clinical supervision of newly trained practitioners to be performed exclusively by a member of the profession in a face-to face setting may make it difficult for a new graduate seeking rural practice to log the number of required hours within the specified time limit to qualify for independent practice. Some states' laws allow supervision that is not face-to-face, a rural-friendly policy. Also discussed are the nature and effects of guild behavior in the mental health professions. Based on the findings, report recommends that states simplify licensure and clarify clinical roles by combining regulatory functions for several professions into a single office or agency; that Medicare reconsider its position on reimbursing Marriage and Family Therapists or Licensed Professional Counselors; that professional competition over the right to practice and be reimbursed be addressed; and that supervision requirements be modified to allow new mental health professional graduates to address rural needs soon after graduation.
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