1. Lorrie McCann, LMHC 239-273-1119 lmccann@flmhca.org WHY ADVOCACY? WHY NOW?

2. 1)Determine why advocacy is important. 2)Develop an understanding of the current situation. 3)Develop an understanding of issues at the national and state levels. 4)Develop an understanding of grassroots advocacy. OBJECTIVES

3. To develop an understanding and interest in advocating for the counseling profession. GOAL

4.  My Story  Florida which has the highest percentage of individuals age 65 and older in the country.  There is a desire to work with those clients age 65+ who are covered under Medicare  Mental health professionals specialize in working with geriatric populations and disorders related to aging.  The shrinking job market for LMHC’s  Employer reluctance to hire LMHC’s in areas with high Medicare populations POLITICS

5.  August 14, 1935: Insurance was excluded in a Social Security Act.  January, 1943: President Roosevelt declares insurance be “from the cradle to the grave” in his State of the Union address.  July 30, 1965: Amendment to Social Security Act signed into law by President Johnson under Title XVIII of the Social Security Act stating psychiatrists were the only mental health providers reimbursed under this provision.  1984: Hospice  2003: Prescription drug benefits  1989: Psychologists and LCSW’s approved as Medicare providers HISTORY OF MEDICARE LEGISLATION

6.  Reintroduction of bills in 2015  Senate Bill 1830: Introduced by Senators Ron Wyden (D-OR) and John Barrasso (R-WY).  House Bill 2759: Introduced by Representatives Chris Gibson (R-NY) and Mike Thompson (D-CA). SENIOR MENTAL HEALTH ACCESS IMPROVEMENT ACT

7.  AMHCA is scanning the legislative environment to find a bill to include our Medicare Provider Status as an amendment.  In response to gun violence there are bills in the House and Senate that seek to reform mental health services. STRATEGY AMERICAN MENTAL HEALTH COUNSELOR ASSOCIATION

8.  The Helping Families in Mental Health Crisis Improvement Act – the “Murphy Bill.”  Sponsored by Rep Tim Murphy (R-PA) provides for a reform of mental health care- currently in committee.  AMHCA is seeking to add our bill as amendment to this or other key legislation. STRATEGY CONT. AMERICAN MENTAL HEALTH COUNSELOR ASSOCIATION

9.  ACA adds millions of beneficiaries through Medicaid expansion and health exchanges.  Parity will increase those seeking care for substance abuse and mental illness.  Shift to Accountable Care Organizations (ACO’s)  Integrated care model designed to focus on managing healthcare and improve outcomes.  ACO’s focus on preventing illness rather than treating the disease  Creates an opportunity for LMHC’s, however not if we are excluded.  Trial ACO’s demonstrating cost savings!  Medicare exclusion will be a major barrier for LMHC’s seeking participation in ACO’s as integrated networks become way of managing healthcare. MEDICARE PROVIDERS STATUS

10.  According to the Institute of Medicine (CBS News, 7/11/12), at least 5.6-8 million Americans age 65 and over suffer from a mental health or substance abuse disorder.  Dr. Peter Rabins, a psychiatrist at Johns Hopkins, states the senior population should double by 2030.  Dr. Ken Duckworth, of the National Alliance on Mental Illness, stated the coming need for geriatric mental healthcare “is quite profound for us as a nation.” MENTAL HEALTH AND SENIORS

11.  Untreated depression impacts the management of diabetes,hypertension, and other health problems.  Co-morbidity among individuals with depression and heart issues.  Individual with depression are more likely to comply with treatment and have poor outcomes, including death.  Higher prevalence of grief among senior population as individuals retire and lose friends, spouse, and health. KEY ISSUES FOR SENIORS

12.  One third of alcoholics develop a problem later in life.  Heavy drinking is defined by 2 or more drinks per day.  In community based study, approximately 6% of individuals age 60-94 met this criteria.  Bereavement and retirement may trigger late onset drinking.  The effects of alcohol at the cellular and organ level are more significant due to the physiological affects of aging.  Increased risk for falls.  Decreased cognitive dysfunction.  Drug Interactions.  Immunosuppression leading to increase risk for pneumonia. SUBSTANCE ABUSE AND THE ELDERLY

13.  Mental Health Counseling, Social Work, and Marriage and Family Interns have an unlimited time to obtain licensure under the 491 Regulatory Board statute.  33% of all disciplinary actions presented to the Board are from long term interns.  As of 2013, there were 697 interns from all 3 disciplines who were practicing for more that 10 years without achieving licensure.  Purpose is to limit internships to 5 years. STATE ISSUES RMHI HB373 S858

14.  HB 373 sponsored by Rep Burgess (R- Pasco) has moved successfully through three committees of reference  S858 sponsored by Senator(R- Pasco/Hillsborough) Legg is beginning the committee process  As an alternate strategy  Rep Harrell (R- Vero Beach area) added RMHI language to major mental health overhaul bill FMHCA STRATEGY

15.  Do your research – learn about key issues.  Join professional organizations at a local, state, or national level.  Do more than pay dues, get involved!  Be persistent, be respectful.  Use the advocacy tools provided by your professional organizations.  Write letters  Let Your Voice Be Heard LET YOUR VOICE BE HEARD

16. “The universe doesn’t give you what you ask for with your thoughts; it gives you what you demand with your actions.” -Dr. Steve Maraboli WHY ADVOCACY? WHY NOW?

17.  AMHCA Website www.amhca.orgwww.amhca.org  FMHCA Website www.fmhca.orgwww.fmhca.org  U.S Senate www.senate.govwww.senate.gov  US House of Representative www.house.govwww.house.gov  Macchio A, Monte S, Pelligrini F et al: Depression Worsens Outcomes in Elderly with HF: European Journal of HF, 2008;10:714-721  Gardner A: Aging Baby Boomers Mental Health Woes Will Swamp Health System: US News & World Report, 7/10/12  Rigler S: Alcoholism in the Elderly: American Family Physician; 2000 Mar 15: 170-1716 RESOURCES