Louisiana's Similar LPC Battle
In the wake of Michigan's fight for LPC's, Louisiana has gone through a similar struggle
For now, Medicaid reimbursement is supposed to remain available for private practices, but not Federally Qualified Health Centers
A quick legislative decision caused LPC services to be considered "non-covered" perhaps setting the precedent for Michigan's legislative move
In the wake of Michigan's fight for LPC's, Louisiana has gone through a similar struggle. Earlier this year, the Louisiana Department of Health says it was made aware of a change on July 1, 2019, affecting Federally Qualified Health Centers. The State of Lousiana is citing federal requirement 42 CFR 405.2411(a) from 2014 as the legal justification for tripping up Medicaid reimbursement for LPCs that provide school-based therapy.
42 CFR 405.2411(a) states:
§ 405.2411 Scope of benefits.
(a) The following RHC and FQHC services are reimbursable under this subpart:
(1) The physicians' services specified in § 405.2412.
(2) Services and supplies furnished as an incident to a physician's professional service.
(3) The nurse practitioner or physician assistant services specified in § 405.2414.
(4) Services and supplies furnished as incident to a nurse practitioner, physician assistant, certified nurse midwife, clinical psychologist, or clinical social worker service.
(5)Visiting nurse services when provided in accordance with 1861(aa)(1) of the Act and § 405.2416.
(6)Clinical psychologist and clinical social worker services as specified in § 405.2450.
(b)RHC and FQHC services are -
(1) Covered when furnished in a RHC, FQHC, or other outpatient setting, including a patient's place of residence;
(2) Covered when furnished during a Part A stay in a skilled nursing facility only when provided by a physician, nurse practitioner, physician assistant, certified nurse midwife or clinical psychologist employed or under contract with the RHC or FQHC at the time the services are furnished; and
(3) Not covered in a -
(i)Hospital as defined in section 1861(e) of the Act; or
(ii) Critical access hospital as defined in section 1861(mm)(1) of the Act.
The debate over the scope of benefits for an LPC continues to be a sticking point for state legislations across the country.
For now, Medicaid reimbursement is supposed to remain available for private practices, but not Federally Qualified Health Centers.
The Louisiana Department of Health says the state's Medicaid program values the work of Licensed Professional Counselors, but it's locked in its position because of federal law. Until it's received the guidance it asked for, the state says Medicaid can't make the reimbursements. The federal government allows Medicaid to pay for these services in schools, mental health clinics and in private practices but not in FQHC's.
According to Megan Lofland (a LPC in Lousiana), "If FQHC's become a Licensed Behavioral Health Service Provider, it would only allow LPC's to bill for skill-building, not therapy, and the reimbursement isn't the same."
She also reported that her organization is still seeing patients but they have yet to be paid for these services according to an interview that she did with WBRZ 2.
The interview can be found here.
So, how does this situation compare and contrast with the current Michigan situation?
Scope of Practice
In both cases, the scope of practice for an LPC is being called into question. The legislative footing and/or precedent that each state is using to justify the scope of practice is a little different.
In Louisiana, the state is using a federal statute passed in 2014 to halt reimbursement. They will not reinstate reimbursement until the state receives guidance from the federal government. There is no telling how long that process could take. So, for the time being, school-based therapy will not be paid for if it is rendered by an LPC at a Federally Qualified Health Center.
In Michigan, LARA is questioning the scope of practice citing that the regulations are not aligned with various industry organizations and best practices.
The speed and silence at which the Louisiana state government operated and how quickly reimbursement was halted is alarming. In Michigan, HB 4325 and the LARA updates are moving at alarming rates. At this time, we cannot make any interpretive postulations, but it the similarity in these two instances cannot be ignored.
In Michigan, there has been an overwhelming show of support and coalition building from LPCs all over the state. Legislators and their offices are receiving a high volume of calls and emails from clinicians and patients alike.
A key difference between Louisiana and Michigan is the amount of visibility and public involvement in the battle for the scope of practice for LPCs. LPCs in Louisiana were taken aback by the changes and sudden halt in reimbursement.
In Michigan, the outcry against reducing access to mental healthcare has been outstanding. That kind of coalition-building may have been a key difference in the state of Louisiana if there had been greater visibility into the scope of practice changes.
Finally, an obvious difference is that insurance and the state have not passed nor ceased payment around the scope of practice for an LPC. This is a positive contrast for the LPCs in Michigan and unfortunate for the state of Louisiana.
What does this mean for private practices?
This has been the key question throughout the process for both states. In Michigan, it is business as usual. No change has been finalized. This means that private practices are still operating and receiving payment from patients and insurance.
That is great news!
For Louisiana, that is yet to be seen. Once the federal government provides clarification, LPCs might start receiving payment for school-based services provided by an FQHC. In the meantime, they will have to weather the storm.
The best-case scenario is that LPCs in Michigan will continue to practice under their previously established scope of practice.
Practice Solutions will continue to stay up to date on these changes and publish any updates that may arise in either situation.
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