Provide universal
coverage. You need mental health care. You have insurance coverage. So you
go out and get mental health care and pay for it with your insurance coverage,
right?
Wrong. Often people are limited to closed lists of
in-network providers (many of whom are full), can’t see certain classes of
therapists such as LMFTs (like me) or LMHCs, or face other roadblocks to care.
And the worst offenders are often taxpayer-supported programs like Medicare, Medicaid,
or the VA.
My solution would be to pass a nationwide Any Willing
Provider law. If you are a licensed psychotherapist, you can provide
services to anyone. Period. And insurance must pay for it. Period.
Let psychotherapists
practice nationwide. Therapists can now technically practice anywhere, thanks
to online technology. But there is one huge roadblock standing in the way: a
stupid and outdated crazy quilt of state licensing laws.
If I practice outside of New York or Arizona, where I am
licensed, I could actually face felony charges in some states. My malpractice
insurance would also become void. It would literally be easier and legally less
risky for me to treat someone in Uzbekistan than in, say, Ohio.
Worse, every state has its own incompatible requirements. Many
have different course and credit hour requirements, forcing you to go back to
school. Some will not accept a distance learning degree. And California, because they
are special, makes everyone start all over again as an intern and then take
their own exam. State requirements not only dramatically limit access to online
therapy, they often trash the careers of good therapists who must move to
another state for personal or family reasons.
If I were President, I would create national
licensure for therapists. Or at least require the easy fix of license
reciprocity. If you have been practicing therapy for, say, five years and
haven’t killed anyone, there should be no good reason you cannot practice in
any state of this great country.
Mandate coverage of
telepractice. Finally, the last piece of the puzzle is providing financial
coverage for online therapy. Telepractice is now legal in most if not all
states. The problem is that insurance usually won’t cover it, so you can’t have
it unless you can afford it yourself. This in turn denies care to people who
could really use online therapy, like the housebound, people in remote
communities, shift workers, and areas with few therapists or long waiting
lists.
Legislating this has turned out to be extremely slippery. New
York, for example, now has a Telehealth
Parity Law mandating such coverage – but it is limited to specific types of
therapists (not including LMFTs, unfortunately), and is full of loopholes: for
example, it does not mandate how much insurers would reimburse for such
sessions, requiring follow-up legislation. As President I would order everyone
to cut the comedy and just cover online therapy at par with regular in-office therapy.
Of course, I am not going to be President
anytime soon – thank goodness. So instead of wasting your vote on me, I am
going to ask you to do the next best thing: become aware of legislation
affecting access to mental health care in your state, and make your voice heard
so that everyone gets the care they deserve. Thank you!
