August 15, 2001
Dear Plan Manager:
I am writing on behalf of the 46,000 licensed Marriage and Family Therapists (MFTs) that deliver quality mental health services throughout the United States. I am interested in learning more about your plan’s experience and policy for covering mental health services provided by MFTs. In addition, I want to provide you with some information to answer questions you may have about our profession.
MFTs are one of five core mental health disciplines recognized by the National Institute of Mental Health. We are licensed health professionals trained to diagnose and treat mental and emotional disorders. In the same manner as social workers and psychologists, we provide medically necessary individual psychotherapy, as well as couples, family and group psychotherapy.
As you know, several years ago Congress identified several types of non-physician health care providers who could be recognized by health plans. Over the years, a misconception has developed that only health professionals listed in the Federal Employee Health Benefits (FEHB) statute can be reimbursed by FEHB plans. Because of this confusion, Congress recently clarified Federal Employee Health Benefit law to make it clear that health plans have wide latitude in determining the types of health care professionals available to federal employees through a FEHB plan. This clarification was referenced in the FY2000 Office of Personnel Management (OPM) Call letter, which states:
The use of qualified health providers in addition to physicians can widen health care options and reduce costs for plans and patients. We encourage plans to provide access to non-physician providers who are qualified to provide covered services ... when it is appropriate and cost effective to do so.
Research has documented that marriage and family therapy is cost-effective because it tends to be brief, solution-focused, specific, with attainable therapeutic goals, and designed with the "end in mind."
With the OPM Call letter in mind, below is a brief list of questions for which I would appreciate a response:
1.) Does your health plan recognize and utilize Marriage and Family Therapists? If not, what is your rationale, and what information might we present to you to make the case for covering MFTs?
2.) What mental health providers are recognized by your health plan?
3.) If your plan covers a mental health service that is delivered by a "licensed provider", would MFTs be covered if they are licensed in that state?
4.) If your plan covers MFTs, can an enrollee access an MFT without a referral from a physician or other primary care provider? Can an enrollee access an MFT without a referral from another mental health professional? If a referral is necessary, what types of health professionals may refer enrollees to MFTs?
5.) If your plan has a closed panel network of providers, how does a marriage and family therapist become a network provider?
Thank you for taking the time to read this letter and respond to our inquiries. Please do not hesitate to contact me or David Bergman, Director of Legal and Government Affairs, AAMFT at (703) 253-0461 if you need additional information. I appreciate and look forward to receipt of your responses to my questions.
American Association for Marriage and Family Therapy