History of the Vermont Mental Health Counselors Association
The following report is designed to present information about the group, Mental Health Counselors of Vermont, Inc.; its intent, process, actions and goals. It covers the period from early 1986 to the present and is divided into half year segments.
EARLY 1986: Blue Cross/Blue Shield, the largest health insurer in Vermont, sent a notice of intent that it planned to discontinue the practice of reimbursement of mental health professionals using the sign off procedure. Under this procedure, in use in Vermont for over 10 years, psychotherapists who were supervised by a licensed psychiatrist or psychologist were reimbursed under the billing done by the supervisor. Many mental health counselors, who had been treating clients and earning their livelihood under this system, banded together in a grass roots effort to preserve 3rd party reimbursement.
During this period the group began to develop a stronger professional identity as mental health counselors. The group formally organized and incorporated. A survey was initiated and tabulated to gain information about the composition of our coalition. An initial membership fee of $125 (now only $75 for full clinical membership) was assessed. We attempted to negotiate directly with BC/BS as did other mental health groups. Although BC/BS did negotiate with Clinical Social Workers, Psychologists, and Psychiatric nurses, they totally rebuffed our efforts to deal with them directly.
LATE 1986: At weekly meetings of the group, a two pronged strategy was developed. First, it became clear that we would need to demand recognition for our group. Litigation seemed to be the only immediate answer to getting that recognition before the approaching deadline when the sign off system would be terminated. Second, long term recognition of our group would need to be established by legislation. Members were asked to pledge money, up to $500 each, to enable us to hire the professionals necessary to carry out our strategy.
At this point, we hired attorney Robert Mello. He was formerly an attorney with the Vermont Department of Banking and Insurance and, in private practice, had experience litigating this kind of case. In November 1986, Attorney Mello commenced action in Vermont Superior Court on our behalf asking that BC/BS be enjoined from implementing its threatened termination of reimbursement. At this same time, a legislative committee within our group began to draft a bill for the certification of mental health counselors. Members of our group got advice and information about drafting legislation from national organizations and mental health counselors in other states. Contacts were made and advice received from Vermont State Legislators. It was determined that we needed to hire a professional lobbyist.
EARLY 1987: The March 31st deadline for termination of the sign off reimbursement system forced many of our members to make difficult professional and economic decisions. Many chose to remain in practice without BC/BS reimbursement, some chose to prepare for other credentializing and some chose to take jobs in other areas. At the eleventh hour, on March 31st, Superior Court Judge Katz entered a Preliminary Injunction Order. As a result, Mental Health Counselors would be able to continue seeing clients they had seen during the month of March 1987. This prevented disruption of service to existing clients but did not allow Mental Health Counselors to take on new clients for reimbursement. For the year 1987 our group charged $125 dues and requested an additional $400 form each member to cover the now mounting expenses. To this point, some members had paid as much as $1,150 each in support of our efforts.
As all the litigation issues were being considered in court our group introduced a bill in the Vermont Senate called S 134, An Act Relating to the Certification of Mental Health Counselors. We hired Attorney Anthony Otis as our professional lobbyist. The bill was met with opposition by BC/BS and the psychologists' lobby. An amendment was added to the bill as proposed, which included the provision for a grandfather clause. The bill passed the senate but not until additional amendments had seriously weakened the educational requirements and other provisions of the bill. Through the intensive lobbying efforts of our own members and our lobbyist the bill went on to the House for consideration in this term, despite the fact that it had missed the official crossover date. In May, at the end of the 1987 Legislative Session, just as passage seemed possible, our bill was tabled in a House committee to await action by the 1988 Legislature, which was to convene in January 1988.
LATE 1987: On July 28th, Judge Katz issued his findings. In the Findings of Fact, the judge concurred with all of the facts our attorney had put forth regarding the importance of mental health counselors in service delivery in the State of Vermont. In the Conclusions of Law, the judge found that we had standing to pursue the questions raised by the court case. Citing that there is no existing law which could be applied to legally support our claim for continued reimbursement, the judge dismissed our case. In his findings he did state, "The conflict between these positions constitutes an important health policy question for this state. It is a substantial social issue. It is a political question."
At this point we, as a group, reconsidered our position and made some major decisions about how to proceed. We called for a vote on the question of continuing to support the grandfather clause in our legislative efforts. The members voted to continue support of the grandfather clause unless it could be shown that it would clearly harm chances of passage of the bill. We sent out a letter to the membership detailing our financial position. To this point we had incurred $38,000 in legal expenses. We had managed to pay $24,000 of those expenses, leaving us with a debt of $14,000. Even with this debt we decided that we had to continue to pursue both the litigation and the legislation that we had started. In August, at the advice of our attorney, we used the first avenue of appeal. Attorney Mello made a motion to alter and amend the court judgment. Judge Katz scheduled a hearing to consider additional testimony on the motion. However, on October 7, Judge Katz denied our motion. At this point, BC/BS contacted Attorney Mello, proposing a meeting with our organization to end this litigation once and for all. Ironically, although we had lost this round of the court battle, we had finally achieved what we had set out to do, which was to have BC/BS negotiate directly with us.
Beginning in November, members of the Mental Health Counselors of Vermont, Inc. and administrators for BC/BS sat down face to face and worked out an agreement. We were politically aware of BC/BS' primary agenda, which was cost cutting. Secondarily, they were in need of a cooperative public image. Our prime agenda was to obtain certification and ultimately third party reimbursement. These agendas meet because having more certified mental health professionals at fee levels less than psychiatrists makes a more competitive insurance product for BC/BS. It was in these negotiations that we obtained a piece of information that altered our legislative direction. BC/BS stated, "Under no circumstances will we reimburse at the bachelor level." We then attempted to mutually agree on a bill which could be supported by both BC/BS and Mental Health Counselors of Vermont, Inc., which would ultimately allow the largest number of our members to qualify. At the same time, we negotiated an agreement for the interim provider status for Mental Health Counselors pending passage of the bill. Prior to the bill passing and credentialing being done by the Secretary of the State, our group would be the interim authority responsible for verifying credentials. The education and supervision standards used for interim provider status would be the same as those in the pending bill. By the end of 1987, a legal agreement regarding the negotiated items had been drawn up but not signed. Mental Health Counselors of Vermont, Inc. began setting up the procedures for the interim verification of credentials.
JANUARY 1988: Signing of the agreement between BC/BS and the Mental Health Counselors of Vermont, Inc. was completed. The agreement was retroactive to December 1, 1987. With the opening of the 1988 Session of the Vermont Legislature, lobbying began in earnest on the bill, S 134. BC/BS and Mental Health Counselors were committed by the agreement to work actively and cooperatively for passage of the bill in that legislative session. Six steering committee members spent one half day per week at the legislature. The bill needed to pass in substantially the same form as it appeared in the agreement for this effort to result in certification which provides for permanent provider status.
The steering committee set 1988 fee structures and dues in consideration of the cost of getting to this point and the anticipated expenses still to be incurred to complete passage of the bill. Current indebtedness for legal and lobbying fees was $17,772. An application fee of $500 had to be paid when credentials were submitted for verification. The dues of $100 were assessed for the year 1988. The highest amount of money would therefore be paid by those most immediately and directly benefiting from the efforts and expenditures of this group. All members not submitting their credentials at that time were asked to contribute substantial amounts in anticipation of their future benefits from these efforts. The financial, professional and personal energies of all current and incoming members were needed to bring this ambitious program to a satisfactory conclusion. Many people, past and current members, deserve credit and appreciation for their many contributions. The current (as of 1988) steering committee wishes to thank everyone for their efforts.
1988 Steering Committee:
Submitted by then President, Marcia Reese
The rest is on its way...