Counselors in the addictions field many of them with years and even decades of experience--may have to go back to school to get their master's degrees if they want to work in the world of the future, experts say. This is not because the Affordable Care Act (ACA)--the health reform law that kicks in in 2014--requires it. Rather, the requirement is coming from payers: state Medicaid programs, and private insurance companies.
"The federal government leaves it to the states to make laws on legal regulation of professionals," said Mark Weber, communications director for the Substance Abuse and Mental Health Services Administration (SAMHSA), which has the responsibility of making sure the workforce will be available to meet the need in 2014. Because the rules are state-based, the requirements vary widely, Weber added.
There are three levels in the legal regulation of addiction professionals: registration, certification and licensing. Typically, only a licensed professional is able to independently diagnose and treat substance abuse conditions. Many states also certify counselors, and for these professionals, "independent practice is not usually in their scope of service law," Weber noted. Nevertheless, a certified substance abuse counselor can usually provide treatment in a clinic because he or she is supervised by someone with at least a master's degree.
Some states now have two levels of counselors; the first does not have a master's, and cannot independently diagnose and treat, and the second does. "The payer then determines what providers may receive payment, usually following state practice laws," said Weber. Many payers do reimburse the facility, but still may require that each clinician working there meet independent practice laws.
"It does look as if states are going in that direction," said Laurie J. Krom, director of the national office of the Addiction Technology Transfer Center, located at the University of Missouri-Kansas City. "A master's degree is going to be needed, and in some states, that's already the case."
Carol McDaid, principal with lobbying firm Capitol Decisions, agreed. "Although there is not an explicit reference in the ACA requiring a master's, there is the marketplace reality that most commercial insurers require it," she explained. Since the commercial insurers will be running many state Medicaid programs and be the main players in the exchanges, McDaid believes that the master's degree "will be a de facto requirement."
Hope for federal action
For a full-time employee in a treatment center who makes $35,000 a year and has family responsibilities, is going back to school for a master's degree even a possibility? "We need to give more thought about what can be done for these individuals," said Krom. "I hope there is some action at the federal level to provide incentives or loan relief, working perhaps with community colleges that can bridge to four-year programs," she said. "We need to design programs that can set people up for success."
Krom is encouraged by the fact that other leaders of substance abuse organizations have started talking about this issue. Also encouraging was the report from the senate committee that appropriates funding to SAMHSA this month directing the agency to take a closer look at the workforce, and to produce a report on it by the end of March, detailing what SAM HSA's role will be and what the role of the Health Resources and Services Administration, which administers federallyqualified health centers, will be.
There has always been a concern that Ph.D. programs training social workers and psychologists don't include enough addiction- specific coursework, said Krom. While there are some programs that include substance abuse, there are many more that don't require even one course, she added. "That's been an issue for years. It's exacerbated by the fact that private insurance companies are de facto approving social workers without looking at whether they are able to treat people with addictions. …