Behavioral health is an umbrella term that includes mental health care and alcohol and substance abuse treatment. Choices Mental Health Counseling PLLC offers individual psychotherapy, group, couple, and family counseling with adults, adolescents and children for trauma history, mood and anxiety disorders, attentional and communication problems, parent-child issues for risk reduction and prevention, pre-adoption home studies and follow-up, psychoeducational services in mental health and abuse of alcohol and other drugs, evaluations for courts, and for the NYS DMV as an OASAS approved provider of clinical screening and assessment services for impaired driving offenders to consider restoration of driving privileges after a DWI, and other behavioral health needs.

Stop "Carving Out" Insurance Benefits For Mental Health From Those Most In Need... Reform Managed Care Medicaid And Medicare In Albany And Washington

Choices Mental Health Counseling, PLLC

At a time when much is said in the media about a need for increased access to behavioral health care, legislative reforms that will actually work receive little attention. I applaud the efforts of reformers like Congressman Chris Gibson at a Federal level, and our local Assemblywoman Aileen Gunther (who chairs the Assembly Mental Health Committee) in Albany and others, for ongoing efforts to reform Medicaid and Medicare.

A major inequity in the current health insurance system is the fact if a person is on Social Security, mental health and substance abuse counseling are most likely designated as "carved out benefits" of managed care. This means they are not covered by, for example, Hudson Health Plan, Fidelis Care NY, or any of the other good quality plans that provide managed care Medicaid to the public (i.e. those who are not classified as disabled or otherwise covered by Medicare).

If a person has SSI or SSD (i.e. those in the community who suffer from the most severe physical or psychiatric disabilities), or is a senior citizen collecting a pension, they are most likely limited to seeking mental health or addiction counseling from a Medicare provider, which can be especially hard to find in a rural county like Sullivan. Under the present system, the majority of outpatient treatment providers are not eligible to participate in Medicare.

This longstanding inequity is neither a result of, nor is it resolved by, the controversial Affordable Care Act. (As of December 15, 2013, uninsured and under-insured New York residents became eligible to apply for health insurance through the NYS Department of Health's Insurance Exchange website, which has not been reported to have had the type of technical problems that have beset the Federal government's website for those states that have elected not to maintain their own health insurance exchange.) But like "Obamacare" or hate it, this problem is not new and has not gone away.

For a real-life example, not long ago a patient was referred to me by her gynecologist for mental health counseling due to depression and anxiety after undergoing a total hysterectomy for cervical cancer. She responded well over the months that I saw her, both to her cancer treatment and to psychotherapy. She was making progress with managing her moods and panic attacks, but suddenly had to stop her attending counseling when her application for Social Security Disability application was approved, and outpatient behavioral health became a "carved out" benefit. Even though I was a participating provider in her managed care network, only a Medicare provider was eligible for reimbursement under her policy once her SSD benefits for the cancer began. Due to her income, she was not able to afford even a reduced self-payment she was offered. She continued antidepressant medication prescribed by her doctor (which was still covered by her insurance), but told me she was not interested in switching therapists to a county or state operated clinic that could bill her "straight" Medicaid.

This gap in coverage is something I see too often. It has the unfortunate discriminatory effect of making life harder for many when they are most in need of treatment.

I get many calls many calls each month from people with managed care Medicaid asking for appointments for mental health treatment. If they have a Medicaid plan that I participate with (such as Hudson Health or Fidelis), the next question I have to ask is whether they receive Social Security benefits. Most say no, and they are offered appointments. If the answer is yes, regardless of the condition for which they are seeking treatment, they are advised to call the number on the back of their insurance card and request a referral to someone who can bill NYS Medicaid or Medicare, which are few and far between due to antiquated Federal and State laws. (See the list at the upper left column of this website for a list of health insurance and EAP plans in which I am currently in-network).

To help address this widespread problem, Congressman Chris Gibson has introduced HR 3662, the Mental Health Access Improvement Act of 2013. Anyone wishing to advocate for the rights of mentally ill and recovering people, regardless of where you may live in the U.S., are invited to click this link, or otherwise contact Congress and voice your views.

For more information, see “Seniors Mental Health Access Improvement Act of 2013,” Bipartisan Counselor Coverage Bill, on the website of the North Carolina Counseling Association.

In the present environment in Washington, getting any bill out of committee and passed through both houses of Congress is a long shot, but our own Congressman Gibson and the other co-sponsors of this bill, on both sides of the isle, deserve support for this bipartisan import effort to reform Medicare by allowing expansion of the pool of treatment providers. This approach is good for the free market system, and good for consumers. They have my thanks for their efforts.

One effect of the ACA, however, will be to increase the number of people with health insurance who are seeking treatment, making licensed, qualified mental health care providers that much harder to access. This problem is described in a recent article in The Wall Street Journal, For the Mentally Ill, Finding Treatment Grows Harder: New health-care law may add to crunch for enough treatment [PDF].

In New York State, the Medicaid Institute at United Hospital issued a report in 2012 on Implementing Behavioral Health Care Reform in New York's Medicaid Program. The authors explain, "This report examines the implementation of Medicaid policy changes in New York, which will require participation in care management for beneficiaries receiving behavioral health services. Until now beneficiaries have typically received these services under a fee-for-service [i.e. "straight Medicaid"] payment model."

The Western New York Law Center reported in late August 2013 that New York State had received Federal approval to begin a trial program that would allow some SSI/SSD/Medicare recipients greater access to behavioral health, in CMS Approves Launch of Demonstration to Manage Care for All Dual Eligibles.

When these changes will be implemented locally is not clear. Provider Relations departments at managed care insurers that I have spoken with tell me they have no information about these "carve-outs" being eliminated any time soon.

However, the above described Federal and State legislation and regulatory changes offer hope that mental health and substance abuse treatment will become more accessible to those who need it most, and work toward abolishing with the existing system of "carving out" these benefits from managed care and leaving the most impaired patients to seek an appointment at a publicly funded clinic or search for a private therapist who bills Medicare.

The foregoing opinion article is posted as a form of non-partisan patient advocacy.
Linked articles and documents are provided in the public interest, for educational purposes.

Giving Public Thanks To Public Sector Workers, While Increasing Accessibility To Private Outpatient Mental Health And Substance Abuse Counseling In Sullivan County

This a public thank you to co-workers at the State of New York and County of Sullivan I have worked with over the years, many of whom for whom I have the greatest respect. Having spent 13 ½ years at Richard C. Ward Addiction Treatment Center in Middletown – plus more than half that with the Sullivan County Department of Community Services as a Staff Social Worker, in mental health day-treatment and at the outpatient addiction clinic; with adult men and women; six years as a child and family therapist for a private agency under a public contract with Sullivan County Division of Health and Family Services children’s Preventive Services; and previously as a Sullivan County Probation Officer; a houseparent in publicly-operated adolescent group home; and clinical coordinator for a not-for-profit after-school program for teens, since 1985 I have done counseling work with adults and adolescents who suffer from mental illness and addiction, and runaway and ungovernable and delinquent youth, as well as family and couples therapy, with goals of family preservation, reunification, and adoption.

Choices Mental Health Counseling opens new office at 433 Broadway in Monticello

Tom and Carmen Rue on the porch at 433 Broadway The offices of Choices Mental Health Counseling, PLLC are now located at 433 Broadway, across from Landfield Avenue, a half block west of Rotary Corner at the intersection of Saint John Street.

Please use private parking in the rear, or park on Broadway. The public is invited to use the side entrance. The front entry is wheelchair accessible. Free wireless connectivity is available in the waiting room for the convenience of guests. The move took place in late February and was completed by the end of March 2013.

The new site includes a larger rooms than the former location for group and individual counseling sessions, and a comfortable waiting room. (See interior photos.)

Tom and Carmen Rue in front of 433 Broadway

The practice continues to provide private and confidential outpatient counseling treatment for mental health for substance abuse recovery, for individuals, groups, couples, and families. Referrals are accepted from healthcare providers, the legal system, schools, human service agencies, and managed care organizations, or by interested individuals. Reimbursement by most insurances, and several employee assistance programs, is accepted (see list at left).

Office hours are presently limited to evenings and Mondays during the day, but the plan is to expand to full-time in the fall of 2013. The practice has been in operation since August 2010, most recently on Pelton Street and originally in an office in the historic rectory of St. John's Church. Presently, the only site address for Choices Mental Health Counseling PLLC is 433 Broadway, though mail should still be addressed to PO Box 706, Monticello, NY 12701.

Bilingual Support Services

Office manager Carmen Rue, who is fluent in English and Spanish and can assist with translation when needed, graduated in nursing from Federico Villarreal National University in Lima, Peru. A woman of many talents, in her spare moments away from serving the Village of Monticello as an elected Trustee (an office she continues to hold), Carmen was behind the office's decoration and selection of comfortable new furnishings.

Experience and Specialties

Licensed as a mental health counselor (LMHC) by the NYS Department of Education and credentialed by the NYS Office of Alcoholism and Substance Abuse Services as a credentialed alcoholism and substance abuse counselor (CASAC), Mr. Rue is state-approved to provide courts with assessments and evaluations of people charged with impaired driving; as well as being qualified under rules of the US Department of Transportation as Substance Abuse Professional (SAP), as well as experience giving input to Family Court on adoptions, custody, visitation, and parenting concerns.

He has worked as a mental health and addiction counselor since earning his Masters degree at Rider University in New Jersey in 1985, including working 13 years for New York State and 6 years for the Sullivan County Department of Community Services, 7 years as a family therapist for Berkshire Farm Center & Services for Youth, and a few years in the 1980s as a probation officer in Sullivan County. He has been certified as a clinical mental health counselor (CCMHC) and National Certified Counselor (NCC) by the National Board for Certified Counselors (NBCC) since 1990.

Building History

The building at 433 Broadway was erected in 1910, a year after Broadway was decimated by a massive fire. It was built by John F. Tyson, who opened a hardware store across Broadway in 1870. Mr. Tymeson left his property to his son-in-law, the Rev. Emmet Sloat, who served as a local minister from 1923 to 1925.

Rev. Sloat continued to serve community causes, including as treasurer of the American Red Cross of Sullivan County until as late as 1929. More recently, the building housed the healthcare offices of chiropractors Paul Sinew, DC; and from 1967 to 1984 of Jack Bosches, DC.

For more information, call 845-513-5002 or visit

View Larger Map

The building at 433 Broadway as photographed by Tom Rue on August 3, 2008 prior to road renovation by the NYS Department of Transportation.

Licensed Mental Health Counselors are Exempt from Reporting Mandates of NY SAFE Act

Don't want to add to the risk of the government taking your guns, but you or a family member need(s) confidential services from a mental health professional? Licensed Mental Health Counselors (LMHCs) are exempt from reporting requirements in the NY SAFE Act, allowing broader privacy protection for persons receiving such services than when provided by other licensed healthcare providers [see NY Mental Hygiene Law § 9.46]. Most insurances are accepted. Call 845-513-5002 to schedule an appointment.

Related external link:
The New York SAFE Act of 2013 and its profound effect on mental health care providers and their patients

March 22, 2013
Health Law Alert
Author(s): Daniel C. Gibbons, Michelle Yuen

Changes In New York State Law Protect Victims Of Domestic Violence

DOMESTIC VIOLENCE PROTECTIONS – Part of the new domestic violence reform law, designed to protect victims’ health care and insurance information, (Chapter 491, S7638), takes effect on January 1, 2012. The landmark law, sponsored by Senator Steve Saland (R-I-C, Poughkeepsie), Chairman of the Senate Codes Committee includes several important provisions to protect victims of domestic violence and establish stronger criminal penalties to punish individuals who commit acts of domestic violence.

As of the first of the year, victims of domestic violence who seek medical and/or mental health services and use their health insurance to pay for that care, can designate alternative contact information so they may receive health insurance correspondence in a safe location of their own choosing, such as the home of a friend or family member, a post office box, or a shelter.

“Current law already bars disclosure of an address and phone number when an order of protection is in place,” Senator Saland said. “This law greatly expands the information to be protected by ensuring that a victims’ health insurance information is not sent to the same address as the alleged abuser, thus affording more protection domestic violence victims.”

Expanding Options and Coordination of Care

Value Options logoI am presently able to directly bill insurance companies for the networks linked in the left column of this website, which include: Aetna Behavioral, Beacon Health Strategies, CIGNA Behavioral, Capital District Physician's Health Plan (CDPHP), EBS-RMSCO, Fidelis Care New York, Hudson Health Plan, MultiPlan, PHCS Savility, TRICARE (military healthcare), and ValuePoint.


Here is a useful patient education flyer entitled "When you are in therapy, what your doctor needs to know..." which explains mental health as closely related, sometimes inexorably so, to physical health.

US DOT Qualified Substance Abuse Professional

SAP Evaluations

A transportation worker who has violated DOT regulations must follow specific procedures before being considered by an employer for return to safety-sensitive function. A SAP credentials packet is available for those wishing to confirm my qualifications under DOT rules.

This process, conducted by a qualified Substance Abuse Professional (SAP), includes:

  • Conducting an initial face-to-face clinical evaluation, including standardized testing.
  • Developing recommendations for treatment and/or education.
  • Sending an initial evaluation report to the employer or, if employee has been released from employment, maintaining information for future employer.
  • Assisting the employee in contacting the treatment provider and arranging for services.
  • Maintaining regular contact with the treatment provider, to monitor the employee's treatment progress.
  • Conducting a face-to-face, follow-up clinical evaluation to determine if the employee has complied with recommendations, and to measure success of treatment.
  • Sending a follow-up report and follow-up testing plan to the employer.
  • It is up to the employer to determine whether or not the employee returns to work, not the SAP.
  • If the employee has been released from employment, this information is held for the future employer.

Tom Rue, MA, LMHC, CASAC, a mental health counselor since 1985 and a credentialed alcohol and substance abuse counselor since 1996 (certified through the International Certification and Reciprocity Consortium [IC&RC]), completed fourteen (14) contact hours of training in October 2012, successfully completing the exam requirement later the same month, both sponsored by the Employee Assistance Professionals Association. This training and exam meet the requirements of 40 CFR Part 40.281(c), Qualification Training for Federal DOT Regulations and Assessment Requirements for the Substance Abuse Professional (SAP).

If you are seeking to schedule an appointment for an assessment, call 845-513-5002. Please be prepared to provide the following information during the initial call or fax it in advance to 866-428-0282:

  • Your name, title, company name, address, phone number
  • DOT Mode, i.e., FMCSA, FRA, FTA, FAA, RSPA or USCG
  • Employee name, address, phone number
  • Social security number
  • Date of birth
  • Violation and date of violation
  • Current employment status
  • Name of Designated Employer Representative (DER)
  • Who is responsible for payment? If employer is, provide name and phone number of DER for verification and arrangements.

For an additional fee, the SAP can conduct ongoing monitoring following the employee's return to work, including monthly in-person interviews and revision of the employee's follow-up testing program, when appropriate.

SAP Service Payments

If fees are paid by the employer, full payment can be forwarded to the SAP at the time of the referral or SAP will provide an invoice when initial report is sent.

If fees are paid by the client, full-payment is required prior to the evaluation. Payment must be in exact amount by cash or money order.

SAP Service Payments

For more information, visit and DOT/FMCSA Drug & Alcohol Testing Program: Substance Abuse Professionals

See my listing on SAP List listing.

Connecting Trauma Stress and Chronic Pain (Informational Brochure)

Old Traumas Add To Present Pain

Many women, and more men than might be generally assumed, who suffer chronic physical pain were sexually abused as children. Many others of both genders experienced physical or verbal abuse during their youth.

There can be little doubt that traumatic experiences in childhood invite chronic pain during later life. Childhood trauma can lead to lasting depression or anxiety, sometimes including flashbacks to the original experience, a condition known as Post-traumatic Stress Disorder, or other complications.


Ties between physical pain and psychiatric conditions – including PTSD, mood and anxiety disorders, or intimacy problems – caused by abuse are close. The appearance of pain, even decades after the abuse, may be accompanied by flashbacks and nightmares, emotional numbness, or an impaired body image.

Thoughts > Beliefs > Perceptions > Experience

Childhood abuse may contribute to multiple chronic physical complaints or sexual problems in adulthood. Grown children who experienced trauma may undergo depression, anxiety, and low self-esteem, made worse by a vicious cycle of negative thoughts, self-talk, and beliefs. Changing these thought patterns and perceptions can lead to shifts that are both subtle and radical in how one experiences the world and relationships. Life can improve!

Everyone feels pain differently. Some can readily cope with a degree of discomfort that others may find unbearably severe. It comes down to learning.


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