Pressure Needed On Medicare Mental Health Extender During August Recess

As you may recall, in 2007 the Centers for Medicare and Medicaid Services (CMS) implemented across-the-board cuts to provider reimbursements as a result of the five-year review regulatory process, which had a disproportionately negative impact on psychological services due to the way Medicare allocates value for services. Following the grassroots mobilization of practicing psychologists across the country, the APA Practice Organization was able to secure a legislative remedy by persuading Congress to restore 5% to Medicare psychotherapy services in 2008 and convincing both chambers to extend the provision again through the end of 2010.

Thanks to your great work, combined with strategic lobbying on Capitol Hill, psychotherapy services were the only services singled out for relief from the cut.

With the House scheduled to adjourn on July 30 and the Senate on August 6, your Senators and Representative need to hear from you during the August recess that Congress should extend the 5% Medicare psychotherapy payment restoration through 2011 to ensure Medicare beneficiaries have continued access to quality mental health services.

This Action Alert contains two requests:

1. Action by psychologists across America through the Legislative Action Center; and
2. Action by Federal Advocacy Coordinators and key contact psychologists through in-district meetings

Action by Psychologists:

Before August 13 click here to urge your Senators and Representative to extend the 5% Medicare psychotherapy payment restoration.

Grassroots feedback is extremely important to our advocacy efforts, so we would very much appreciate it if you would e-mail Jeff Cook (see the end of this announcement) or fax (202-336-5797) us any substantive responses (other than auto-responses) you receive from your Senators or Representative.

Targets: All U.S. Senators and Representatives

Suggested Message:

I am writing as a psychologist and constituent to urge you to extend the 5% Medicare payment restoration to mental health services previously cut as a result of the Centers for Medicare and Medicaid Services’ (CMS) “5-year review” regulation.

Extending the psychotherapy payment restoration is critical to protecting access to Medicare mental health services. Psychologists and social workers provide almost all of the Medicare psychotherapy services, but many have indicated that they may have to reduce their caseloads or leave the Medicare program if they are faced with these reimbursement cuts. This provision must be extended through December 2011.

Please protect Medicare beneficiaries’ access to quality mental health services by extending the 5% payment restoration. Thank you for your time and consideration

Action by FACs:

Before September 10, mobilize key psychologists to meet with legislators and/or staff in district

During the August recess Senators and Representatives will be paying more attention than usual to the concerns of constituents, which will provide us with an excellent opportunity to deliver the critically important message regarding Psychology’s priorities on their home turf. In consultation with your regional field team member (David Hill, Ph.D. or Nan Klein, Ph.D.), please coordinate key psychologists to engage their targeted legislators in in-district meetings:

In-district Meetings – Request or coordinate a key psychologist to request an in-district meeting with the targeted legislator. Start by calling the legislator’s scheduler and informing him/her that you are from the __________ (SPTA) psychological association and would like to set up an appointment with the legislator in the district office to discuss Medicare reimbursement. Please be aware that the legislator may have separate schedulers for the Hill and the district. Your regional field team member can provide you with the scheduler’s contact information and prepare you and participants in advance of the meeting.

Many Federal Advocacy Coordinators have already identified key psychologists for the targeted offices, while some others may not have. Key psychologists may include previous Hill visit participants during the State Leadership Conference. If you have not yet identified key psychologists for your targeted offices, now is a great time to identify and work with constituent psychologists to build new relationships with their elected officials.

Please keep Jeff Cook and your regional field team member apprised of your progress, including names and information for key psychologists and staffers, dates, the nature of interactions, and any feedback or questions from staffers, which we may share with our allies on the Hill.

Targets:

• Alabama-Senator Richard Shelby (R) and Representative Artur Davis (D-07, W&M)
• Alaska-Senators Lisa Murkowski (R) and Mark Begich (D)
• Arizona-Senator Jon Kyl (R, Fin) and Representative John Shadegg (R-03, E&C)
• Arkansas – Senator Blanche Lincoln (D, Fin) and Representative Mike Ross (D-04, E&C)
• California – Representatives Xavier Becerra (D-31, W&M), Lois Capps (D-23, E&C), Anna Eshoo (D-14, E&C), Jane Harman (D-36, E&C), Wally Herger (R-02, W&M), Doris Matsui (D-05, E&C), Jerry McNerney (D-CA, E&C), Nancy Pelosi (D-08, Speaker), Linda Sanchez (D-39, W&M), Pete Stark (D-13, W&M), Mike Thompson (D-01, W&M) and Henry Waxman (D-30, E&C Chair)
• Colorado – Senator Michael Bennet (D) and Representative Diana DeGette (D-01, E&C)
• Connecticut – Representatives John Larson (D-01, W&M) and Chris Murphy (D-05, E&C)
• Delaware – Senator Tom Carper (D, Fin) and Representative Mike Castle (R-AL)
• District of Columbia – Delegate Eleanor Holmes Norton (D-AL)
• Florida – Senator Bill Nelson (D, Fin) and Representatives Kathy Castor (D-11, E&C), Kendrick Meek (D-17, W&M) and Cliff Stearns (R-06, E&C)
• Georgia – Representatives John Barrow (D-12, E&C) and John Lewis (D-05, W&M)
• Guam – Delegate Madeleine Bordallo (D)
• Hawaii – Senators Daniel Akaka (D) and Daniel Inouye (D)
• Idaho – Senators Mike Crapo (R, Fin) and Jim Risch (R)
• Illinois – Senator Dick Durbin (D, Majority Whip) and Representatives Danny Davis (D-07, W&M), Bobby Rush (D-01, E&C) and Janice Schakowsky (D-09, E&C)
• Indiana – Senator Dick Lugar (R) and Representative Baron Hill (D-09, E&C)
• Iowa – Senator Chuck Grassley (R, Fin Ranking Member) and Representative Bruce Braley (D-01, E&C)
• Kansas – Senators Sam Brownback (R) and Pat Roberts (R, Fin)
• Kentucky – Senator Jim Bunning (R, Fin) and Representatives Ed Whitfield (R-01, E&C) and John Yarmuth (D-03, W&M)
• Louisiana – Senator Mary Landrieu (D) and Representative Charlie Melancon (D-03, E&C)
• Maine – Senators Susan Collins (R) and Olympia Snowe (R, Fin)
• Maryland – Representatives Steny Hoyer (D-05, Majority Leader), John Sarbanes (D-03, E&C) and Chris Van Hollen (D-08, W&M)
• Massachusetts – Senator John Kerry (D, Fin) and Representatives Edward Markey (D-07, E&C) and Richard Neal (D-02, W&M)
• Michigan – Senator Debbie Stabenow (D, Fin) and Representatives Dave Camp (R-MI, W&M Ranking Member), John Dingell (D-15, E&C) and Sander Levin (D-12, W&M Chair)
• Minnesota – Senators Amy Klobuchar (D) and Al Franken (D)
• Mississippi – Senators Thad Cochran (R) and Roger Wicker (R)
• Missouri – Senator Claire McCaskill (D) and Representative Roy Blunt (R-07, E&C)
• Montana – Senators Max Baucus (D, Fin Chair) and Jon Tester (D)
• Nebraska – Senator Ben Nelson (D) and Representative Lee Terry (R-02, E&C)
• Nevada – Senator Harry Reid (D, Majority Leader) and Representative Shelley Berkley (D-01, W&M)
• New Hampshire – Senators Judd Gregg (R) and Jeanne Shaheen (D)
• New Jersey – Senator Bob Menendez (D, Fin) and Representatives Frank Pallone (D-06, E&C) and Bill Pascrell (D-08, W&M)
• New Mexico – Senators Jeff Bingaman (D, Fin) and Tom Udall (D)
• New York – Senator Chuck Shumer (D, Fin) and Representatives Eliot Engel (D-17, E&C), Joe Crowley (D-07, W&M), Brian Higgins (D-27, W&M), Charles Rangel (D-15, W&M) and Anthony Weiner (D-09, E&C)
• North Carolina – Representatives G.K. Butterfield (D-01, E&C) and Bob Etheridge (D-02, W&M)
• North Dakota – Senator Kent Conrad (D, Fin) and Representative Earl Pomeroy (D-AL, W&M)
• Ohio – Representatives Zach Space (D-18, E&C) and Betty Sutton (D-13, E&C)
• Oklahoma – Senator Jim Inhofe (R) and Representative John Sullivan (R-01, E&C)
• Oregon – Senator Ron Wyden (D, Fin) and Representative Earl Blumenauer (D-03, W&M)
• Pennsylvania – Representatives Mike Doyle (D-14, E&C), Tim Murphy (R-18, E&C) and Allyson Schwartz (D-13, W&M)
• Puerto Rico – Resident Commissioner Pedro Pierluisi (D)
• Rhode Island – Senators Jack Reed (D) and Sheldon Whitehouse (D)
• South Carolina – Senator Lindsey Graham (R) and Representative Jim Clyburn (D-06, Majority Whip)
• South Dakota – Senators Tim Johnson (D) and John Thune (R)
• Tennessee – Representatives Bart Gordon (D-06, E&C) and John Tanner (D-08, W&M)
• Texas – Senator John Cornyn (R, Fin) and Representatives Joe Barton (R-06, E&C Ranking Member), Lloyd Doggett (D-25, W&M) and Charles Gonzalez (D-20, E&C)
• Utah – Senator Orrin Hatch (R, Fin) and Representative Jim Matheson (D-02, E&C)
• Vermont – Senator Bernie Sanders (I) and Representative Peter Welch (D-AL, E&C)
• Virginia – Representatives Rick Boucher (D-09, E&C) and Eric Cantor (R-07, W&M)
• Virgin Islands – Delegate Donna Christensen (D-AL, E&C)
• Washington – Senator Maria Cantwell (D, Fin) and Representatives Jay Inslee (D-01, E&C) and Jim McDermott (D-07, W&M)
• West Virginia – Senators Carte Goodwin (D) and Jay Rockefeller (D, Fin)
• Wisconsin – Representatives Tammy Baldwin (D-02, E&C) and Ron Kind (D-03, W&M)
• Wyoming – Senators John Barrasso (R) and Mike Enzi (R, Fin)

* “E&C” denotes members of the House Energy and Commerce Committee, “W&M” is for House Ways and Means Committee, and “Fin” is for Senate Finance Committee.

Background:

Congress Should Protect Medicare Mental Health Payment

To ensure the viability of the Medicare outpatient mental health benefit, Congress should extend through 2011 the restoration of cuts to Part B mental health services.  Congress should also require Medicare reimbursement for psychologists’ psychotherapy with evaluation and management (E/M) services provided within their licensure and include psychologists in the Medicare definition of physician.

Mental Health Restoration. In 2007, the Centers for Medicare & Medicaid Services (CMS) slashed Medicare part B reimbursement for psychologists due to its “5-year review” rule. Under this rule, CMS increased payments for E/M codes, raising Medicare costs by $4.5 billion. Due to budget neutrality requirements, CMS reduced the reimbursement values of all other services, with mental health and psychological testing services hit hard with the greatest cuts.

MIPPA restored payments temporarily but now needs to be extended.Through the Medicare Improvements for Patients and Providers Act of 2008, Congress partially restored the cuts made by the 5-year review through 2009. The Patient Protection and Affordable Care Act then extended the restoration through December 2010. Congress should pass new legislation to extend payments through 2011, until the next 5-year review, in which the value of psychotherapy services is being reconsidered by CMS.

Extending the psychologist payment restoration is crucial to protecting access to Medicare mental health services. Psychologists and social workers provide almost all of the Medicare psychotherapy and testing services, but many have indicated that they may have to reduce their caseloads or leave Medicare if they are faced with these reimbursement cuts. The cost of protecting mental health services is very low, increasing costs by only $30 million per year.

The 5 year review is different from pay adjustments related to the SGR. Psychologists were saved from a second and even more devastating reduction when Congressional action halted the projected 21.2% Sustainable Growth Rate cut through May 31, 2010. On May 28, the House passed H.R. 4213, Section 523 of which replaces the SGR cut with a 1.3% increase from June through December 2010 and provides an additional 1% increase in 2011. The Senate should prevent drastic payment reductions from taking place by passing H.R. 4213. Ultimately Congress must replace the flawed SGR formula with one that responsibly and permanently addresses provider payments.

Jeff Cook, J.D.
Director of Field & State Operations
American Psychological Association Practice Organization
750 First Street, NE Washington, DC 20002
(202) 336-5875 (Office)
(202) 336-5797 (Fax)
jco…@apa.org (click to verify and reveal email)

Republished with permission: APAPO