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Legislation Introduced To Include Psychologists In Medicare Physician Definition

U.S. CapitolIn an exciting development for psychology, I am pleased to report that Congresswoman Jan Schakowsky (D-IL) has introduced legislation (HR 6147 to include psychologists in the Medicare “physician” definition. Our lobbying team has been working for several months to identify and recruit a champion on the Hill, and we are pleased that Schakowsky, who has a key role on the House Energy and Commerce Committee, has chosen to lead the charge on this important issue for practicing psychologists.

You can view the APA Practice Organization’s letter of support here.

We have a long way to go to see this common sense measure implemented into law, but this is an important first step in a long process to ensure psychologists are able to provide Medicare mental health services free of unnecessary physician supervision requirements that hinder patient access. In the few weeks left of this session of Congress, we need your help to recruit cosponsors and build support on the Hill.

Action by Psychologists:

Before October 7 call the Capitol Switchboard at 202-225-3121 and urge your Representative to cosponsor HR 6147.

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

Targets: All U.S. Representatives

Message:

I am calling as a constituent and psychologist to urge the Congressman/woman to cosponsor HR 6147 to remove barriers to patient access to quality mental health care by including psychologists in the Medicare “physician” definition. Psychologists are the only doctoral trained non-physician providers who have still not been included in the definition. The bill it is needed to ensure we can serve our Medicare patients to the full extent of our licensure independent of unnecessary physician supervision requirements.

If the Representative indicated support during SLC, then say: Your office indicated that the Congressman/woman would likely be supportive when constituents visited on March 9.

If you know the staffer, then ask: Can we count on the Congressman/woman’s cosponsorship?

Background:

Congress Should Include Psychologists in Medicare’s “Physician” Definition to Improve Patient Access to Mental Health Services.

Right now, several Medicare physician supervision requirements are hampering psychologists from providing Medicare beneficiaries the full range of services under their state licensure. Medicare pays for and recognizes the importance of psychologists’ services, but restricts patient access through archaic and unnecessary physician supervision requirements. As a result, Medicare mental health services are being left behind at a time of growing recognition that they are centrally important to ensuring the health of elderly individuals.

Psychologists are key mental health providers in Medicare. Psychologists provide nearly half of the psychotherapy services to Medicare beneficiaries in the hospital outpatient setting and more than 70% of the psychotherapy services in the hospital inpatient, partial hospital, and residential care settings. They provide the vast majority of mental health testing services, many of which are unique to their training and licensure.

Psychologists’ services are of growing importance for beneficiary health as Medicare increasingly emphasizes primary and chronic care for beneficiaries, including care for the mind and body as one.

According to SAMHSA, individuals age 65 and older will comprise 20% of the country’s population by 2030. There will be increased demand for mental health treatment as the number of older adults with mental disorders, including depression, anxiety, and dementia, grows from 7-15 million. Treatment for these individuals will be more complicated because mental disorders in older persons are associated with adverse outcomes such as poorer functioning, increased morbidity and mortality, and a higher risk of institutionalization.

More than ever psychologists are working with medical doctors in Medicare to treat patients with co-morbid physical and mental health and substance use disorder conditions.

Including psychologists in the Medicare physician definition will improve Medicare beneficiary access to the mental health services they need. At a time when Medicare beneficiaries need the full range of services that psychologists provide, it is critically important that inappropriate physician supervision barriers be removed. Psychologists provide critical care to beneficiaries in a range of Medicare settings, including in the inpatient hospital, psychiatric hospital, hospital outpatient, partial hospital, comprehensive outpatient rehabilitation facility (“CORF”), rural health clinic, federally qualified health center, and skilled nursing facility settings. Inclusion of psychologists in the physician definition will provide for a long-overdue reassessment of supervision and oversight that is not appropriate.

For example, partial hospital services provide intensive treatment for Medicare beneficiaries who would otherwise need inpatient psychiatric care, and are furnished by hospitals to outpatients or by community mental health centers. Psychologists can and do run partial hospital programs in the private health system today-overseeing, supervising and providing treatment-yet Medicare requires that such services must be prescribed by a physician, provided under a written treatment plan established and periodically reviewed by a physician, and furnished while under the care of a physician. If these physician barriers were removed, Medicare beneficiaries would have better access to the partial hospital services they need.

Including psychologists in the physician definition will particularly help Medicare beneficiaries in rural areas where psychiatrists are not available to provide supervision. Based on a 2007 APAPO study prepared by the Center for Health Policy, Planning and Research at the University of New England, there are 2,943 psychiatrists in non-Metropolitan Statistical Areas in the U.S.- a rate of 5.2 psychiatrists per 100,000 population. There are three times as many psychologists in these areas – 8,867 psychologists or a rate of 15.7 psychologists per 100,000 population.

The lack of psychiatrists to supervise treatment in the various Medicare settings has stifled the development and expansion of mental health services delivery in rural areas. If, for example, a physician is not available to supervise partial hospital services in a rural area, then such services are not provided, even if needed by rural Medicare patients. Removing unnecessary physician supervision requirements will help remedy rural mental health access to these mental health services. Psychologists will be able to provide partial hospital services within their licensure without unnecessary physician oversight while still working with physicians regarding medication and other services beyond their licensure.

Congress references the Medicare physician definition in enacting laws to evolve the Medicare program or to improve beneficiary access to services. When psychologists are not included in the definition, mental health services are left behind.

HPSA Bonuses – Medicare “physicians,” including chiropractors, optometrists, and podiatrists, receive a 10% bonus payment for providing services in a Health Professional Shortage Area. By excluding psychologists, mental health services are mostly left out of bonus payments designed to improve Medicare beneficiary access in underserved areas.

HIT Incentive Payments – The Health Information Technology for Economic and Clinical Health (“HITECH”) Act provides for incentive payments to Medicare “physicians,” including chiropractors, optometrists and podiatrists when they adopt electronic medical records into their practices. With the exclusion of psychologists from these payments, mental health is essentially left out in the development of electronic medical records in the Medicare program.

Including psychologists in the Medicare physician definition does not make them physicians, but it does remove barriers to the services they provide. Medicare’s physician definition (1861(r) of the Social Security Act) includes non-physician providers. Dentists, podiatrists, optometrists and chiropractors are included in the Medicare physician definition so that they may provide services to the full extent of their licensure.

Inclusion of psychologists would not reconstitute psychologists as physicians or expand their scope of practice. Only state licensure law can do that. But as with the other non-physician providers already in the definition, psychologists will be able to serve Medicare beneficiaries to the full extent of their licensure. In fact, psychologists are the only doctoral-trained Medicare providers of the health care practitioners not in the physician definition. It is time to include psychologists in the physician definition.

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

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