As you know, Members of Congress have returned home to their districts to compete in the 2010 midterm elections. The House and Senate are expected to return to Washington for a lame duck session beginning the week of November 15, and they will have two short weeks to complete action on the “must-pass” Medicare bill to prevent the 23% Sustainable Growth Rate (SGR) cut from taking effect on December 1. It is critically important that the bill includes the 5% psychotherapy payment extender because this package may be the last chance in this Congress to ensure the extension of expiring Medicare provisions.
Thanks to your great work, psychology has convinced Congress to restore critical reimbursement funding for psychologists beginning in 2008 through the end of 2010. Legislative action this year is needed to enact the restoration for 2011. Your current Representatives, who will be making the decisions on Medicare in November, need to hear from you during the fall recess to ensure our provision is included.
Action by FACs
Before November 2 mobilize key psychologists to ask incumbent legislators to ensure the psychotherapy payment extender is included in the lame duck Medicare bill.
During the fall recess Representatives will make frequent stops throughout the district on the campaign trail providing an excellent opportunity for psychologists to engage their legislators and 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 a key psychologist in each congressional district to engage their Representative at a community event with the following message:
Congressman/woman ______, my name is Dr. _______, I am a psychologist living in the district and I understand that Congress plans to take up a Medicare bill to deal with the SGR during the lame duck session. Can psychologists and our patients count on your support to ensure that the bill includes the Medicare mental health payment extender? It is critically important to ensure seniors have continued access to quality mental health care.
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.
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 in June halted the projected 21.2% Sustainable Growth Rate cut through November 30, 2010. 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