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Healthcare Providers’ Help Is Needed On Critical Medicare Payment Issues

U.S. CapitolNext week the House and Senate return for the lame duck session, and they face critical Medicare reimbursement issues. If they fail to act, the 23% Sustainable Growth Rate (SGR) cut will take effect on December 1 and the 5% psychotherapy payment restoration will expire on December 31. Psychology needs your help to ensure Congress fulfills its responsibility to Medicare patients and providers in the few short weeks they have to pass legislation.

The APA Practice Organization is working in coalition with many other providers to prevent the massive SGR cut, but we need the grassroots support of psychologists across the country to focus legislators on the critical importance of extending the psychotherapy payment restoration because it exclusively affects psychologists, psychiatrists and social workers. The final SGR measure is expected to be the last chance to ensure the extension of expiring Medicare provisions in this Congress.

Thanks to your great work, psychology 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 Senators and Representative, who will be making the decisions on Medicare, need to hear from you to ensure our provision is included.

Visit the Legislative Action Center to urge your Senators and Representative to quickly pass the psychology payment restoration extension.

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

Sample Letter:

I am writing as a psychologist and constituent to share my deep concern that Congress has not yet taken action on several key Medicare priorities. Congress must extend the 5% psychotherapy payment restoration when it moves to prevent the 23% Sustainable Growth Rate cut.

An extension of the psychotherapy restoration, originally enacted as part of the Medicare Improvements for Patients and Providers Act, is absolutely essential to protect Medicare patients’ access to quality mental health care. My practice is already facing significantly lower reimbursement in 2011 due to CMS’s recent practice expense and Medical Economic Index adjustments, and I simply cannot afford to provide services for less.

Please enact the restoration extension as soon as possible. This is critically important to my practice and the patients I serve. Thank you for your time and consideration.


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.

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) (click to verify and reveal email)

Republished with permission: APAPO

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