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Information Alert! House Committees Include Psychology’s Top Medicare Priority

us_capitolOn Friday, three key House committees, the Ways and Means, Energy and Commerce, and Education and Labor Committees, released their joint draft of health care reform legislation, which includes Medicare provisions.

I [Jeff Cook, J.D.] am pleased to inform you that the committees have included psychology’s top Medicare priority – a two-year extension of the 5% psychology payment restoration previously passed as part of the Medicare Improvements for Patients and Providers Act (MIPPA) in 2008. The provision would ensure approximately $60 million will continue to support Medicare psychotherapy services that would otherwise have been cut as a result of the Centers for Medicare and Medicaid Services (CMS) five-year review rule. This is a critically important first step to ensure our provision is included in any final legislation Congress adopts and sends to the President.

The draft bill also includes other positive developments for practitioners and their patients, including a proposed revision of the current payment formula to prevent the 21% Sustainable Growth Rate (SGR) cut from taking effect in 2010. Based on projections from CMS, services would be expected to receive a 1% update in 2010. The draft would also remove the discriminatory cap on inpatient psychiatric hospital stays, building on MIPPA’s phased-in implementation of copayment parity and bringing the Medicare program closer to full parity between mental and physical health. Unfortunately, the draft does not amend the Medicare “physician” definition to include psychologists, but APAPO [American Psychological Association Practice Organization] will keep pushing for this change to remove unnecessary and inappropriate physician supervision of psychologists’ services.

The Practice Organization is concerned about a provision in the bill that would authorize the Department of Health and Human Services (HHS) to establish Medicare medical home models under the leadership of physicians or nurse practitioners who would coordinate and arrange for care with other providers. APAPO is particularly concerned that the draft language contains few details about how beneficiaries would access the services of other health care professionals, including psychologists who provide critical testing and assessment services. The Practice Organization seeks a fully inclusive model, such as the HELP Committee model discussed below, and at the minimum is requesting that psychologists be made eligible to provide these services.

Senate Action

On the Senate side, the Health, Education, Labor and Pensions (HELP) Committee has begun formal consideration of its health care reform bill, the Affordable Health Choices Act (AHCA). I am pleased to report to you that the HELP Committee’s draft features psychology’s top health care reform priorities – inclusion of mental health/substance use in insurance benefit packages and integration of psychologists and psychological services into primary care. Your grassroots support has been critical to ensuring key Congressional committees understand the importance of these provisions to psychologists and their patients.

While the HELP Committee has yet to release any details of a public plan option, the AHCA would establish state-administered “gateways” in which insurers would compete to provide health plans to individuals who do not have employer-based coverage and are not otherwise qualified for Medicare, Medicaid or other similar coverage. Both the AHCA and the House tri-committee draft require these plans to include mental health and substance use benefits. The federal parity law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, and state parity laws would apply to such plans in the larger group (50 or more
employees) market.

The AHCA also sets out a new grant program to establish community-based, multi-disciplinary, inter-professional “health teams” to facilitate better primary care services. These patient-centered health teams, which would include psychologists and other mental health providers, would be designed to work together to provide patients with coordinated and integrated care, with priority given to those with chronic diseases or conditions, and access to a continuum of health care services, including referrals for mental and behavioral health services.

On June 16, APA Chief Executive Officer Norman B. Anderson, Ph.D., expressed APA’s support for the bill to committee leaders in a letter that can be viewed here:

Affordable Health Choices Letter

APAPO continues to work with the committee to make additional technical amendments that would benefit psychologists and their patients as the “mark-up” process moves forward over the next few weeks.

At the same time, the Senate Finance Committee is also preparing to consider health care reform legislation, which like the House bill will include Medicare provisions. The Finance Committee measure is expected to include provisions directly related to Medicare reimbursement and is now likely to be considered after the recess scheduled for June 27 through July 5. APAPO is working hard to ensure the bill contains our top Medicare priority, extension of the 5% psychology payment restoration, as well as inclusion of psychologists in the “physician” definition.

We will keep you posted as these important issues move forward in the coming weeks.

Jeff Cook, J.D.
Director of Field & State Operations
American Psychological Association Practice Organization

Reprinted with Permission: APA Practice Organization

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