Psychologists are currently prohibited from practicing independent of physician supervision under Medicare in many treatment settings, even when authorized to do so under their state's licensure law. Bipartisan legislation — sponsored by Sen. Sherrod Brown (S. 1064) and Rep. Jan Schakowsky (H.R. 794) — will fix this, improving Medicare beneficiaries' access to care, especially in rural and underserved areas.

Psychologists are a major provider of mental and behavioral health services to Medicare beneficiaries, but are unable to provide their full range of services due to Medicare's outdated and inappropriate physician oversight requirements. Psychologists provide over 70 percent of hospital inpatient, partial hospital and residential mental health care; nearly 50 percent of hospital outpatient care; and nearly all psychological and neuropsychological testing. Psychologists are licensed to practice without supervision in all states and the District of Columbia. Psychologists practice independently, without physician supervision, in all private sector health plans, Medicare Advantage plans, the Veterans Health Administration and TRICARE.

Unlike other health insurance payers, Medicare requires physician supervision of psychologists' services in many treatment settings, which means that when no physician is available, psychologists cannot treat beneficiaries. Medicare requires supervision of psychologists' services provided in hospital outpatient departments, partial hospitalization programs, comprehensive outpatient rehabilitation facilities, rural health clinics and federally qualified health centers. Supervision of psychologists' services is frequently done by physicians who do not have significant training in psychological treatments.

Allowing psychologists to practice independently will provide Medicare beneficiaries better access to mental health services. The need for psychologists' services is growing:

  • Each year, about 26 percent of all Medicare beneficiaries (more than 13 million Americans) experience some mental disorder, including cognitive disorders like Alzheimer's disease. Serious mental illness, including bi-polar disorder or schizophrenia, is especially prevalent among beneficiaries who are under 65 and eligible for Medicare based on their disability.
  • Studies show that roughly 70 percent of older adults who meet diagnostic criteria for major depressive disorder or for anxiety disorder do not receive mental health treatment.
  • Medicare beneficiaries are at greater suicide risk than the general population: although adults over age 65 make up only 12 percent of the nation's population, they account for 16 percent of all suicide deaths, according to the National Institute of Mental Health.

There is a shortage of mental health professionals available to treat Medicare beneficiaries, and the shortage is getting worse as the U.S. population ages. The Institute of Medicine has concluded that "if the nation is to confront the growing burden of Medicare costs, it must develop ways to maximize the productive capacity of the geriatric MH/SU [mental health and substance use] workforce."

Medicare policy should be changed to let psychologists practice independently:

  • Requiring physician supervision gets in the way of providing treatment. An estimated 77 percent of U.S. counties have a severe shortage of psychiatrists, the only physician specialty with significant training in the diagnosis and treatment of mental disorders. Psychiatrists have by far the lowest Medicare participation rates of any physicians.
  • Medicare has long allowed dentists, podiatrists, chiropractors, and optometrists to practice independent of physician supervision, with no adverse effect on beneficiaries' treatment.
  • The Medicare Mental Health Access Act would not expand psychologists' scope of practice. Psychologists' scope of practice is established solely by state — not federal — laws.
  • Letting psychologists practice independently in Medicare will not increase program costs. Medicare Advantage programs have not experienced cost increases associated with independent practice by psychologists. Physician supervision requirements add unnecessary costs and can delay or prevent treatment.
  • An actuarial analysis of the physician supervision requirement found no evidence that it increases quality of care, or adds appropriate access limitations or restrictions. Medicare has strict guidelines for consultation and care coordination that remain in place under the legislation.

Allowing psychologists to practice independently under Medicare will make it easier for beneficiaries to get the help they need. Waiting to obtain physician supervision of services gets in the way of providing necessary care, especially in areas without adequate access to psychiatrists. This is why the Medicare Mental Health Access Act is supported by consumer and provider organizations, including:

  • Association for Ambulatory Behavioral Healthcare
  • American Federation of Teachers
  • American Foundation for Suicide Prevention
  • American Group Psychotherapy Association
  • American Psychological Association
  • Center for Medicare Advocacy Inc.
  • Mental Health America
  • National Council for Community Behavioral Healthcare

APA Practice Organization
June 2014