Increase Medicare Beneficiaries' Access to Mental Health Care by Allowing Psychologists to Practice Independently
Medicare prohibits psychologists from practicing without physician referral or supervision in many treatment settings, even when they are authorized to do so under their state's licensure law.
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health services to Medicare beneficiaries, but are unable to provide their full range of services due to Medicare's outdated and inappropriate physician oversight requirements.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 mental health 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.
“I am the CEO and the primary person responsible for three clinics, 70 clinicians, 3,000 clients. Having a psychiatrist supervise me and everyone already supervised by me or someone else or working independently, is redundant clinically, time and cost wise….
We are licensed to practice independently. It makes the public mental health system much more expensive than it needs to be to maintain quality. It is VERY old school and no longer applies to a modern efficient clinic.”
--K.S., psychologist in Maryland
Allowing psychologists to practice independently will improve Medicare beneficiaries' access to mental health services, at a time when the need for psychologists' services is growing:
- 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 dire shortage of mental health professionals available to treat Medicare beneficiaries, and the shortage is getting worse. 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.
- For years, Medicare has allowed dentists, podiatrists, chiropractors and optometrists to practice without physician referral, 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, and Medicare has strict guidelines for consultation and care coordination remain in place under the legislation.
- Letting psychologists practice independently in Medicare will not increase program costs significantly. Medicare Advantage programs have not experienced cost increases by letting psychologists practice independently. Physician supervision requirements add unnecessary costs and can delay or prevent treatment.
Allowing psychologists to practice independently in all Medicare treatment settings will make it easier for beneficiaries to get the help they need — when they need it — regardless of where the service is provided. Legislation to do this is supported by a wide range of consumer and provider organizations, including:
- National Association for Rural Mental Health
- Brain Injury Association of America
- Paralyzed Veterans of America
- National Council for Behavioral Health
- American Foundation for Suicide Prevention
- Mental Health America
- Association for Ambulatory Behavioral Healthcare
- Center for Medicare Advocacy Inc.
- American Association of Pastoral Counselors
- American Group Psychotherapy Association
- American Board of Professional Neuropsychology