Capitol Hill wrap-Up: Psychology's priorities getting attention in health care reform debate

On issues such as the 5 percent Medicare restoration and ensuring psychology is included, both the House and Senate bills look positive

by Government Relations Staff

October 28, 2009 — With the Senate Finance Committee passing its bill October 13 after months of consideration, health care reform legislation has now been approved by all five congressional committees of jurisdiction.

The House bills and the Senate HELP Committee bill all include key provisions that are favorable for professional psychology. In addition, the Senate Finance Committee, which has jurisdiction over the Medicare portion of health reform, also passed a bill favorable to psychology.

How psychology's priorities fare
The key provisions in health care reform pertaining to professional psychology are the 5 percent restoration of the Medicare reimbursement rate cut, integrated care and the Sustainable Growth Rate (SGR).

The 5 percent Medicare restoration

Status Update: This provision has the support of both the House and Senate committees. Back in June 2008 with passage of the Medicare Improvements for Patients and Providers Act of 2008, the American Psychological Association Practice Organization (APAPO) won an 18-month restoration of Centers for Medicare and Medicaid Services (CMS) reimbursement payments that partially offset cuts imposed in 2007. But the law provided the increased payments only through December 31, 2009. Both houses of Congress have now passed legislation to increase payments by 5 percent until 2012. Psychology was the only provider group to win an adjustment in Medicare fees.

Looking Ahead: We are optimistic that the final health care reform bill will maintain the 5 percent Medicare restoration.

Ensuring that psychologists and their services are a core part of the integrated care initiatives in the reform legislation

Status Update: The Senate HELP Committee bill includes broad provisions for care integration throughout the new health system. This integration fully incorporates all providers, including mental and behavioral health providers.

By contrast, the House bills have a very narrow provision, which would establish a Medicare Medical Home Pilot Program - basically a provision to test an integrated care model only in the Medicare program — where care will be directed by primary care physicians and nurses.

In the House bills, no other providers would coordinate this care, although the primary care physicians and nurses are required to arrange for care with other providers, which would include psychologists.

Looking Ahead: We are working to extend this language as it moves through the House so that it includes psychologists as participants in providing care both as part of their practices and through referral to outside teams.

Ultimately, we favor the Senate HELP Committee approach — due to its breadth and inclusiveness of psychology - and will champion that language for final passage.

Status Update: The American Psychological Association Practice Organization (APAPO) has also locked in mental health and substance use services as a core benefit that must be provided by all plans provided through the new health coverage "Exchange" — or insurance pool — and the Wellstone-Domenici mental health parity law that we won last year applies to these plans.

Looking Ahead: We are well positioned to win this issue. All of the Senate and House committee bills are requiring that mental health and substance use benefits must be a core benefit in all plans sold in the Exchange and would apply the new parity law.

Status Update: We are working to ensure that mental and behavioral health is part of prevention and wellness initiatives.

Looking Ahead: So far, all of the House and Senate bills provide that the federal government will take a lead role in transforming the health care system to better value prevention and wellness, appointing a commission to make recommendations for the future. The broadly written provisions include mental and behavioral services as well as those for physical services.

Replace the Medicare "sustainable growth rate" or "SGR" payment formula.

Status Update: The Medicare "sustainable growth rate" or SGR payment formula ties Medicare provider payments to factors related to the national economy, and it has operated automatically in recent years to cut most provider payments. If no action is taken, all Part B reimbursements will be cut by 21 percent in January.

The House bill would replace the formula and provide a 1 percent increase in its stead. The Senate's bill, in contrast, delays the cut for one year and replaces it with a half percent increase for 2010.

Looking Ahead: Last week, Congressional leaders separated the SGR issue from reform and tried to move it as a separate bill - as a permanent fix is expensive: $245 Billion over ten years. On October 21, the Senate began consideration of S. 1776, which would permanently repeal the flawed Sustainable Growth Rate (SGR) formula; the legislation failed on a procedural vote 47-53 due to concerns related to a lack of offsets to pay for the package.

We anticipate that the Senate will still address the scheduled 21 percent SGR cut to Medicare provider reimbursements by the end of the year, most likely as a one-year fix, as originally intended by Senator Max Baucus' health care reform bill.

Looking ahead to November
Senate leadership has begun the process of merging the Finance Committee measure with the Health, Education, and Labor and Pensions (HELP) Committee bill to form one bill for consideration on the Senate floor. The Senate needs 60 votes to limit debate and move the bill to a vote.

House leadership has already merged the Ways and Means, Education and Labor, and the Energy and Commerce bills into one bill for floor consideration. The House needs 218 votes to take up and pass the bill.

Neither Senator Majority Leader Harry Reid nor House Speaker Nancy Pelosi is expected to begin consideration of the legislation until each is confident of having the votes necessary to ensure its passage. Therefore, it is likely that the bill will not go to the Senate and House floors until November.

APAPO continues working to protect our successes while working to make the reform bill as good as we can for professional psychology.