Medicare physician definition legislation introduced in the Senate

The APA Practice Organization has worked hard to gain the bill, and needs your help to support it.

By Government Relations staff

On May 23, Senator Sherrod Brown, D-Ohio, introduced a bill to include psychologists in the Medicare physician definition. S. 1064 would amend title XVIII of the Social Security Act to treat clinical psychologists as physicians for the purposes of furnishing clinical psychologist services under the Medicare program. Sen. Brown’s bill has been referred to the Senate Committee on Finance, where it awaits further review and approval.

Sen. Brown’s bill is the companion bill to HR 794, introduced in the House by Rep. Janice Schakowsky, D-Ill., on Feb. 15, 2013. The APA Practice Organization (APAPO) has worked to gain 23 bipartisan cosponsors since Rep. Schakowsky’s bill was reintroduced in this legislative session. HR 794 has been referred to the Subcommittee on Health of both the House Energy and Commerce Committee and the House Ways and Means Committee, where it also awaits further review and approval before being sent back to the full committees.

The bills are supported by consumer and provider organizations including: 

  • American Federation of Teachers 

  • American Foundation for Suicide Prevention 

  • American Group Psychotherapy Association 

  • American Psychological Association 

  • Association for Ambulatory Behavioral Healthcare 

  • Center for Medicare Advocacy Inc. 

  • Mental Health America 

  • National Council for Community Behavioral Healthcare

The campaign to include psychologists in Medicare’s physician definition has been and continues to be one of APAPO's key legislative advocacy priorities. For the past two years, psychology leaders attending APAPO’s annual State Leadership Conference have taken this issue to meetings with their senators and representatives on Capitol Hill.

Psychologists already deliver nearly half of all psychotherapy services to Medicare beneficiaries in hospital outpatient settings and more than 70 percent of psychotherapy services in hospital inpatient, partial hospital and residential care settings. And the Medicare program and patient need for mental health substance use and behavioral health services will only continue to grow in the coming years. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates individuals age 65 and older will comprise 20 percent of the country’s population by 2030.

The Brown and Schakowsky bills will allow psychologists to be treated like all other non-physician providers already included in the Medicare physician definition, thereby ending unnecessary physician supervision without increasing Medicare costs.

In inpatient hospital and psychiatric hospital settings, this bill would enhance psychologists’ ability to direct appropriate care for their patients. Psychologists are licensed to assess, diagnose and treat mental and substance use disorders and are already key providers in these settings, but they are often hindered by inappropriate physician supervision of services provided within their licensure. This overdue change would help clarify clinical oversight for hospital patients under the care of psychologists and reduce the administrative burden on hospital staff.

In outpatient hospital and community mental health center settings, Medicare patients who would otherwise need inpatient psychiatric care are provided partial hospital services. Psychologists can and do run partial hospital programs in the private health system today — overseeing, supervising and providing treatment — yet Medicare requires that such services must be prescribed by a physician, provided under a written treatment plan established and periodically reviewed by a physician, and furnished while under the care of a physician. If these physician barriers are removed, beneficiaries will have better access to needed partial hospital services.

APA and the APA Practice Organization have always been honored by the friendship of Sen. Brown and his staff, and we are pleased with the introduction of S. 1064. APAPO staff will continue to meet with both Republicans and Democrats on the Senate Finance Committee and beyond to make this a bipartisan effort. Staff will reach out to APAPO members for continued support with targeted meetings and email campaigns. Additionally, you can help raise awareness about the importance of this legislation through social media. Extend your support for the bill on any of your social media accounts, such as Facebook, LinkedIn or Twitter. On Twitter, use the hashtag #psychaccess and Sen. Brown’s Twitter handle, @SenSherrodBrown. Follow @APAPractice on Twitter for updates on the legislation and messages to share.