APA Practice Organization continues advocating for bills that boost psychologists’ participation in Medicare

Consulting firm Avalere Health Inc. analyzes the “physician definition” bill, and APA supports legislation on Medicare equity.

According to a new analysis, the Medicare Mental Health Access Act (H.R. 1173, S. 448), adding clinical psychologists to the list of providers Medicare defines as “physicians” would have minimal cost. The estimate, produced by consulting firm Avalere Health Inc., projects the legislation would cost the federal government $239 million over 10 years. This is a miniscule amount within the context of annual Medicare spending, which is about $600 billion.

Avalere also concluded that the cost of the legislation would result from psychologists becoming eligible for Medicare bonus payments for services provided in mental health-professional shortage areas, not from any increase in psychologists’ reimbursement rates or change in which services they can bill.

The APA Practice Organization commissioned Avalere’s analysis to help address cost concerns of members of Congress.

Analysis could help advance bill in Congress

The Medicare Mental Health Access Act would allow Medicare-participating psychologists to practice independently, without prior physician sign-off, in all Medicare-covered treatment settings. Currently, psychologists in certain settings such as partial hospitalization programs or outpatient rehabilitation facilities must wait for a physician’s approval before providing services to Medicare beneficiaries. By including clinical psychologists within Medicare’s definition of a “physician”— a definition which already includes dentists, chiropractors, optometrists and podiatrists — the legislation would remove this requirement.

Avalere’s estimate will provide important context for any future evaluation of the legislation by the Congressional Budget Office (CBO), Congress’s official scorekeeper. APA Practice Organization staff are briefing congressional staff on Avalere’s analysis as part of our work to gain more co-sponsors for the legislation, and to support its inclusion in a broader package of Medicare legislation later in the year.

New bill to end lifetime limit for psychiatric services

APA and the Practice Organization are also supporting the Medicare Mental Health Inpatient Equity Act of 2017 (H.R. 2509), which would eliminate the 190-day lifetime limit for Medicare beneficiaries receiving care in a psychiatric hospital. The legislation was reintroduced May 18 by U.S. House Representatives Paul Tonko, D-N.Y., John Conyers, D-Mich., Diana DeGette, D-Colo., Joe Kennedy, D-Mass., Ro Khanna, D-Calif., and Doris Matsui, D-Calif.

Psychologists provide a significant share of mental and behavioral health services within the Medicare program, and diagnose and treat mental and substance abuse disorders in a wide range of treatment facilities. The Medicare Mental Health Inpatient Equity Act would go a long way towards assisting Medicare patients with mental health disorders who may require ongoing psychiatric treatment and hospitalizations, when in crisis, in a range of Medicare settings. The 190-day lifetime limit does not apply to psychiatric units in general hospitals.

The legislation seeks to end the discrimination against mental illnesses that continues to exist in the Medicare program long after Congress ended the Medicare coinsurance inequity for mental health and physical health, and established mental health and substance use parity in private health plans through the passage of the Affordable Care Act of 2010 and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

The Practice Organization and APA are joined by members of the Mental Health Liaison Group (MHLG), the premier coalition of national mental health and substance use advocacy organizations, in supporting the bill. APA is an active member of MHLG, with practice government relations staff serving on the board of directors and as co-chair of the Health Policy Committee.