House committees include psychology's top Medicare priority in reform bill

If passed, health care reform legislation that includes an extension of psychology pay restoration would result in an estimated $60 million in psychotherapy payments for 2010 and 2011

by Government Relations Staff

June 30, 2009 — Three key House committees have included professional psychology's top Medicare priority — a two-year extension of the five percent psychology payment restoration — in draft health care reform legislation. The Ways and Means, Energy and Commerce, and Education and Labor committees unveiled their draft on June 19.

If passed, the extension will result in an estimated $60 million in payments for psychotherapy services in 2010 and 2011. This money otherwise will be cut as a result of the Centers for Medicare and Medicaid Services (CMS) five-year review rule. The APA Practice Organization (APAPO) won an 18-month restoration of reimbursement as part of the Medicare Improvements for Patients and Providers Act in 2008, but that expires at the end of 2009.
The recent development is a critically important first step to ensure that psychology's provision is included in any final Medicare legislation that Congress adopts and sends to the president.

The draft bill includes other positive proposals for practitioners and their patients, including:

  • preventing the 21 percent Sustainable Growth Rate (SGR) cut from taking effect in 2010 by replacing the current payment formula. Based on current projections from CMS, Part B Medicare services would be expected to receive a 1 percent payment increase next year. Preventing a 21-percent cut would avert an estimated decrease in payments of approximately $91 million for psychological services.

  • removing the discriminatory 190-day lifetime cap on inpatient psychiatric hospital stays, which would bring the Medicare program closer to full parity between mental and physical health.

Unfortunately, the draft bill does not amend the Medicare "physician" definition to include psychologists. APAPO will keep pushing for this change to remove unnecessary and inappropriate physician supervision of psychologists' service. We will deliver this message through grassroots emails from constituent psychologists, direct lobbying and political giving by AAP/PLAN, psychology's national political action committee.

The APA Practice Organization is concerned about a provision in the bill that would authorize the Department of Health and Human Services to establish Medicare "medical home models" under the leadership of physicians or nurse practitioners who would coordinate and arrange for care with other providers.

Of particular concern, the draft language contains few details about how beneficiaries would access the services of other health care professionals, including psychologists who provide critical testing and assessment, among other professional services.

APA and the APA Practice Organization are seeking a fully inclusive model involving integrated, multidisciplinary care, such as the Senate Health, Education, Labor and Pensions (HELP) Committee model discussed below.

We are advocating for legislative language that would ensure beneficiary access to a full range of non-physician health care services available in the community, along with physicians' services.

Further, we are asking that, where a patient's chronic conditions primarily involve mental health, substance use or behavioral disorders or conditions, a psychologist be eligible to play a leadership role in providing care.

Senate action
On the Senate side, members of the Health, Education, Labor and Pensions Committee have begun voting on amendments to the committee's health care reform bill ("markup"). Their draft bill — the Affordable Health Choices Act (AHCA) — features professional psychology's top health care reform priorities: inclusion of mental health/substance use in insurance benefit packages and integration of psychologists and psychological services into primary care.

Grassroots support has been critical to ensuring that key congressional committees understand the importance of these provisions to psychologists and their patients.

Psychologists have sent more than 20,000 messages to their legislators on Capitol Hill on behalf of psychology's priorities. Key psychologists have placed calls to their contacts in Congress to secure support for the professional psychology's legislative goals.

While the HELP Committee has yet to release any details of a public option, the AHCA would establish state-administered "gateways" in which insurers would compete to provide health plans to individuals who do not have employer-based coverage and are not otherwise qualified for Medicare, Medicaid or other similar coverage. Both the AHCA and the House tri-committee draft require these plans to include mental health and substance use benefits.

The federal parity law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, and state parity laws would apply to such plans in the larger group (50 or more employees) market.

The AHCA also sets out a new grant program to establish community-based, multi-disciplinary, inter-professional "health teams" to facilitate better primary care services.

These patient-centered health teams, which would include psychologists and other mental health providers, would be designed to work together to provide patients with coordinated and integrated care, with priority given to those with chronic diseases or conditions, and access to a continuum of health care services, including referrals for mental and behavioral health services.

On June 16, APA Chief Executive Officer Norman B. Anderson, PhD, expressed APA's support for the bill. APAPO continues to work with the HELP Committee to make additional technical amendments that would benefit psychologists and their patients as the "markup" process moves forward over the next few weeks.

At the same time, the Senate Finance Committee is also preparing to consider health care reform legislation, which like the House bill will include Medicare provisions. The Finance Committee measure is expected to include provisions directly related to Medicare reimbursement and is now likely to be considered soon after the holiday recess ends on July 6.

APAPO is working hard to ensure that the bill contains our top Medicare priority — extension of the 5 percent psychology payment restoration — as well as inclusion of psychologists in the "physician" definition.

Moving forward
According to lobbyists for the APA Practice Organization, the Senate will try to combine the bills from the two committees of jurisdiction over health care and Medicare reform. The House committees will proceed with markup before the three-committee bill is debated on the floor of that chamber.

Assuming the two chambers complete action on their respective bills, negotiations will be required to reconcile the differences.

There is a question of whether Congress as a whole will be able to come to terms. "Bipartisan support may be elusive, especially in the Senate," said Peter Newbould, director of congressional and political affairs for the APA Practice Organization.

Newbould also noted that several more factors need to coalesce in order for health care reform legislation to emerge from Capitol Hill later this year. The staggering price tag is being closely scrutinized. Further, the legislation ultimately needs to maintain the support of the public and other key stakeholders.