Congress perseveres on Medicare and health care reform

The Senate Finance Committee began its long-awaited markup of Medicare and health care reform legislation and the House Rules Committee plans to merge the three reform bills pending in the House

by Government Relations Staff

September 29, 2009 — The Senate Finance Committee began its long-awaited markup of Medicare and health care reform legislation on September 22. More than 500 amendments were filed as potential modifications to the bill proposed by Chairman Max Baucus (D-MT), a controversial bill due to its centrist approach that has not yet gained Republican support. The Finance Committee is continuing to consider amendments this week, and liberal members of the committee are expected to advocate for a government-run insurance option to compete with private insurers.

The bill includes professional psychology's top Medicare priority: a two-year extension of the 5 percent psychotherapy payment restoration passed in 2008 as part of the Medicare Improvements for Patients and Providers Act (MIPPA). This important victory for psychology follows House action during the summer, when the three committees of jurisdiction passed bills that also included the payment restoration provision.

The win also follows more than 6,600 messages from practicing psychologists through the online Legislative Action Center asking their senators and representatives to help pass comprehensive health care reform legislation that includes the payment restoration and fully integrates psychologists and psychological services into the health care delivery system.

Enacting the extension would ensure that approximately $60 million will continue to support Medicare psychotherapy services; these monies would otherwise have been cut as a result of the Centers for Medicare and Medicaid Services (CMS) five-year review rule. The Baucus bill also would avert the impending 21 percent cut in reimbursement for independent professional services under Medicare Part B and replace it with a half-percent increase in 2010 reimbursement levels.

Favorable provisions in Baucus bill
The APA Practice Organization (APAPO) government relations team has been carefully reviewing the bill, which contains other provisions that would benefit psychologists and their patients. The bill includes mental health and substance use disorder services in benefit packages. By requiring that all new health insurance plans made available comply with state and federal laws, the bill would continue the good work of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act by requiring that such services are provided at parity.

The health care reform bills introduced thus far have proposed creating a national insurance "exchange" that would help facilitate the purchase of private insurance by individuals and groups, thereby creating more choice for consumers. Another positive aspect of the Baucus bill resulted from the Finance Committee accepting by voice vote an amendment reaffirming that the parity law applies to plans in the exchange.

The bill also includes language in support of integrated care models to promote a team-based approach to health care. Integrated health care is characterized by a high degree of collaboration and communication among health professionals. What makes integrated health care unique is that team members share information among themselves related to patient care and establish a comprehensive treatment plan to address a patient's biological, psychological and sociocultural needs.

APAPO is advocating that the Finance Committee delete provisions of the draft legislation that would create new national plans that could provide coverage to consumers without having to comply with state mental health and substance use mandated benefits and parity laws. States have enacted these laws over many years to ensure that mental health and substance use coverage adequately protects their citizens.

Also in the Senate, the Health, Education, Labor and Pensions (HELP) Committee passed its Affordable Health Choices Act on July 15. A very favorable reform bill for psychology, it includes broad provisions for integration of care that fully incorporate mental and behavioral health providers. This bill also requires coverage of mental health and substance use benefits in health plans available through a national insurance exchange. Because of the committee's jurisdiction, the bill did not contain any Medicare provisions.

It is uncertain when the Finance Committee will finish its work, as Republicans continue to demand that the Congressional Budget Office score the final bill's costs before the committee votes. After the Finance Committee approves an amended version, Senate Majority Leader Harry Reid (D-NV) will have the task of merging the Finance and HELP Committee versions of the legislation and putting a bill on the Senate floor, possibly in early to mid-October.

APAPO will continue advocating after the Finance Committee markup concludes to protect state mental health mandated minimum benefits and parity laws and to ensure the final bill that the president signs includes the Medicare restoration extension and fully inclusive language on integrating psychologists and their services into the health care delivery system.

APA endorsed the House bill, the America's Affordable Health Choices Act (H.R. 3200), on July 17 because it made great progress toward these goals and also included the Medicare reimbursement extension. Soon the House Rules Committee will merge the three bills into one version for consideration on the House floor in October.

Once the House and Senate pass their versions of health care reform legislation, a final bill negotiated by leadership will have to pass both chambers before going to President Obama.

While the Senate and House leadership remain committed and legislators are working hard to send a bill to the president this year, health care legislation continues to face several political and procedural challenges before comprehensive reform can be enacted into law.

If you have questions, please contact the Government Relations Department at 800-374-2723, ext. 5889 or by e-mail.