Legislative advocacy: A look ahead in 2012

APAPO advocacy includes Medicare reimbursement and inclusion in electronic health record-keeping incentive payments

By Legal and Regulatory Affairs Staff

January 12, 2012—As members of Congress return to work in the coming days after their winter recess, here’s a look at how the APA Practice Organization (APAPO) is working to advance and protect professional psychology in the coming year.

Medicare reimbursement

Congress reached a short-term agreement at the end of 2011 preventing scheduled reductions in Medicare payments through February 29, 2012.

Now key legislators serving on a conference committee to negotiate a longer-term measure have begun returning to Washington. Much remains at stake for practicing psychologists, as changes in Medicare reimbursement rates will not only affect Medicare beneficiaries but also individuals with TRICARE or private insurance from third party payers that follow Medicare’s lead. Without further action by Congress, psychologists will face payment cuts of 27.4 percent for all services resulting from application of the Sustainable Growth Rate (SGR) formula and an additional 5 percent for psychotherapy services due to expiration of the psychotherapy extender the APA Practice Organization has secured four times since 2008.

Visit the Legislative Action Center to urge your Senators and Representatives to halt Medicare cuts to psychological services.

APAPO is guardedly optimistic about the chances of blocking reductions in Medicare if grassroots psychologists again advocate for the necessity of the extender. With constituents making clear they care about the issue, those legislators in favor of the extender will have the support they need to stand up for it in these challenging budgetary times and those opposed will be less apt to object.

Going forward, APAPO will continue to keep up the pressure for Congress to enact a permanent solution to the SGR payment formula.

Health care reform

As discussed in depth in an earlier PracticeUpdate article, even as elements of the 2010 health care reform legislation known as the Patient Protection and Affordable Care Act (ACA) are implemented, the federal law is unfolding in a landscape of growing uncertainty. Much of the uncertainty surrounding health care reform relates to the long timeline for implementation, combined with political dynamics and stark budget realities.

In late December, the Supreme Court announced it will hear several issues related to ACA – key among them whether Congress can impose a mandate that individuals purchase health insurance and whether states can be coerced to pay part of the cost of persons newly covered in Medicaid. The high court is expected to issue its decision in June.

If the Court blocks Medicaid expansion, 16 million of the 32 million Americans expected to benefit from expanded health insurance coverage under ACA will not obtain it.

Inclusion of mental health providers in HIT incentive payments

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted by Congress in 2009 as part of the American Recovery and Reinvestment Act, failed to include psychologists and most other non-physician providers among those eligible to receive Medicare and Medicaid incentive payments and grant funds to adopt electronic health record keeping (EHR).

APAPO pursued legislation to include psychologists and in March of 2011, Senator Sheldon Whitehouse (D-RI), introduced The Behavioral Health Information Technology Act of 2011 (S. 539), which would allow mental health practitioners and facilities to seek reimbursement for purchasing EHR systems.

APAPO continues to meet with congressional offices to build support for and gain cosponsors of S. 539. A similar bill will soon be introduced in the House by Rep. Tim Murphy (R-PA), who sits on the committee with jurisdiction over the issue. APAPO believes this issue is more likely to move in the Senate than in the House, but will have a better sense of its chances once the bill is introduced and Representatives react.

Physician definition in Medicare

Early last year key allies of professional psychology in the Senate and House introduced legislation to include psychologists in the Medicare “physician” definition, which would eliminate barriers to the services psychologists provide by removing inappropriate physician supervision requirements that are imposed by Medicare but not by private health insurance plans.

Passage of this legislation improves the Medicare mental health benefit accessibility to the beneficiary population poised to explode in the coming decades. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), individuals age 65 and older will comprise 20 percent of the country’s population by 2030. This means increased demand for mental health treatment as the number of older adults with mental disorders, including depression, anxiety and dementia, grows from 7 to 15 million. Psychologists will assume greater roles in working with physicians and other Medicare providers to address comorbid physical and mental/substance use disorders.

Senators Olympia Snowe (R-ME) and Jeff Bingaman (D-NM), who sit on the Finance Committee, sponsored S. 483, introduced on March 4, 2011. Congresswoman Janice Schakowsky (D-IL), who serves on the Energy & Commerce Committee, took the lead on H.R. 831, introduced on February 28, 2011. APAPO continues working to increase the number of bill co-sponsors and will again feature the bill as one of three issues to be discussed when psychology leaders meet with their members of Congress and staff during the State Leadership Conference this March.

APAPO hopes the bipartisan support for physician definition legislation will encourage its movement this year.