Current Federal Advocacy Topics
Medicare Fact Sheet
We want to encourage our congressional representatives to protect Medicare mental health payments by extending the MIPPA provision that restored 2007 cuts to Medicare Part B mental health services. Congress should also require Medicare reimbursement for psychologist evaluation and management (E/M) services within their licensure.
Medicare definition of “physician”
We want to encourage our congressional representatives to amend the Medicare “physician definition to include psychologists. This change would remove unnecessary and inappropriate physician supervision of psychologists services, which impedes patient access to needed mental health care.
Federal Parity Law
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (The Wellstone-Domenici Parity Act), enacted into law on October 3, 2008, will end health insurance benefits inequity between mental health/substance use disorders and medical/surgical benefits for group health plans with more than 50 employees. The law becomes effective on January 1, 2010. Under this new law, 113 million people across the country will have the right to non-discriminatory mental health coverage, including 82 million individuals enrolled in self-funded plans (regulated under ERISA), who cannot be assisted by State parity laws.
Q&A on Federal Parity (October 2008).
Federal Health Parity Consumer Information Sheet (September 2009)
An Employers Guide to the Mental Health Parity and Addiction Equity Act (September 2009)
Medicare reimbursement for psychologists that was cut by the CMS “Five Year Review” is discussed in “Congress Should Protect Medicare Mental Health Payment.” As you recall, Congress last July passed legislation to restore monies cut from psychotherapy reimbursements in 2007, but that fix lasts only until December 2009. We will ask Congress to extend this restoration and also make psychologists eligible to be paid for Evaluation and Management codes. The fact sheet also calls for replacing the “SGR” payment formula (through which a 20% cut in Part B looms in January), and adding psychologists to the Medicare definition of physician.
Evaluation and management codes are explained in the fact sheet updated from last year, “Medicare Should Reimburse Psychologists for Evaluation and Management Services Provided to Patients.”
With the Obama Administration prioritizing health care reform, we begin our advocacy with “Fully Integrate Mental Health Services in Health Care Reform.” This builds on the success of last year’s mental health parity law, by arguing that psychologists and psychological services should be included in every facet of reform.
We also elaborate on the role of psychologists in the health system with the fact sheet, “Health Care Reform: Congress Should Ensure that Psychologists’ Services are Key in Primary Care Initiatives.”
Senate Passes HITECH Act with Privacy Protections
Tuesday, February 10, 2009 the Senate passed the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the economic stimulus package (H.R. 1) by a vote of 61-37. The HITECH Act builds on
the current efforts of the federal government to encourage the development of a national interoperable, electronic health records network to provide better care to patients and introduce cost-saving efficienies. I am pleased to report that the comprehensive records' privacy and security provisions that we have fought for were included in the bill.
The House also passed the HITECH Act as part of its economic stimulus package on January 28th. The House and Senate health information technology (HIT) measures are largely the same with relatively minor differences, which the two chambers are expected to reconcile in the next week or so. Importantly, in last minute negotiations APAPO succeeded in getting sensitive mental health testing records included in the current HIPAA Privacy Rule "psychotherapy notes" authorization requirement. This inclusion means that testing records will be afforded the same protection as psychotherapy notes both in the current HIPAA law and as the law applies in the developing electronic records system as a whole. APAPO will seek inclusion of this important provision in the final law.
As mentioned, the HITECH Act has comprehensive privacy protections.
When enacted the HITECH Act will:
- Provide for an on-going process for setting standards to better ensure that privacy and security are protected in the health care system,
- Incorporate HIPAA Privacy and Security Rule standards, where possible, including with regard to psychotherapy notes, mental health testing data, and other sensitive patient information,
- Improve upon the HIPAA "minimum necessary" standard, which requires that only the minimum amount of patient information can be disclosed depending on the request for the information,
- Call for a reexamination of the HIPAA "health care operations" definition to determine, for example, whether such operations may be performed with de-identified information,
- Allow a patient to pay privately for health care and not have his or her records included in an electronic network,
- Implement a process to explore segmenting particularly sensitive patient records (such as mental health records),
- Provide a notice to the patient when privacy is breached,
- Contain new strong patient enforcement measures and strengthen existing HIPAA enforcement measures,
- Expand the HIPAA psychotherapy notes authorization requirement to include mental health testing data,
- Make psychologists eligible for funding provisions in the law to implement HIT into their practices and to join into electronic networks in their communities,
- Preserve stronger state laws and allow the continued application of state consent provisions and the well-established psychotherapist-patient privilege currently recognized under federal and state law, and
- Provide for continued Congressional oversight to ensure the bill's privacy and security standards are effective.