Policy & Advocacy
What’s New in Policy?
The Substance Abuse and Mental Health Services Administration (SAMHSA) recently developed a strategic plan, Leading Change 2.0: Advancing the Behavioral Health of the Nation 2015-2018. Unfortunately, there is not a single mention of older adults in the entire report. Although there are multiple lists of underserved populations throughout the document, older adults are never listed. For example, even for Goal 1.3, “Prevent and reduce attempted suicides and death by suicide among populations at high risk”, older adults are not included in the high risk list. The recent death of Robin Williams highlights how older adults have the highest risk of suicide. In addition, although there was a recent Institute of Medicine (IOM) Report documenting the shortage of geriatric mental health workers, there is no mention of the mental health workforce shortage for older adults in Section 6 on Workforce Development.
Each of you please take a few moments to submit on-line comments so that your and geropsychology’s voices can be added to the hopefully sizable chorus of mental and behavioral health advocates for older adults asking for SAMHSA’s attention to this issue. To increase ease of submitting comments, Deborah DiGilio in the APA Office on Aging has received the permission of the National Coalition of Mental Health and Aging (NCMHA, of which APA is a member) to share and use NCMHA draft comments on the plan (pasted below). You can cut and paste or integrate any of the comments into your own (without needing to cite them). The NCMHA comments are written to match the format of the online comment form; there are boxes for overall comments and the six strategic initiatives: Prevention of Substance Abuse and Mental Illness, Health Care and Health Systems Integration, Trauma and Justice, Recovery Support, Health Information Technology, and Workforce Development. So, information can be easily cut and pasted directly from the letter into the online comment form if desired. The deadline for comments is Monday, August 18th.
The Plan can be downloaded and viewed, and the comments input at: http://store.samhsa.gov/leadingchange/feedback/
Read an article about this at McKnights.com
Dr. Tony Puente presented a webinar on Coding, Billing, & Documenting Professional Psychological Services: Introduction to the CPT on May 14, 2014. Associated slides are available here. Posted May 15, 2014.
New law prevents 24% cut to Medicare reimbursement rates and postpones ICD-10 implementation
April 4, 2014, APA announcement: President Obama has signed a new law – Protecting Access to Medicare Act of 2014 (H.R. 4302) – averting the 24-percent Sustainable Growth Rate (SGR) cut in Medicare provider payments that was scheduled to take effect on April 1. The bill, whose passage came down to the wire, was negotiated by Senate Majority Leader Harry Reid (D-NV) and Speaker of the House John Boehner (R-OH).
The new law postpones the SGR cut until March 31, 2015 and extends a 0.5 percent Medicare reimbursement rate increase through December 31, 2014. A December 2013 law known as Pathway for SGR Reform Act of 2013 postponed the SGR cut for the first three months of 2014 and increased Medicare reimbursement by 0.5 percent through March 31 of this year.
A significant provision of the law delays adoption of the International Classification of Diseases-10 (ICD-10) code set from October 1, 2014 until October 1, 2015. The practical effect is that practitioners should continue to use the ICD-9-CM code set for coding and billing purposes until the new October 2015 deadline for using ICD-10-CM. Posted 4/9/14.
Medicare database will be released this week, allowing access to information about which doctors bill how much and for what procedures. Posted 4/9/14.
APA reported on the 2014 updates to Medicare’s Physician Quality Reporting System. Take a look at the 2014 PQRS Measures List. Posted on 1/18/14.
“NCOA is launching a new online tool to help older adults improve their financial security. EconomicCheckUp® asks a series of questions to help seniors identify benefits and services that could save them money, cut expenses, get trained for and find a job, and better utilize their assets. Early tests in 25 communities found that seniors using the tool saved up to $3,000 a year on average.” Posted 12/10/13
SAMHSA’s Center for Financing Reform & Innovations (CFRI) Financing Focus, November 18, 2013. This report includes information about:
- Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rule Published
- HHS: 106,185 Individuals Selected Marketplace Plans Through November
- Budget Bill Increases Federal Marketplace Income Eligibility Oversight
- Centers for Medicare & Medicaid Services Finalizes Medicare Conditions of Participation for Community Mental Health Centers
CMS memo states: Surveyors should consider facilities’ visitation policies for same-sex couples, following US Supreme court striking down DOMA. Posted 7/1/13.
“Washington, DC – The newly created federal Commission on Long-Term Care has elected a Chair and Vice Chair, and has scheduled its first meeting for June 27th. Bruce A. Chernof will serve as Commission Chair, with Mark Warshawsky serving as Vice Chair. The Commission was created by the American Taxpayer Relief Act – the so-called “fiscal-cliff” law – to advise Congress on how long-term care can be better provided and financed for the nation’s older adults and people with disabilities, now and in the future.” Read more. Posted 6/18/13.
Medicare physician definition legislation introduced in the Senate to include psychologists. Learn more! Posted 6/13/13.
“APA leaders join the dialogue at the White House National Conference on Mental Health. APA CEO Norman B. Anderson, PhD, cited a need for mental health care to be integral in primary care while on a panel at the White House National Conference on Mental Health on June 3.” Learn more. Posted 6/11/13.
President Obama Applauds Commitments to Raise Awareness and Increase Understanding of Mental Health at White House Conference. View the press release. Posted 6/6/13.
The U.S. Congress marked May 2013, Older Americans Month, by recognizing the importance of key pieces of legislation targeting older adults. On Thursday, May 23, Senator Bernard Sanders (I-VT), Chairman of the Senate HELP Subcommittee on Primary Health and Aging, introduced legislation to reauthorize the Older Americans Act (OAA), the Older Americans Act Amendments of 2013 (S. 1028; fact sheet). The Eldercare Workforce Alliance, of which APA is a member, issued a press release and submitted a letter of support for the legislation, highlighting provisions to support family caregivers and strengthen the eldercare workforce. APA Public Interest Government Relations Office (PI-GRO) staff participated in the OAA Summit on May 23, which is available on video stream, and will continue to work independently and with key coalitions to inform and promote a comprehensive reauthorization of the OAA that addresses the behavioral health, social service, and medical needs of older adults.
APA PI-GRO has also been working with key congressional offices in the U.S. House and Senate to support the re-introduction of the Positive Aging Act. This critical piece of legislation would significantly improve access to quality mental and behavioral health care for older adults by integrating mental health services in primary care and community settings where older adults reside and receive services. Specifically, the bill would support efforts to develop inter-professional teams of mental health, medical, and social service providers in order to promote an integrated approach to addressing the health and well-being of our nation’s growing, increasingly diverse older adult population. APA will continue to advocate for the introduction and ultimate passage of this critical legislation in the 113th Congress, and will call upon APA members and experts in the field to support the bill as it moves through the legislative process.
Nida H. Corry, PhD, Senior Legislative and Federal Affairs Officer; Director, Congressional Fellowship Program; Government Relations Office, Public Interest Directorate, American Psychological Association; firstname.lastname@example.org.
Physician definition proposed to include psychologists! Senator Sherrod Brown (D-OH) has introduced S. 1064, legislation to include psychologists in the Medicare “physician” definition. This legislation is a companion bill to (H.R.794), introduced by Illinois’ very own Congresswoman Janice Schakowsky in the House of Representative earlier this year, which currently has 23 cosponsors.
Now we need your help to build support for these bills by recruiting cosponsors! Please visit the APAPO Legislative Action Center and send letters to Senators and your local district Representative requesting support as a cosponsor of S.1064 and H.R. 794, respectively. When you contact your Representatives, please edit your correspondence to thank them if the member is currently a cosponsor. A link to the list of current cosponsors can be found below:
Congress Should Pass the Brown and Schakowsky Bill
To Include Psychologists in Medicare’s “Physician” Definition
Unnecessary physician supervision requirements in the Medicare program are hampering psychologists from providing to Medicare patients their full range of services within state licensure. Congress should pass the Sen. Sherrod Brown (S. 1064) and Rep. Jan Schakowsky (H.R. 794) bill to include psychologists in the Medicare “physician” definition.
Psychologists are key Medicare mental health providers, delivering nearly half of the psychotherapy services to Medicare beneficiaries in the hospital outpatient setting and more than 70% of the psychotherapy services in the hospital inpatient, partial hospital, and residential care settings. Psychologists also provide the vast majority of mental health testing services, many of which are unique to their training and licensure.
The Brown/Schakowsky bill is supported by consumer and provider organizations, including:
American Federation of Teachers
American Foundation for Suicide Prevention
American Group Psychotherapy Association
American Psychological Association
Association for Ambulatory Behavioral Healthcare
Center for Medicare Advocacy, Inc.
Mental Health America
National Council for Community Behavioral Healthcare
The Brown/Schakowsky bill will allow psychologists to be treated like all other non-physician providers already included in the Medicare physician definition, thereby ending unnecessary physician supervision without increasing Medicare costs.
Psychologists provide critical care to beneficiaries in a range of Medicare settings, including the inpatient hospital, psychiatric hospital, hospital outpatient, partial hospital, comprehensive outpatient rehabilitation facility, rural health clinic, federally qualified health center, and skilled nursing facility settings. Inclusion of psychologists in the physician definition will provide for a long-overdue reassessment of the services psychologists may provide within licensure without supervision.
In inpatient hospital and psychiatric hospital settings, this bill would enhance psychologists’ ability to direct appropriate care for their patients. Psychologists are licensed to assess, diagnose and treat mental and substance use disorders and are already key providers in these settings, but they are often hindered by inappropriate physician supervision of services provided within their licensure. This overdue change would help clarify clinical oversight for hospital patients under the care of psychologists and reduce the administrative burden on hospital staff.
In outpatient hospital and community mental health center settings, Medicare patients who would otherwise need inpatient psychiatric care are provided partial hospital services. Psychologists run partial hospital programs in the private health system today—overseeing, supervising and providing treatment—yet Medicare requires that such services must be prescribed by a physician, provided under a written treatment plan established and periodically reviewed by a physician, and furnished while under the care of a physician. If these physician barriers were removed, beneficiaries would have better access to partial hospital services they need.
An actuarial analysis of the Brown and Schakowsky bill has determined that including psychologists in the Medicare physician definition will not increase Medicare claims costs. Psychologists already provide their services in settings throughout the program and sufficient provisions will remain in place to ensure that the services psychologists provide are medically necessary and appropriate.
Including psychologists in the Medicare physician definition does not make them physicians, but it does remove barriers to the services they provide.
Medicare’s physician definition (1861(r) of the Social Security Act) already encompasses non-physician providers. Dentists, podiatrists, optometrists and chiropractors are included in the Medicare physician definition so that they may provide services to the full extent of their licensure.
Inclusion of psychologists would not reconstitute them as physicians or expand their scope of practice. Only state licensure law can do that. But as with the other non-physician providers in the definition, psychologists will be able to serve Medicare beneficiaries to the full extent of their licensure. In fact, psychologists are the only doctoral-trained health care practitioners not in the physician definition. As a result, the Medicare program has fallen behind the private insurance market. Many insurers already define “physician” to include not only medical doctors and doctors of osteopathy, but also psychologists and other non-physicians currently in the Medicare physician definition.
Including psychologists in the physician definition will particularly help Medicare beneficiaries in rural areas where psychiatrists are not available to provide supervision.
Based on a 2007 APAPO study prepared by the Center for Health Policy, Planning and Research at the University of New England, there are 2,943 psychiatrists in non-Metropolitan Statistical Areas in the U.S.—a rate of 5.2 psychiatrists per 100,000 population. There are three times as many psychologists in these areas—8,867 psychologists or a rate of 15.7 psychologists per 100,000 population.
The lack of psychiatrists to supervise treatment in the various Medicare settings has stifled the development of mental health services delivery in rural areas. If, for example, a physician is not available to supervise partial hospital services in a rural area, then such services are not provided. Removing unnecessary physician supervision requirements will help remedy rural access to mental health services. Psychologists will be able to provide partial hospital services within their licensure without unnecessary physician oversight while still working with physicians regarding medication and other services beyond their licensure.
Congress references the Medicare physician definition in enacting laws to improve beneficiary access to services. Since psychologists are not included, mental health services are too often left behind.
For example, Medicare “physicians,” including chiropractors, optometrists and podiatrists, receive a 10% bonus payment for providing services in Health Professional Shortage Areas. By excluding psychologists, mental health services are mostly left out of bonus payments designed to improve Medicare beneficiary access in underserved areas. Also, the Health Information Technology for Economic and Clinical Health Act provides for incentive payments to Medicare “physicians,” including chiropractors, optometrists and podiatrists, when they adopt electronic medical records into their practices. With the exclusion of psychologists from these payments, mental health is essentially left out in the development of electronic medical records in the Medicare program.
Thanks for your help!
Patricia Farrell PhD, Federal Advocacy Coordinator, President, Il Psychological Association
Balancing Incentive Program: Highlighting State Approaches and Progress. NCOA Webinar MAY 30 02:00 PM ET – 03:30 PM ET. The Balancing Incentive Program is a time-limited opportunity for states to receive additional federal funding to improve access to home and community-based services and make structural changes. States spending less than 50% of their total long-term services and supports funding on community-based services are eligible. Thirteen states have received awards totaling approximately $1.7 billion. Additional states must apply by Aug. 1, 2014. This webinar will highlight the work of three states that have received awards: Texas, Indiana, and Missouri. States will discuss the application process, requirements, and how they are using the program. Posted 5/21/13.
Check out Kaiser Health News Blog Watch. Posted 5/16/13.
May is National Mental Health Month! Read the Presidential Proclamation. “… I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 2013 as National Mental Health Awareness Month. I call upon citizens, government agencies, organizations, health care providers, and research institutions to raise mental health awareness and continue helping Americans live longer, healthier lives.” Posted 5-2-13.
Feds ask for mental health clarifications in light of HIPAA rules. McKnight’s Long Term Care News & Assisted Living article 4/23/13 by Elizabeth Leis Newman, Senior Editor. Posted 4/23/13.
Administration on Aging 2012 Profile of Older Americans is now available! Posted 4-22-13.
Countdown to health care reform: Opening session of the 2013 State Leadership Conference focuses on key issues and approaches to reform. APA Practice Update | April 11, 2013. Posted 4/17/13.
Integrating behavioral and physical care: Health care reform offers new opportunities for psychologists. APA Practice Update | April 11, 2013 by By Rebecca A. Clay. Posted 4/17/13.
On April 10th the Senate Health, Education, Labor and Pension (HELP) Committee approved legislation promoting awareness of mental health disorders. The Mental Health Awareness and Improvement Act of 2013 (S.689), is set to reauthorize and improve key mental health programs administered through the U.S. Departments of Education and Health & Human Services. The programs and provisions addressed in the legislation range from elementary and secondary education to the reauthorization of training grants for mental health services. The legislation will also address children’s mental health examinations, suicide prevention measures, evidence-based practice for older Americans, a GAO study on the Virginia Tech shooting recommendations and other provisions working to improve behavioral health interventions in the health care system. From: Marilyn Richmond, J.D., Assistant Executive Director for Government Relations; American Psychological Association Practice Organization. Posted 4-12-13.
Find Medicare and Medicaid Electronic Health Records Incentive Program payment and registration data in report form as of February 2013 here. Posted 4-11-13.
Implementing Policy Change to Advance Falls Prevention: Training, Examples, and Resources. Webinar on April 11, 2013 @ 3:00 PM ET – 4:30 PM ET by the National Council on Aging. Posted 4/8/13.
Immigration Reform: Key Issues for Older Adults and People with Disabilities. From the National Council on Aging. Materials available from the NCOA April 4 webinar. Posted 4/8/13.
ASPP STUDENT TRAVEL AWARD: Learn How APA Governance Works: The Assembly of Scientist/Practitioner Psychologists (ASPP), a caucus of the Council of Representatives (COR) of APA, is providing a $1,000 travel award for the February 2014 Council meeting in Washington, DC for a doctoral student in psychology. The purpose of the award is to give an interested graduate student the opportunity to learn about the governance structure and activities of the APA Council and the associated caucuses. At the COR meeting, the student who receives the award will be mentored by the Chair of the ASPP. The ASPP Board will review all submissions, select a student, and announce the recipient during the August 2013 ASPP caucus meeting. Interested students may send (a) their CV, (b) 100-word statement explaining their reasons for applying for the award, and (c) a letter of endorsement from their advisor addressing the student’s promise as a scientist-practitioner. Applications should be emailed to the Chair of the ASPP, Dr. Ellen W. Williams at email@example.com. Deadline for submission is July 12, 2013. Ellen W. Williams, Ph.D., EMDR Certified Therapist, AASP Certified Sport Psychologist, 480-345-7031, Fax: 480-831-6799. Posted 04-03-13.
Summer Policy Workshop, June 30-July 1, 2013, Washington, DC. The Society for the Psychological Study of Social Issues (SPSSI), in collaboration with the American Psychological Association (APA), the Society for Personality and Social Psychology (SPSP), the Society for Community Research and Action (SCRA), the Society for Environmental, Population, and Conservation Psychology (SEPCP), and the American Psychology-Law Society (AP-LS), is delighted to announce a special summer Policy Workshop. This exceptional training opportunity will take place on June 30 and July 1 in Washington DC. The workshop content is diverse and applicable to psychologists at all career stages, but several sessions are targeted primarily at early career psychologists and graduate students. Posted 03-29-13.
Affordable Care Act Third Anniversary, SAMHSA Blog by: Suzanne Fields, MSW, LICSW, Senior Advisor on Health Care Financing. Posted 3-22-13.