Over the past two weeks, historic health care reform legislation was signed into law—the Patient Protection and Affordable Care Act (P.L. 111-148) on March 23 and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) on March 30, which includes a package of amendments. The legislation is primarily designed to extend health coverage to tens of millions of uninsured persons, reduce health care costs for those with and without insurance, and end discriminatory insurance practices. I would like to take this opportunity to highlight some important legislative provisions of special interest to psychology, psychologists, and the public whom we serve. On a related front, this update also reports on the very successful State Leadership Conference of the APA Practice Organization (APAPO), which has helped further APAPO’s ongoing efforts to increase Medicare beneficiary access to services delivered by psychologists.
Gains for Psychology in Health Care Reform
Due in large measure to the combined advocacy efforts of APA and APAPO government relations staff and our members, numerous legislative provisions favorable to psychology were included in the final health care reform legislation. These offer new and expanded opportunities for psychologists in our various roles as practitioners, educators, and researchers.
What follows are several highlights related to our APA priorities for health care reform. I would also like to direct your attention to a more comprehensive listing of legislative provisions of interest to psychology and to an APAPO article for a discussion of the significance of this legislation for psychologist practitioners.
1. Integrated Health Care
- Inclusion of psychologists on community-based interdisciplinary, interprofessional health teams to support primary care practices as part of a new grant program
- Participation of psychologists as part of health teams or designated providers of health home services to provide health care to eligible individuals with chronic conditions (including mental disorders) through a new Medicaid state option
2. Mental and Behavioral Health Care
- Inclusion of mental health and substance use disorder services, along with behavioral health treatment, at parity with medical/surgical services in essential benefit packages
- Extension of the 5% Medicare psychotherapy payment restoration from January 1 through December 31, 2010, which will increase access to mental health services
3. Prevention and Wellness
- Elimination of cost sharing for eligible preventive health services and expansion of prevention and wellness initiatives to address depression, postpartum conditions, and elder abuse
- Directive for the Clinical Preventive Services Task Force to consider best practices presented by scientific societies, such as APA, in developing recommendations
4. Psychology Workforce Development
- Designation of a separate $10 million set-aside for doctoral, postdoctoral, and internship-level training through accredited programs and internships in professional psychology
- Establishment of a loan-repayment program for psychologists in pediatric care and expansion of eligibility to psychologists, psychology programs, and psychology students for geriatric education and training programs
5. Elimination of Health Disparities
- Data collection and quality measure development to further the elimination of health disparities
- Development of a national strategy to improve the delivery of health care services and patient health outcomes
6. Support for Psychological Research
Creation of an infrastructure to support comparative effectiveness research (which received a $1.1 billion infusion of funds through the economic stimulus package last year) to enhance treatment decisions
7. Involvement With Consumers, Families, and Caregivers
Promotion of long-term care services and supports for adults with functional limitations and family caregivers
Hundreds of Psychologists Have Their Voices Heard on Capitol Hill
On March 9, the voices of psychologists from across the country who participated in the APAPO State Leadership Conference (SLC) echoed in the halls of Congress. The psychologists conducted over 300 meetings with members of Congress and their staffs to request extending through 2011 the 5% outpatient mental health reimbursement, adding psychologists to the Medicare “physician” definition, and making psychologists eligible for reimbursement for “psychotherapy with evaluation and measurement” codes. Psychologists also discussed their support of health care reform that integrates psychological services into primary care, preventive services, and benefit packages.
This year’s SLC was entitled “The Power of Advocacy” and featured sessions on such critical topics as the new mental health and substance use parity law and its ongoing implementation. Special programs honored two of our mental health champions in Congress—Representative Patrick Kennedy (D-RI) and Senator Olympia Snowe (R-ME)—and offered a memorial tribute to Senator Edward M. Kennedy, a staunch mental health advocate, who died last year.
Approval of Medicare Access Provisions of Vital Importance to Psychology
The day after the SLC congressional visits, the Senate passed highly favorable legislation that would retroactively extend the 5% Medicare psychotherapy payment restoration through the end of 2010. The legislation would also prevent the 21.2% Sustainable Growth Rate (SGR) cut from going into effect through September 30. These vital provisions were included in the American Workers, State, and Business Relief Act of 2010 (H.R. 4213). Six Republicans joined with 56 Democrats to pass the bill in a bipartisan 62-36 vote.
The newly enacted health care reform law mirrors the recent Senate action by extending the 5% Medicare psychotherapy payment restoration from January 1 through December 31, 2010. This will restore about $30 million to Medicare mental health reimbursements. APAPO continues to push for passage of Medicare legislation that extends the restoration through the end of 2011 and further delays the SGR cut from taking effect, ideally by changing its flawed formula.
The Reality of Health Care Reform
The enactment of health care reform legislation is a momentous achievement that has been likened to the adoption of the Social Security Act in 1935 and Medicare legislation in 1965. Over the past 15 months, APA and APAPO government relations staff have effectively advocated for our health care reform priorities with Congress and the White House. Yet, much of the credit for psychology’s legislative gains is due to you, our members, for your calls, e-mails, and visits to members of Congress. Thank you on behalf of APA, APAPO, and the field of psychology for your valiant efforts. We now look forward to working with you to get the word out that psychology also has much to contribute to the effective implementation of health care reform through the regulatory process at the federal and state levels.
As always, your thoughts on our health care reform activities are welcome. While I am unable to respond individually to each message, your views are carefully considered. I also encourage you to visit our APA health care reform website for more information about our health care reform priorities and initiatives.
By. Norman B. Anderson, PhD
Chief Executive Officer
American Psychological Association
750 First Street, NE
Washington, DC 20002-4242