Advocacy Highlights
Parity Compromise Passed by Congress and Signed into Law
Click here for an in-depth APA fact sheet on the details of recently passed parity legislation along with questions that you may have
On October 3rd, the U.S. House of Representatives voted 263-171 to approve H.R. 1424, the Senate-passed financial institutions bail-out bill that also includes the final compromise agreement on mental health “parity” legislation. House approval cleared the parity bill to be signed by the President in the same day as its passage.
This is a tremendous victory for the APA leadership and Assembly, our grassroots activists, and all APA members and staff. It is most particularly a victory for patients and their families across the country. This caps an extraordinary year, one from which APA leaders, members, and central office and District Branch/State Association staff can take tremendous satisfaction.
Not only have we succeeded in our long campaign to enact health insurance parity for psychiatric patients, we have also won an end to Medicare's 50% coinsurance for outpatient mental health treatment, developed new protections for access to psychiatric medications under Medicare Part D, restored coverage of benzodiazepines and barbiturates under Part D, rolled back the impending 10.4% cut in Medicare payments to physicians, and secured other changes in Medicare payment policy that will directly benefit APA members across the country. Any one of these victories would be cause for celebration. To have them occur within months of each other in the same year is truly remarkable.
DGR will issue a summary of the compromise federal parity legislation shortly. In the meantime, we wanted to let you know of this major victory. Thanks to all of you for your hard work to secure all of these victories, with particular thanks to Nada Stotland, M.D. and Carolyn Robinowitz, M.D. for their steady guidance, leadership and support during their terms as APA president when these complex and sometimes volatile issues were “in play,” as well as to Ron Burd, M.D., and Jeff Akaka, M.D., the APA Board of Trustees and Assembly, and particularly John Wernert, M.D. and the APAPAC Board whose persistence and dedication opened many doors to DGR lobbyists. Finally, our deep appreciation for the untiring support of Jay Scully, M.D., APA’s CEO and Medical Director.
Medicare Payment Cuts Blocked; Historic Improvements in Mental Health Enacted
On July 15 the House and Senate overrode the President's veto of H.R. 6331 -- the Medicare Improvements for Patients and Providers Act of 2008. The House vote to override was 483-41, even wider than the original House vote on passage of the bill. The Senate vote to override was 70-26.
Medicare Payment Improvements:
Congressional action blocks the impending 10.6% cut in the Medicare payment update for the rest of 2008 and for 2009, and makes other changes in the payment formula that will directly benefit psychiatrists. In addition, H.R. 6331 includes several technical changes that we believe will result in welcome improvements in Medicare payments to psychiatrists. For the rest of 2008 and for 2009, the bill provides a temporary 5% bump in payment for psychotherapy services provided in an inpatient, outpatient, office, partial hospital, or residential care setting, provided that the services are "insight oriented, behavior modifying, . . . supportive . . . or interactive psychotherapy."
H.R. 6331 also shifts the underlying Medicare payment budget neutrality requirement from work relative value units to the conversion factor, effective with the fee schedule in 2009. Under current policy, the budget neutrality requirement falls on the relative work value component of the payment formula. This concentrates the effects on physicians who provide cognitive services, which disproportionately hurts psychiatrists. By shifting the budget neutrality requirement from the work value to the conversion factor, the bill spreads the obligation to all health professionals, rather than to cognitive specialists. Taken together, we believe that all of these changes in payment policies will have a significant positive impact on Medicare payments to psychiatrists.
Historic Improvements in Mental Health Coverage:
More importantly, the override means that most significant changes in Medicare coverage of treatment of mental illness since the program was founded more than 40 years ago are now the law of the land.
First, our long campaign for mental health outpatient treatment "parity" in Medicare has succeeded. Starting in 2010, the discriminatory 50% coinsurance for outpatient mental health services will be reduced by 5% per year through 2013. In 2014 and thereafter, Medicare patients will pay the same 20% coinsurance for outpatient mental health services that they pay for all other care under Part B.
Second, effective January 1, 2013, Medicare Part D will pay for benzodiazepine and barbiturate prescriptions.
Third, effective with the date of enactment, Medicare law will include special protections to ensure that medically vulnerable patients will be assured access to "all or substantially all" of the medications they require, specifically including antidepressants and antipsychotics among other medications.
Taken together, all of these provisions mean that Medicare Improvements for Patients and Providers Act of 2008 is landmark legislation representing the culmination of many years of effort by APA, its leadership, members and staff. We can all be tremendously proud of the result of our collective work.
Senate Introduces Reauthorization of Juvenile Crime Prevention Legislation
On June 18, Senators Patrick Leahy (D-VT), Arlen Specter (R-PA) and Herbert Kohl (D-WI) introduced the reauthorization of the Juvenile Justice and Delinquency Prevention Act (JJDPA). JJDPA authorizes competitive grant programs through the Department of Justice to fund programs designed to help protect youth and reduce instances of juvenile crime.
The proposed legislation would increase federal funding for crime reduction programs by incorporating federal support and guidance to state programs, which would make key improvements to state justice systems. The legislation also prioritizes and funds mental health and drug treatments for juvenile offenders, while encouraging state programs to address the problem of overrepresentation on juveniles in the justice system. Under the legislation, funds will be made available to states in the form of improvement grants to help states comply with the Act.