PI-GRO Health Reform Overview — March 2010

As you know, President Obama signed the health reform bill into law (P.L. 111-148) on March 23, 2010. This new landmark law reflects over a year of tireless advocacy by the APA Public Interest Government Relations Office (PI-GRO), in collaboration with the Executive Office; the Education, Science, and Practice Government Relations Offices; and several coalitions. Some of these efforts included drafting and reviewing legislative language; meetings and correspondence with key members of Congress and their staff, the White House, and the Executive Branch agencies; coalition leadership and collective advocacy; and grassroots advocacy by APA and coalition members (e.g., advocacy trainings, constituent visits on Capitol Hill, action alerts). APA’s health reform priorities included: 1) integrate mental and behavioral health care into primary care and other health care services; 2) ensure access to quality mental and behavioral health promotion, screening and referral, prevention, early intervention, and wellness services; 3) develop and maintain a diverse psychology workforce; 4) ensure that quality mental and behavioral health care and access to psychologist providers are include in benefit plans; 5) eliminate disparities in mental health status and mental health care; 6) increase federal funding for basic and translational psychological and behavioral research and training; 7) include strong privacy and security records protections in the development of health information technology; and 8) enhance the involvement of psychologists and other health care professionals with consumers, families, and caregivers.

Below is an overview of some of the key provisions that PI-GRO successfully secured in this new law. PI-GRO also developed a health reform matrix that provides a more detailed overview of our work. This document will soon be available on our website. During the coming weeks and months, we will continue to share with you more detailed information regarding these health reform provisions, and look forward to opportunities for involvement in the implementation of this historic effort. Please do not hesitate to contact us, if you have any questions or would like any additional information.

Integrate Mental and Behavioral Health Care into Primary Care and Other Health Care Services

  • Authorizes several programs to promote integrated interdisciplinary/interprofessional health care in primary care and other settings, which include behavioral and mental health professionals. (Language from the APA-Supported Community Mental Health Services Improvement Act — S. 1188/ H.R. 1011 and the Health Professions and Primary Care Reinvestment Act — S. 3708/H.R. 7302 - 110th Congress)
  • Authorizes grants to schools of medicine or osteopathic medicine for capacity building in primary care. Priority will be given to applicants that: 1) propose approaches to clinical teaching using models of primary care, such as the patient centered medical home, team management of chronic disease, and interprofessional integrated models of health care that incorporate the integration of physical and mental health care; 2) provide training in the care of vulnerable populations such as children, older adults, individuals experiencing homelessness, victims of abuse or trauma, individuals with mental health or substance-related disorders, individuals with HIV/AIDS, and people with disabilities; 3) teach trainees the skills to provide interprofessional, integrated care through collaboration among health professionals; 4) provide training in cultural competency and health literacy. (Language from the APA-Supported Health Professions and Primary Care Reinvestment Act — S. 3708/H.R. 7302 — 110th Congress)

Ensure Access to Quality Mental and Behavioral Health Promotion, Screening and Referral, Prevention, Early Intervention, and Wellness Services

  • Establishes a fund to provide an expanded and sustained national investment in prevention and public health programs.
  • Authorizes grants for theimplementation, evaluation, and dissemination of evidence-based community preventive health activities.
  • Authorizes a Task Force to review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community. Such recommendations must consider clinical preventive best practice recommendations from a variety of organizations, including scientific societies.
  • Authorizes CDC to provide employers with technical assistance, consultation, tools, and other resources in evaluating employer-based wellness programs.
  • Requires insurers to provide coverage (without imposing cost-sharing requirements) for a number of preventive health services, including evidence based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the U.S. Preventive Services Task Force; and evidence-informed preventive care and screenings for infants, children, adolescents and women, as provided for in the comprehensive guidelines supported by HRSA. (Language related to women’s services from the APA-Supported Amendment S.A. 2791 — Senator Mikulski)
  • Amends Medicaid to include diagnostic screening, preventive, and rehabilitative services.
  • Authorizes continued research to expand the understanding of the causes of, and treatments for, postpartum conditions. Authorizes grants for the establishment, operation and coordination of effective and cost efficient systems for the delivery of essential services to individuals with or at- risk for a postpartum condition and their families.(Language from the APA-Supported Melanie Blocker Stokes MOTHERS Act — S. 324/H.R. 20)
  • Prohibits cost-sharing for American Indians and Alaska Natives enrolled in any qualified health plan in the individual market through an exchange with income at or below 300 percent of the federal poverty level.
  • Authorizes an Institute of Medicine Conference on Pain; encourages continuation and expansion of an aggressive program of basic and clinical research on the causes of and potential treatment for pain; and authorizes grants, cooperative agreements, and contracts to health professions schools, hospices, and other public and private entities for the development and implementation of programs to provide education and training to health care professionals in pain care.
  • Establishes programs for comprehensive prevention, detection, and treatment of elder abuse, neglect, and exploitation. (Language from the APA-Supported Elder Justice Act of 2009 - S. 795/H.R. 2006)
  • Authorizes incentives for the prevention of chronic diseases for Medicaid beneficiaries.
  • Establishes a national public-private partnership for a prevention and health promotion outreach and education campaign.
  • Authorizes grants for the establishment and operation of school-based health centers, which provide comprehensive primary health services (including mental health).
  • Authorizes coverage for an annual wellness visit under Medicare.
  • Eliminates coinsurance and deductible for personalized prevention plans, initial preventive physical examinations, and screening and preventive services covered by Medicare and recommended by the U.S. Preventive Services Task Force.
  • Authorizes grants for public health community interventions (including mental health and substance abuse), screenings (including mental health and substance abuse), and follow-up clinical referrals for individuals who are between 55 and 64 years of age.
  • Authorizes grants to establish national centers of excellence for depression, which must engage in activities related to the treatment of depressive disorders. (Language from the APA-Supported Amendment S.A. 2883 — Senator Stabenow)
  • Authorizes grants to employers for providing their employees with access to comprehensive workplace wellness programs.
  • Requires coverage of counseling and pharmacotherapy for cessation of tobacco use by pregnant women in Medicaid. (Language from the APA-Supported Amendment S.A. 3076 - Senator Durbin )
  • Authorizes grants to deliver services under early childhood home visitation programs to promote improvements in maternal and prenatal health, infant health, child health and development, parenting related to child development outcomes, school readiness, and the socioeconomic status of such families, and reductions in child abuse, neglect, and injuries.

Develop and Maintain a Diverse Psychology Workforce

  • Expands eligibility for Geriatric Academic Career Awards to a variety of new disciplines, including faculty in psychology. (Language from the APA-Supported Retooling the Health Care Workforce for an Aging America Act of 2009 — S. 245/H.R. 468)
  • Expands authority for Geriatric Education Centers to offer short-term intensive courses (fellowships) in geriatrics for faculty members in medical schools and other health professions schools with programs in psychology or other health disciplines. (Language from the APA-Supported Retooling the Health Care Workforce for an Aging America Act of 2009 — S. 245/H.R. 468)
  • Authorizes a new Geriatric Career Incentive Awards Program to provide financial support to foster greater interest among a number of health professionals in entering the field of geriatrics, including students of psychology. (Language from the APA-Supported Retooling the Health Care Workforce for an Aging America Act of 2009 — S. 245/H.R. 468)
  • Authorizes a loan repayment program for qualified health professionals (including psychologists) who agree to be employed full-time for no less than two years providing pediatric care (including mental and behavioral health care). Priority will be given to those who have familiarity with culturally and linguistically competent health care services. (Language from APA-Supported Child Health Care Crisis Relief Act — S. 999/H.R. 1932)
  • In collaboration with Education GRO, successfully secured language to authorize a psychology workforce development program. (Language based on the APA-Supported Graduate Psychology Education Act of 2009 — S. 811/H.R. 2066; the Health Access and Health Professions Supply Act of 2009 - H.R. 3109; and the Health Professions and Primary Care Reinvestment Act — S. 3708/H.R. 7302 — 110th Congress)
  • Establishes a National Health Care Workforce Commission that serves as a national resource and develops and commissions evaluations of education and training activities to determine whether the demand for health care workers is being met. The commission must include no less than one representative of the health care workforce and health professionals (includes psychologists and other behavioral and mental health professionals).
  • Establishes a National Center for Health Workforce Analysis to, in coordination with the National Health Care Workforce Commission, provide for the development of information describing and analyzing the health care workforce.

Ensure that Quality Mental and Behavioral Health Care and Access to Psychologist Providers are Included in Benefit Plans

  • Prohibits a group health plan and a health insurance issuer offering group or individual health insurance coverage from establishing rules for eligibility based on any of the following: health status; medical condition (including both physical and mental illnesses); claims experience; receipt of health care; medical history; genetic information; evidence of insurability (including conditions resulting from acts of domestic violence); or disability.

Eliminate Disparities in Mental Health Status and Mental Health Care

  • Establishes standards for data collection and analysis to further understand health disparities.
  • Reauthorizes the Indian Health Care Improvement Act.
  • Authorizes the establishment of an Office of Women’s Health within multiple agencies, including HHS, CDC, AHRQ, HRSA, and FDA. Offices would report to the Director of the agency and set short-range and long-range goals and coordinate activities that relate to health issues that are of particular concern to women . Requires the Associate Administrator for Women’s Services at SAMHSA to report to the Administrator, and the Director of the Office on Women’s Health Research at NIH to report to the Director .
  • Establishes grants for the development, evaluation, and dissemination of research, demonstration projects, and model curricula for cultural competency, prevention, public health proficiency, reducing health disparities, and aptitude for working with individuals with disabilities training for use in health professions schools and continuing education programs.
  • Transfers existing Office of Minority Health to the Office of the Secretary. Establishes individual offices of minority health within the CDC, HRSA, FDA, SAMHSA, AHRQ, and CMS.
  • Authorizes grants for the purpose of developing, improving, updating, or expanding quality measures with priority given to the development of quality measures that allow the assessment of specific issues, including the equity of health services and health disparities across health disparity populations and geographic areas.
  • Authorizes incentives for the implementation of activities that reduce health care disparities, including through the use of language services, community outreach, and cultural competency training.

Enhance the Involvement of Psychologists and other Health Care Professionals with Consumers, Families, and Caregivers

  • Establishes a new national insurance program to help adults with functional limitations to maintain personal and financial independence and live in the community. (Language from the APA-Supported CLASS Act — S. 696/H.R. 1721)
  • Authorizes funding to expand State Aging and Disability Resource Centers.
  • Requires Geriatric Education Centers receiving certain grants to develop and offer training courses to family caregivers and direct care providers at no charge or minimal cost or incorporate mental health and dementia “best practices” training into their courses. (Language from the APA-Supported Retooling the Health Care Workforce for an Aging America Act of 2009 — S. 245/H.R. 468)
  • Authorizes initiatives to assist States in providing home and community-based services and supports.
For more information, please contact Diane Elmore, PhD, MPH, in the Public Interest Government Relations Office at (202) 336-6104 or by e-mail.