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Federal Update
Kristen G. Anderson, Member-at-Large, Public Interest Chair, Policy and Advocacy Committee
Reform of our nation’s health care system continues on a rocky course. Since the TAN Fall/Winter 2009 issue, substantial headway was made in passing healthcare reform legislation in the House and Senate. However, the outcome of the special election in Massachusetts on January 19, 2010, substantially changed the tenor of discussions around the legislative process. Below is a summary of progress to date as it pertains to issues for mental health and addiction services at the national level.

Healthcare Reform
Care for America Act (H.R. 3962) in November, followed by the Senate bill, the Patient Protection and Affordable Care Act (H.R. 3590) on December 24, 2009. APA advocated for a number of actions pertaining to mental health services and addiction in these bills, including: treatment parity, Medicaid coverage for tobacco cessation programs for pregnant women, integrated health care initiatives, increased comparative effectiveness research and support for prevention and wellness programs. Both reform bills changed Medicare payment provisions to extend the 5% psychotherapy payment restoration, increasing access to mental health services. An amendment to the Senate bill established minority health offices in the Centers for Disease Control, Substance Abuse and Mental Health Services Administration and the Centers for Medicare and Medicaid services.

Given the loss of the 60-vote majority in the Senate, the Democratic leadership is now considering the next step for healthcare reform legislation. Options include passing the Senate legislation in the House, precluding the inclusion of amendments, or using a fast track budgetary procedure to pass the legislation. While the second option would prevent a Republican filibuster, reconciliation requires the bill to only address healthcare reform issues that impact the federal budget. For a more comprehensive view of this process and the implications for reform, I would suggest reviewing the Kaiser Family Foundation website (http://healthreform.kff.org/).

Medicare Access
In November 2009, the House passed the Medicare Physician Payment Reform Act (H.R. 3961), replacing the Sustainable Growth Rate (SGR) formula with inflation-based adjustments for Medicare payments in the future. Senate action on this issue was included in the healthcare reform bill (H.R. 3590). Had the overall healthcare reform bill passed, these measures would have halted the 21.2% cuts to Medicare provider payments set to take effect on January 1, 2010. As a stopgap measure, an amendment to a defense appropriations bill in December 2009 postponed the rate cuts until February 28, 2010. It is hoped that movement on healthcare reform will prevent these cuts and allow for increases in payments from 0.5–1.0% for providers for 2010.

Mental Health Parity
The Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was released for comment in late January 2010. The rules outlined by the legislation are under review in preparation for the July 1, 2010 enactment. Interested parties can download this document from the U.S. Department of Labor website (www.dol.gov/federalregister/PdfDisplay.aspx?DocId=23511) and provide comment before the end of April. Congratulations to our members who worked to make this a reality!