Feature

In a huge win for the 44 million seniors and people with disabilities enrolled in Medicare, Congress overrode a presidential veto on July 15 to pass the Medicare Improvements for Patients and Providers Act of 2008.

The new law lowers Medicare co-payments for mental health services to bring them in line with out-of-pocket physical health-care services and provides funding for additional psychological services in rural areas. The law also restores psychologists' reimbursement rates, which were cut by the Centers for Medicare and Medicaid Services (CMS) last year.

The APA Practice Organization (APAPO) was one of hundreds of health-care organizations that spent nearly two years supporting the bill's key elements. APAPO members around the country joined the effort by contacting Congress to encourage the bill's ratification. In 2007 and 2008, psychologists sent 33,417 messages to their members of Congress about the Medicare bill. That's not including the incalculable number of phone calls and other contacts that psychologists made throughout the fight.

"In an era when Congress isn't giving in to anything without a huge, enormous fight, for us to mobilize the resources to overturn a veto was tremendous," says Alice Randolph, PhD, former president of the Ohio Psychological Association and one of APAPO's federal advocacy coordinators. "This is a great example of how APA Practice and psychologists at both the state associations and within the divisions really worked together in a coordinated way to have a phenomenal effect."

Improving patient access

Under the new law, by 2014 patient costs for outpatient mental health services will be reduced from the current 50 percent co-insurance fee to a 20 percent co-payment, which matches that required for other types of medical care.

That change is great news for most Medicare beneficiaries, who live on fixed or limited incomes and can't afford Medicare's current out-of-pocket expense for mental health treatment, says APA's Executive Director for Professional Practice Katherine C. Nordal, PhD.

"The phased-in parity will now afford these underinsured and underserved individuals access to needed care--care that should result in better health-care outcomes," she says.

APAPO played an important role in securing the provision. The organization served as a founding member of the Medicare Mental Health Equity Coalition, a group of 15 mental health care groups that worked to advocate for Medicare co-insurance parity.

In an additional gain for psychology, the Medicare legislation also restores $45 million in funding for 18 months for psychotherapy and other psychological services cut in 2007 after CMS's five-year review of Medicare payments. These cuts had a larger negative impact on the provision of mental health care than medical care to Medicare patients, because a larger percentage of psychologists' fees are tied to the amount of time they spend with patients, rather than the costs of medical equipment or evaluation. The law will also halt for 18 months the 10.6 percent sustainable growth rate cut to Medicare reimbursement scheduled to take effect July 1, and provides a 1.1 percent payment increase for 2009.

"Many psychologists were at the point where they were going to have to start cutting Medicare patients or get out of the program entirely because they would no longer be able to afford to provide services if these cuts were enacted," says Marilyn Richmond, APAPO's associate executive director of congressional and political affairs.

The law also is a boon for veterans' mental health care: The legislation provides for an additional $50 million in federal authorizations in 2009 and 2010 for psychological services delivery in rural areas.

Next steps

While the new law will primarily improve mental health access for those enrolled in Medicare, millions more patients may benefit as well.

"Medicare rates bleed into other systems," says Richmond.

The bill's victory will help prevent additional cuts by private insurance companies and secure continued access to and affordability of psychological services.

But the fight for improved patient access is hardly over, notes Randolph. The mandate now heads back to CMS, which must decide exactly how the bill will be implemented.

"Psychologists have to be diligent to make sure that contractors are following the spirit of the law as well as the letter of the law," she says. "The vigilance must be continued."