Government Relations Update

When President Bush signed full mental health parity into law on Oct. 3, the United States took a great step forward in the decade-plus effort to end health insurance discrimination against those who seek treatment for mental health and substance use disorders. This historic legislation requires that group health plans with more than 50 employees equally cover mental and physical health benefits.

Equity in coverage will apply to all financial requirements, including lifetime and annual dollar limits, deductibles, co-payments, coinsurance and out-of-pocket expenses, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage and other similar limits. For most health plans, the new parity law will apply on Jan. 1, 2010.

The 2008 law closes several loopholes in the 1996 Mental Health Parity Act, which remains in effect through 2009. It preserves existing state parity and consumer protection laws while providing mental health services to 82 million Americans who are not protected by state laws. The new law also ensures mental health parity for both in-network and out-of-network services.

APA has worked with Congress for more than a decade to achieve a full parity law. Since its creation in 2001, the APA Practice Organization (APAPO) has kept up the push for parity in myriad ways, including crafting legislative language, leading a coalition of supportive groups and coordinating more than 40,000 messages and countless calls in 2007 and 2008 alone.

Psychology will closely monitor the regulatory process to ensure that the sponsors' intention is carried out in rules implementing the new law next January. APAPO also plans to disseminate guidance for employers and insurers during 2009 to guide them as they plan compliance with the law. More information about the new mental health parity law is found at apapractice.org.

Improving access to care

Last July, after several votes in the House and Senate and even a rare override of a presidential veto, Congress enacted Medicare legislation improving access to mental health services for the 44 million seniors and people with disabilities enrolled in the program. Psychology played an important role as part of a broad-based coalition supporting passage of the bill's key provisions and in mobilizing over 33,000 messages from constituent psychologists to their members of Congress.

Included in the Medicare Improvements for Patients and Providers Act's key provisions are mental health coinsurance parity and restoration of payments for psychological services cut by the Centers for Medicare and Medicaid Services (CMS) in 2007.

For years, Medicare beneficiaries faced a discriminatory 50 percent co-payment for outpatient mental health services. The new law ensures Medicare co-insurance parity by 2014, providing enrollees with a 20 percent co-payment for mental health, equal to that for physical health. As a founding member of the 15-group Medicare Mental Health Equity Coalition, psychology worked to secure this provision to reduce a treatment barrier for millions of America's seniors.

The law also addresses two payment issues. It halts for 18 months the 10.6 percent sustainable growth rate cut that was scheduled to take effect on July 1. The new Medicare law also restores $45 million in payments for psychological services cut as a result of CMS's five-year review of Medicare reimbursements. APAPO fought hard for this provision—the bill's only one singling out specific services for payment increase—by convincing congressional leaders of the unintended, disproportionate impact of the regulation on mental health services delivery.

The Medicare law is especially important because many private insurance companies base their payment rates on the federal program, affecting patient access to services in the private market as well. In 2009, psychology will work to:

  • Extend the hard-fought restoration provision.

  • Make psychologists eligible for reimbursement for the evaluation and management services they provide within their licensure.

  • Prevent another large sustainable growth rate cut.

  • Include psychologists in the Medicare "physician" definition.

Challenges and opportunities

The new administration and Congress have identified health-care reform as a priority—and psychology leaders are eager to place professional psychology at the forefront of the debate.

"The renewed focus on health-care reform creates a tremendous opportunity for psychology," says APA Executive Director for Professional Practice Katherine C. Nordal, PhD. "We are working to engage psychology in helping to design a system that appropriately values the skills and expertise of psychologists as doctoral-level professionals."

APAPO's advocacy efforts are guided by the principles for reform approved by APA's Council of Representatives in 2007:

  • Everyone should have coverage that provides affordable health care for all basic services.

  • Basic health-care services eliminate the artificial distinction between "mental" and "physical" health, recognize the inseparable relationship between mental and physical well-being, and offer access to treatment for "mental health conditions" equivalent in all respects to access for "physical health conditions."

  • Basic health-care services include the psychological treatment of physical conditions in order to maximize rehabilitation and quality of life.

  • Basic health-care services include appropriate prevention services that address the role that behavior plays in seven of the ten leading causes of mortality and morbidity.

Psychology is closely examining reform proposals from President Barack Obama and the Senate Finance Committee and laying the necessary groundwork for professional psychology to play significant roles in any reformed health-care system. Nordal emphasizes that psychologists, by virtue of their education, training and professional experience, are uniquely qualified to play important roles in primary-care settings.

"This country's principal health-related problems are chronic in nature, and their management depends on the ability to motivate patients to be responsible partners in their own health care," she says. "Psychologists are the experts in working with patients to change their unhealthy behaviors."

Health information technology promises to be another key issue in 2009. Through leadership within the Mental Health Liaison Group, psychology has been working to ensure that patient records privacy and security are a cornerstone of any legislation Congress passes. APAPO is advocating to specifically protect psychotherapy notes as in the Health Insurance Portability and Accountability Act and also include psychological testing materials, pursue provisions that recognize a patient's fundamental right to privacy, and preserve stronger state laws.