Feature

APA played a key role last year in the passing of a landmark House bill allowing injured patients to sue managed-care companies for negligence.

But the war hasn't been won yet.

The corresponding Senate bill does not give patients any such right. Differences between the two bills will have to be ironed out in a House-Senate conference this spring.

Dave Nelson, APA's director of federal advocacy, says the main patient-protection item on APA's legislative agenda right now is to convince conferees to agree on the House liability provision that alters the Employee Retirement and Income Security Act of 1974 (ERISA). That law bars negligence suits by plaintiffs in state courts.

Supporters of making managed-care firms liable contend that health insurers should not be shielded from state laws.

The House bill permits suits in state courts to recover damages resulting from personal injury or from wrongful death. The bill prohibits insurers from retaliating against a patient or provider based on that individual's use of the appeals process.

Normally, a conference of House and Senate members, who presumably represent the views of their respective legislative bodies, attempts to hammer out a compromise.

But Nelson says it is going to be an uphill battle because "the House Republican leadership stacked the conference committee with House members who are adamantly opposed to the liability provision."

In other words, House leaders who lost the fight against the House bill on the floor are hoping to block the negligence issue in the conference room.

Nelson says that, in addition, "the managed-care industry mounted an intense advertising lobbying campaign recently, warning that employers would face increased liability if accountability became law. APA has taken the lead in countering this claim by pointing out that the House bill protects employers from being sued for negligent care, provided the employer is not directly involved in decision-making about benefit claims in a way similar to a health-care professional, hospital or health plan, Nelson says.

Marilyn Richmond, assistant APA executive director for government relations, says the Practice Directorate plans to use the same advocacy tactics that were successful in the passage of the House bill last year.

"Support for the bill involved thousands of calls from psychologist-constituents to their members of Congress, fly-ins to Washington, D.C., for meetings between practitioners and key congressmen and, more locally, psychologist participation in town hall meetings," she says.

Meanwhile, APA is pursuing other priorities on Capitol Hill:

Mental Health Parity: Action is expected this year on two mental health parity bills before Congress. The House bill, sponsored by Rep. Marge Roukema (R­N.J.), would provide full parity in insurance coverage for mental health and substance abuse services, including inpatient days and outpatient visiting. But the Senate bill sponsored by Sens. Pete Domenici (R­N.M.) and Paul Wellstone (D­Minn.) requires full parity only for designated "severe biologically based mental illnesses" such as schizophrenia, bipolar disorder and major depression. APA continues to advocate for full parity not restricted to specific mental disorders.

Confidentiality: Federal legislators missed the deadline last August to enact patient confidentiality standards as required by the Health Insurance Portability and Accountability Act of 1996. Now, Congress wants new regulations written this year. Proposed regulations specify that psychotherapy notes may not be shared without the patient's consent. APA's Practice Directorate has consistently advocated that patient records must be protected through comprehensive requirements regarding confidentiality.

Medicare Graduate Medical Education Funding: The Health Care Financing Administration intends to propose a rule that would include psychology among health professions eligible for Medicare Graduate Medical Education funding.