Even though this session of Congress is likely to be the least productive in history, the APA Practice Organization (APAPO) has successfully advanced psychology's legislative advocacy agenda. Much of this success can be attributed to grassroots psychologists working with APAPO to advocate for mental health services and build relationships with lawmakers.
As we move into the last few weeks of this Congress, APAPO staff and members are continuing to strategize, educate and cultivate relationships with their representatives and staffs, setting the stage for our federal advocacy work with the next Congress. One of our legislative priorities is securing patient access to psychological services. Each year, about 26 percent of all Medicare beneficiaries — more than 13 million Americans — experience at least one mental disorder. Yet studies show that roughly 70 percent of older adults who meet diagnostic criteria for major depressive or anxiety disorder do not receive any mental health treatment. Meanwhile, serious mental illness, including bipolar disorder and schizophrenia, is especially prevalent among beneficiaries who are under 65 and eligible for Medicare based on their disability.
Access to mental health services is particularly low in underserved areas, and the nation is facing a shortage of mental health professionals available to treat Medicare beneficiaries. This shortfall is exacerbated by a statutory barrier in the Medicare program that requires unnecessary physician supervision of psychologists' services.
As part of our work to alleviate that shortfall, APAPO supports the Medicare Mental Health Access Act, sponsored by Sen. Sherrod Brown (D-Ohio) and Rep. Jan Schakowsky (D-Ill.). The bill calls for allowing psychologists to practice independent of physician supervision, consistent with state licensure, in all Medicare treatment settings by adding psychologists to Medicare's definition of "physician."
Advocacy on this and other federal initiatives is informed by our practitioner members: We rely on your engagement with members of Congress. The expertise you share helps us prepare our efforts on Capitol Hill. The critical issue of access to mental health services will carry over into the next Congress, so it's important for our grassroots psychologists and APAPO staff to continue to cultivate relationships with congressional staffers. Last summer, many practicing psychologists attended town hall meetings and roundtables with their legislators. Psychologists in North Carolina and Florida, for example, shared their expertise at town hall events held by Rep. Rene Ellmers (R-N.C.) and Rep. Vern Buchanan (R-Fla.) with Rep. Tim Murphy (R-Pa.), sponsor of the Helping Families in Mental Health Crisis Act. These local meetings allowed practitioners to share their experiences and expertise and to reinforce the importance of access to mental health care as a national issue.
Patient access to psychological services is also jeopardized by declining payments for Medicare services. An analysis conducted in early 2014 by Healthcare Visions Inc. on behalf of APAPO found that Medicare's reimbursement rates for psychologists are 17 percent lower on average than private sector indemnity insurance reimbursement rates. A separate 2013 survey conducted by the APA Practice Directorate's Practice Research and Policy Office found that 26 percent of psychologists had stopped participating in Medicare — primarily due to low reimbursement rates.
The gap between Medicare's rates and private sector payments discourages psychologists' participation in Medicare and undermines beneficiaries' access to mental health treatment. APAPO is addressing Medicare reimbursement on several fronts, including working to increase psychologists' Medicare payment rates under the physician fee schedule and replace the flawed sustainable growth rate formula.
Passage of the Mental Health Parity and Addiction Equity Act of 2008 was a huge victory for psychologists and their patients and proof that years of hard work and bipartisan efforts can pay off. Regardless of the political landscape, APAPO and grassroots psychologists will continue to educate members of Congress about the importance of improving the health of the patients and systems we serve.
