APA 2014 Summary of APAPO GR Activities, and 2015 Preview
Tuesday, January 20, 2015
Posted by: Amy Dietrich
From: Jennifer F. Kelly, PhD, ABPP, Federal Advocacy Coordinator
American Psychological Association Practice Organization
Re: 2014 Summary of APAPO GR Activities, and 2015 Preview
Although many analysts refer to the 113th Congress (2013-2014), which just ended, as a “do-nothing” Congress, the good news is that in 2014 we gained significant victories for psychologists. Along with all other Medicare providers, we faced a more than 20% cut in Medicare reimbursement rates under the sustainable growth rate (SGR), but thanks to your work—through both in-person visits with Members of Congress during the State Leadership Conference (SLC) and grassroots contacts from psychologist constituents—we stopped the SGR cut once again. In early 2015, however, we will again have to battle the pending SGR cut. In the process of avoiding the cut this past year, we worked closely with key congressional committees in developing bipartisan legislation to permanently repeal the SGR and replace it with a modernized payment system. This legislation will be back next year.
We also achieved the enactment of a demonstration program to establish federal standards for community mental health programs and funding for a range of evidence-based mental health services. This legislation—based on the Excellence in Mental Health Act (S. 264) introduced by Sen. Debbie Stabenow (D-MI)—was enacted as part of legislation to postpone Medicare’s SGR cut. Congress also enacted the Caring for America’s Heroes Act (S. 2276/H.R. 4656), which provides for parity of insurance coverage for inpatient mental health services under the TRICARE program.
Here are some highlights of our work over the course of 2014, and our initial planning and preparation for 2015:
Medicare Sustainable Growth Rate
For the first time ever, congressional committees with jurisdiction over Medicare reached bipartisan, bicameral agreement on legislation to permanently repeal the SGR. The legislation (S. 2000/H.R. 4015) would have replaced the SGR formula with a 0.5% overall rate increase for five years and a phase-in of payment reforms to encourage cost-effective care. Unfortunately, Congress could not agree on how to pay for the legislation’s $140 billion price tag, and consideration of the bill ended in the fall.
Congress, however, is widely expected to take up where it left off on the SGR repeal bill early in 2015, in order to prevent the reimbursement rate cuts from taking effect on April 1, 2015. This means that Congress will be focused on Medicare during the State Leadership Conference, giving psychologists a prime opportunity to influence the process. Before, during, and after the SLC, we will be working with Congress to push for a permanent end to the SGR cut, not just a postponement.
The “Medicare Mental Health Access Act” (S. 1064/H.R. 794)
APAPO gained bipartisan support in both the House of Representatives and Senate for legislation to add psychologists to Medicare’s “physician” definition, with 58 cosponsors joining Rep. Jan Schakowsky (D-IL) in the House of Representatives, and 10 cosponsors signing on to the Senate companion bill introduced by Sen. Sherrod Brown (D-OH). The legislation would allow psychologists to provide services independently in all Medicare-covered treatment facilities; in some treatment settings, psychologists can only provide services under physician referral and/or supervision.
In order to identify new champions for the legislation in the new Congress, APAPO staff have been meeting regularly with House and Senate offices. With your help, we have also gathered several personal, first-hand examples from psychologists of the need for this bill. We greatly appreciate your assistance with this, and we hope you will continue to find similar stories from psychologists that would be useful in this effort. We will be working hard together on this issue next year.
Medicare Reimbursement Rates
Averaged together, Medicare payment rates for psychologists’ services have declined by more than 36% since 2007, adjusted for inflation. This is unacceptable, and we worked with you and your colleagues during the 2014 SLC to raise this issue in lobbying visits with congressional offices. APAPO has also met regularly with the Centers for Medicare and Medicaid Services (CMS) over the past several years to highlight this problem, most recently this past October. In that meeting, we offered specific options for addressing the issue, based on a detailed study of Medicare policies. We have urged CMS to fix this problem, but may pursue legislation to change Medicare’s payment formula for psychologists, if CMS is unable to resolve the issue.
The “Behavioral Health Information Technology Act” (S. 1517/S. 1685/H.R. 2957)
In coalition with several other organizations, APAPO is working on legislation to make psychologists and other mental health service provider’s eligible for the same Medicare electronic health records (EHR) use incentive payments currently available to physicians. . Legislation introduced by Sen. Sheldon Whitehouse (D-RI) (S. 1517) differs slightly from bills introduced by Sen. Rob Portman (R-OH) (S. 1685) and Rep. Tim Murphy (R-PA) (H.R. 2957), but all three hold the same benefit for psychologists. Senator Portman sits on the Senate Finance Committee, which has jurisdiction over Medicare, and our coalition worked with his office earlier this year on an amendment to the SGR repeal bill that helped raise awareness of the EHR incentives issue with Finance Committee members. To further increase awareness, we also helped organize several congressional briefings over the course of 2014, some of which featured psychologist participation. Our coalition is now working closely with Sen. Portman’s office to lay the groundwork for adoption of his legislative language in 2015.
Medicare PQRS Registry
APAPO is taking action to help psychologists who report quality measures in Medicare. Psychologists who participate in Medicare will face a 2% payment penalty in 2016 unless they participate in the program’s physician quality reporting system (PQRS) in 2014. To avoid this, APAPO has teamed up with Healthmonix, a leading health care data and technology company, to offer “PQRSPRO” to mental and behavioral health professionals in individual and group practices. PQRSPRO is a web-based registry allowing psychologists and other providers to share PQRS data—including retrospective data—with CMS more readily. Psychologists wishing to use the PQRSPRO registry for the 2014 reporting year have until January 31, 2015 to enroll and must submit their reporting data by February 15, 2015. The registry is accessible online at http://apapo.pqrspro.com, and providers can register at the site for a flat rate of $199 per reporting year. Using the registry will greatly increase psychologists’ chances of successfully participating in PQRS, while reducing their risk of future reductions in payment due to PQRS penalties.
Psychologists who successfully reported in 2014 will earn a 0.5% bonus on all of their Medicare charges, in addition to avoiding the 2% penalty for 2016. CMS is now sending out letters informing providers that they will be subject to a 1.5% penalty on all of their 2015 Medicare payments if they did not meet the PQRS reporting requirements in 2013. Psychologists who believe they are being penalized in error may request an informal review between January 1, 2015 and February 28, 2015. Requests for a review may only be made during this time period and must be submitted through the CMS Communications Support page, which can be found at the online address provided in the letter.
The “Helping Families in Mental Health Crisis Act” (H.R. 3717)
In 2014 APAPO worked closely with Rep. Tim Murphy, with APA’s Public Interest, Science, and Education Directorates, and with other major mental health organizations on comprehensive mental health reform legislation introduced by Rep. Murphy at the end of 2013. APAPO and APA offered broad support for the bill’s intent of reforming the mental health delivery system for people with a serious mental illness, and we promoted consideration of the bill and refinement of some of its provisions. The legislation garnered over 100 cosponsors from both political parties, but fell short of gaining the support necessary for its consideration on the House floor. Representative Murphy, however, is expected to reintroduce the Act in 2015, and APAPO looks forward to working with him and our other colleagues in support of this legislation.
In closing, let me thank you for all your hard work. APAPO could not advocate without you, and we are grateful for your assistance and dedication.