Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles via Google Scholar Articles by Lehmann, C. Search for Related Content Related Articles

APA Advocacy Agenda Focuses on Access Issues

Budgetary constraints facing Congress this year will create a major challenge for APA advocacy.

APA-supported legislation that could have a major impact on individuals with mental illness has been introduced in the first session of the 109th Congress since it convened on January 4.

In its advocacy efforts on Capitol Hill, APA works with a number of coalitions in addition to working on its own. One of the coalitions of which APA is a member is the Mental Health Liaison Group (MHLG), formerly the Liaison Group on Mental Health. It was formed in 1969 to exchange political information, coordinate advocacy strategies, and discuss public policy issues related to mental health.

The MHLG, which now has more than 50 member organizations, develops annual recommendations for federal spending on mental health research and services. APA and its members use these recommendations when they advocate on Capitol Hill for increases in federal appropriations.

The toughest challenge this year for APA and its coalition partners will be persuading Congress to preserve or increase current levels of spending on biomedical research and mental health services. Congress is under increasing pressure from President George W. Bush to cut the rapidly expanding federal budget deficit in half by 2010. Bush proposed in his February budget request to Congress that the deficit be reduced by cutting discretionary (nonentitlement) spending on domestic programs, including health care, that do not relate directly to defense and homeland security (Psychiatric News, March 4).

"We are concerned that the president's proposed miniscule increase in federal funding for the National Institutes of Health in Fiscal 2006 will not sustain a robust biomedical research agenda," Nicholas Meyers, director of APA's Department of Government Relations, told Psychiatric News.

Moreover, APA opposes the president's proposed drastic cuts to the federal Medicaid budget; the cuts could reach $20 billion over five years, Meyers said.

"The states receive federal matching grants to provide medical services to low-income beneficiaries including individuals with disabilities," he continued. "Many states have budget problems, and we don't think they can absorb draconian cuts in federal Medicaid spending without further eroding services to psychiatric patients."

The following bills have been introduced or are expected to see action in the first session of the 109th Congress. They are designed to expand access to psychiatric care for millions of Americans.

• Parity: The Sen. Paul Wellstone Mental Health Equitable Treatment Act (MHETA) of 2003 is expected to be reintroduced this session. APA continues to work with the bill's sponsors in the House and Senate to move it forward. The comprehensive parity measure builds on the 1996 parity law by requiring companies that offer mental health benefits to ensure that the coverage, including copayments, deductibles, and coinsurance, is equivalent to that for physical illnesses.
  
• Medicare copayment: The Medicare Mental Health Copayment Equity Act (HR 1125) was introduced in the House last month. The legislation would reduce Medicare's copayment for psychiatric treatment from 50 percent to 20 percent over six years. Medicare beneficiaries pay a 20 percent copayment for the treatment of most medical illnesses. APA has emphasized repeatedly in its advocacy that Medicare's 50 percent copayment for psychiatric treatment is discriminatory.
  "Every member of Congress that we have spoken to about the 50 percent coinsurance for most psychiatric care has expressed dismay about the discriminatory cost sharing," Meyers said.
  (Some psychiatric care is reimbursed at 80 percent, including initial diagnostic interviews under certain CPT codes and psychiatric care provided to patients with Alzheimer's disease or related disorders unless the primary service is psychotherapy.)
  The cost of implementing the legislation remains a barrier to gaining congressional support. Increasing the reimbursement would increase Medicare's costs between $5.2 billion and $5.9 billion over 10 years, according to the Congressional Budget Office and independent budget analysts, said Meyers.
  
• Medicare Part D: APA will continue to work with the Centers for Medicare and Medicaid Services (CMS) to shape how the final Medicare Part D regulations for the new outpatient prescription drug benefit are interpreted and implemented for low-income beneficiaries with disabilities whose Medicaid prescription drug coverage ends January 1, 2006. CMS administrator Mark McClellan, M.D., Ph.D., testified last month before the Senate Committee on Aging about the continuity of care for beneficiaries who currently receive drug coverage under Medicaid but will be moved to Medicare under Part D effective January 1 (see page 13). McClellan told the senators that CMS will automatically enroll these "dual-eligible" beneficiaries in private drug plans by December. Once enrolled, dual eligibles have the option to switch into a different prescription drug plan.
  APA continues to advocate for additional protections for psychiatric patients during the transition to minimize disruptions to their coverage for psychotropic medications (Psychiatric News, March 4).
  
• Medicaid: The Bipartisan Medicaid Commission Act of 2005 (HR 985/S 338) was introduced in February. The bill would establish a bipartisan commission to conduct a comprehensive review of the health care program's strengths and weaknesses and recommend reforms (see story at right).
  
• Substance abuse: APA and a coalition representing addiction medicine, including psychiatry, medical colleges, group medical practices, and managed care, have been advocating for legislation that would amend the Controlled Substances Act. The legislation (HR 869/S 45), introduced in the Senate and House in February, would remove the limit—now 30—on the number of opiate-addicted patients who can be treated with buprenorphine at any one time by medical professionals in group practices.
  
• Association health plans (AHPs): APA joined several mental health and other organizations last month in expressing concerns about the Small Business Health Fairness Act of 2005 (HR 525/S 406) now making its way through Congress. AHPs allow small businesses to band together through trade and professional organizations to purchase health benefits collectively. AHPs are regulated by federal and state law. APA is concerned about a provision in the legislation exempting AHPs from state regulations, including mental health parity requirements.
  
• Genetic privacy: The Senate passed the Genetic Information Nondiscrimination Act of 2005, which would prevent employers and health insurance providers from discriminating against applicants based on their genetic information. APA will continue to advocate for introduction of a companion bill in the House.
  

At the state level, APA will continue to assist district branches and state associations in opposing legislation allowing psychologists to prescribe medications. "The AMA has proposed creating a new `scope of action center' to assist national and state medical associations facing prescribing challenges from nonphysician practitioners," said Meyers. "We expect to hear more details about the center later this year from the AMA."

See page 4 for Internet-access information on the bills cited in this article.

Related Articles:

Medicare Law Causes Concern Over Continuity of Care

Jim Rosack
Psychiatr News 2005 40: 13. [Full Text]

Email this article to a Colleague Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles via Google Scholar Articles by Lehmann, C. Search for Related Content Related Articles

Get information about faster international access.

Privacy Policy

Copyright © 2005 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us