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December, 2001

 

Congress finally adjourned for the year on December 20, leaving many priorities for APA and the rest of the physician and health care communities undone. In many respects, this was an unprecedented year. We began the year in the wake of a bitterly contested presidential election, and with single party control of the White House and both houses of Congress. Five months later, Senate control shifted to the Democrats in the wake of the decision of Vermont Senator Jim Jeffords to leave the Republican Party. And just four months later, the events of September 11 reshaped the entire legislative agenda yet again. In the first two-thirds of the year, Congress enacted little of substance except for a major tax cut bill. But in the last third, Congress passed sweeping anti-terrorism legislation, bailed out the airline industry and beefed up airline security, provided massive emergency spending, finished a major education bill, gave the President new trade powers, and passed all 13 appropriations bills.

Despite the flurry of activity, much significant legislation was left undone. Congress remained deeply divided on an economic stimulus package. The Senate failed to take up a Medicare regulatory reform bill that passed the House by a unanimous vote. Legislation to address the physician fee cuts caused by Medicare's quirky and faulty payment update formula was introduced in both the House and Senate but neither body took action. While broad new parity legislation was stripped from a House-Senate spending conference, Congress did extend the limited 1996 parity law for another year and set the stage for action on expanded parity coverage in 2002.

All told, this was a typically mixed bag from a highly atypical Congress. Your DGR staff wishes you a safe and happy holiday season and New Year. We look forward to working with you in 2002. Here are some of the highlights of the end of session legislative push:

 

 

  • Conferees Drop Parity Expansion; Extend 1996 Law for One Year

In late December, House and Senate conferees on the fiscal year 2002 Labor-HHS Appropriations bill met in a packed hearing room in the U.S. Capitol for an impassioned debate on mental health parity. With APA DGR staff in the room and lobbying until the last minute, many conferees spoke in favor of the Domenici-Wellstone mental health parity amendment passed overwhelmingly by the Senate in October. In the end, House conferees – under relentless pressure from the House GOP leadership – rejected the Senate parity amendment. The vote was 7 Ayes to 10 Nays, strictly along party lines. All Democrats voted for the amendment; all Republicans voted against it.

Conferees subsequently approved a one-year extension of the limited 1996 Mental Health Parity Act. More importantly, Representative Ralph Regula (R-OH), Chairman of the House Labor-HHS Appropriations Subcommittee and the key House conference leader, inserted strongly worded report language into the conference agreement directing the House authorizing Committees -- whose chairmen had objected to passage of parity as an appropriations rider -- to take action on parity legislation in 2002. The report language says that the "conferees recognize the devastating impact of mental illnesses on Americans from every walk of life and the widespread bipartisan support of mental health parity legislation in both houses of Congress. The conferees strongly urge the committees of jurisdiction in the House and the Senate to convene early hearings and undertake swift consideration of legislation to extend and improve mental health parity protections during the second session of 107th Congress."

Despite the outcome, we can and should focus on the fact that we have made tremendous progress this year in pushing our ultimate objective of ending discrimination between health insurance coverage for psychiatric illness as contrasted to other medical illness. Chief among these accomplishments is the fact that two-thirds of the Senate and over half the House are now on record as supporting mental health parity, and President Bush has pledged to work on parity in 2002. We can also take pride and satisfaction in the fact that APA's core message that the case for parity is clear and compelling on the grounds of basic civil rights, scientific merit, and long-term cost savings has been heard and largely accepted by public decision makers and opinion leaders.

Your DGR staff would like to offer a big THANK YOU to all the APA members, spouses, family members, patients, and District Branch and State Association staff who responded time and again to our repeated urgent pleas for help in waging the war for parity in the Congress. We were repeatedly told by Hill staff that they were hearing in unprecedented numbers from local constituents including prominently among them local psychiatrists with a clear message of support for parity, and that the local message was vitally important to their decision to support parity legislation in the Senate and House. The parity struggle literally could not be won without your personal dedication. (Contacts: nmeyers@psych.org; mstrazzella@psych.org)

The Labor-HHS appropriations bill includes significant funding for NIH and the Institutes. Funding for the National Institutes of Health in FY02 will be $23.3 billion dollars, an increase of 15% over FY01. This increase keeps the NIH on track for a doubling of its budget in 2003. The Center for Mental Health Services received a 6.5% ($50 million) increase for FY02. (Contact: lboroughs@psych.org)

 

 

 

 

The Medicare Regulatory and Contracting Reform Act (H.R. 3391), the APA- and AMA-supported bill to reform Medicare's adversarial and burdensome regulatory structure, passed the House in December by a vote of 408-0. The bill would, in part, give physicians greater flexibility in setting up schedules for repaying Medicare overpayments, limit carrier use of extrapolation and prepayment review, require carriers to give clear, accurate, and timely responses to questions from physicians, block implementation of any new E & M guidelines until they have been pilot tested, and clarify Medicare coverage of emergency services. Final passage of this long-overdue measure will be a top APA priority in 2002. (Contacts: nmeyers@psych.org; mstrazzella@psych.org)

Bills have been introduced in the House (H.R. 3351) and Senate (S. 1707) to significantly reduce the minus 5.4 percent Medicare physician payment update scheduled for 2002. As previously reported in APA alerts, the negative update is the result of technical problems with the complex Medicare fee schedule formula established by Congress years ago. The negative update can translate into actual dollar reductions of 10 percent or higher from 2001 to 2002 fees, and is particularly troublesome for psychiatrists who must also contend with Medicare's underlying discriminatory 50 percent copayment requirement. APA, AMA, and all of medicine have joined together to support the House and Senate bills. 66 Senators -- two thirds of the Senate -- have sponsored S. 1707, and 287 Representatives (well more than half the House) have sponsored H.R. 3351. Enactment of the legislation will be a top APA priority in 2002. (Contacts: nmeyers@psych.org; mstrazzella@psych.org)

James Thompson, M.D., APA Director of the Division of Education, Minority and National Affairs, testified before the Practicing Physicians Advisory Council on the adverse impact of Medicare teaching physician regulations on the provision of psychiatric care to patients in teaching hospitals. The Council advises the Centers for Medicare and Medicaid Services (CMS) on Medicare policy affecting physicians and patients in a variety of practice settings.

Dr. Thompson's testimony (available on-line at www.psych.org) noted that existing rules which require physical presence of the teaching physician, or the use of a one way mirror or concurrent videotaping, were clinically inappropriate and not feasible fiscally. The rules have resulted in fewer available teaching physicians, which in turn has had an adverse impact on outpatient clinics and produced longer patient waiting lists.

Dr. Thompson argued that the existing teaching physician regulations which permit the supervision and immediate availability of a teaching physician for up to four residents for primary care outpatient clinics with the teaching physician billing low to mid level evaluation and management CPT codes (the primary care exception) should be expanded to include psychiatry. PPAC members were very receptive to our proposal and to the expansion of the exception to all residency training programs. Its unanimous recommendation to CMS was to "extend the primary care exception to all specialties including psychiatry to level 3 evaluation and management CPT codes or their equivalent." This is an important first step and APA will work with CMS towards implementation, most likely through new rulemaking. (Contact: ecassel@psych.org)

 

 

 

APA President Richard Harding, M.D., South Carolina School of Medicine Department of Neuropsychiatry and Behavioral Science Chairman Jay Scully, M.D., APA Medical Director Steven Mirin, M.D., and other APA staff met with Tom Scully, Administrator of the Centers for Medicare and Medicaid Services (formerly HCFA) to discuss a range of issues affecting psychiatry, including seclusion and restraint, Medicare teaching physician rules, ICD/DSM and HIPAA, privacy regulations and Medicare inpatient PPS for psychiatric services. In a positive meeting, the Administrator provided APA the opportunity to work with his physician outreach staff to address APA concerns. (Contact: ecassel@psych.org)

APA lobbying helped kill the controversial "Tiahrt amendment" to the Elementary and Secondary Education Reauthorization Act (ESEA). The House-passed amendment was intended to give parents more control over reproductive education that their child receives at school. Unfortunately, the Tiahrt amendment as drafted precluded school officials (teachers, principals, athletic coaches) from having any sort of "concerned conversation" with a student regarding health, mental health or substance abuse matters under the penalty of having federal funds revoked from the school district. The APA’s chief concern was that the amendment would block school officials from referring a student who was seriously depressed, suicidal, suffering from an eating or substance abuse disorder for help. The APA worked closely with Senator Edward Kennedy (D-MA) to remove the provision from the final version of the Education bill. Thanks to the many APA members who contacted their Senators and Representatives on this issue. (Contact: lboroughs@psych.org)

The House approved the reauthorization of a 1997 law granting pharmaceutical companies an extra six months of patent protections if they test a drug's efficacy on children, sending the bill to the White House for the President’s signature. The measure, which was approved by the Senate in early December, would extend by six years the pediatric exclusivity law, which supporters say has led to some 400 drugs being tested on children since its enactment. The reauthorization would expand the original law by encouraging testing of drugs whose patents expired before the exclusivity law (when pediatric testing rarely took place). Senator Christopher Dodd (D-CT), co-sponsor of the Senate's version of the extension, said, "Guessing may work for cooking, but when it comes to dosages of medicines for children, it's a recipe for disaster. This measure helps remove any guesswork," adding that President Bush is expected to sign the extension. The APA is pleased with the reauthorization because improved accurate dosage and efficacy data assists psychiatrists with providing the very best treatment for their young patients. (Contact: lboroughs@psych.org)

APA met with officials of the U.S. Department of Health and Human Services Office of the Inspector General (IG) to discuss our concerns over controversial IG reports on Medicare billing for mental health services. Kenneth M. Sakauye, M.D., Chair of APA's Council on Aging led the APA contingent, which also included Jay Cutler, Director of Government Relations, Lloyd Sederer, M.D., Director of Clinical Services, and other APA staff. APA was joined at the meeting by representatives of the American Association for Geriatric Psychiatry.

In an intensive two-hour discussion, APA and AAGP pressed home concerns about two IG reports issued in 2001, one on Medicare payments for mental health services in nursing homes, and the other on Medicare payment for mental health services in outpatient settings. APA and AAGP discussed in detail our substantive and technical concerns about and objections to the presentation of information in the reports, including questionable data and imprecise terminology that, for example, equated psychological testing with psychiatric treatment. The IG representatives pledged to work for greater precision in terminology and expressed interest in further discussions with both APA and AAGP. The 2002 IG agenda includes numerous investigations of Medicare mental health issues, largely because the IG alleges that questionable billing remains a problem. (Contacts: nmeyers@psych.org; ecassel@psych.org)

Congress gave final approval to legislation allocating $4 million as part of the FY 2002 budget for the Justice Department (DOJ) for the new federal mental health courts program. This funding is part of the FY 2002 Commerce-Justice-State appropriations bill (H.R. 2500). DOJ estimates that as many as 12 to 15 mental health courts can be funded in 2002, depending on the maximum grant amount set and any local cost sharing requirements.

Congress first authorized the federal mental health Courts program as part of legislation passed in 2000 (P.L. 106-515). The establishment of mental health courts is rapidly emerging as one of the most successful strategies to address the stark reality that jails and prisons have become the nation's depository for people with severe mental illnesses. Mental health courts have grown out of concern among judicial, law enforcement, and corrections officials about the disturbing trend of placing persons with severe mental illness in jails for non-violent offenses. The law was enacted in order to assist states and communities across the nation in putting in place innovative approaches to diverting offenders into treatment programs and ease the growing burden on criminal justice and corrections systems. (Contact: lboroughs@psych.org)

The insurance, hospital and pharmaceutical industries are attempting to change APA-supported provisions in the comprehensive health care privacy regulation. APA is working to ensure that HHS Secretary Tommy Thompson retains key provisions of the regulation on the necessity of obtaining the prior consent of the patient, and maintains the minimum necessary requirements for the use and disclosure of protected health information and the non-preemption of more privacy-protective state laws.

Congress has passed -- and the President has signed into law -- H.R. 3323, legislation sponsored by Representative David Hobson (R-OH) to extend for one year the compliance date of the HIPAA electronic transactions regulation. The new law requires health plans and providers not in compliance with the electronic transaction regulation by October 16, 2002 to submit compliance plans to the Department of Health and Human Services (DHHS) by that date, and empowers DHHS to withdraw Medicare participation of organizations that are not in compliance and do not file a plan.

The law also requires all but small health care providers to submit Medicare claims electronically after the extended compliance date of October 16, 2003. Initially, the measure would have imposed a $1 user fee on every paper claim submitted to the Medicare program after the compliance deadline. APA lobbied successfully for the user fees to be dropped from the bill. In an important nod to privacy, the new law also explicitly reaffirms the current April 4, 2003 compliance date for the privacy rule. (Contact: ntrenti@psych.org)

 

  • APA Launches Political Action Committee

In response to APA members' interest in expanding APA advocacy and with the recent change in APA's tax status, politically concerned psychiatrists are now able to support federal candidates who will best represent psychiatry's interests in Congress through the American Psychiatric Association Political Action Committee (APAPAC).

APAPAC permits politically active psychiatrists to maximize support for Members of Congress who share APA's principles and goals, and will actively support APA's positions in the legislative process. APAPAC will also educate other Members of Congress on the legislative issues and positions vital to our patients and profession. APAPAC enables individual APA members to participate directly and effectively in the political process by providing opportunities for APAPAC contributors to have access to congressional candidates and key Members of Congress. Among other benefits, APAPAC contributors will have opportunities to advocate for psychiatry at key political events.

This is the first time that the APA has a political fundraising voice allowing individual APA members to directly participate in advancing our goals for our patients and the profession of psychiatry. To successfully launch APAPAC, you are now able to contribute to the PAC on your 2002 APA dues billing. Simply check off your voluntary contribution to APAPAC on your 2002 APA dues bill. The success of APAPAC depends 100% upon voluntary support. Maximum participation is essential for success. This is the opportunity for you to take part in the process. Please do your part!

For more information on how to contribute to and become involved with APAPAC, please contact Jason Pray at (202) 682-6060, or by e-mail at jpray@psych.org