AMA Spotlights Problems In Accessing MH Care

At this year’s annual meeting, the American Medical Association’s House of Delegates, celebrating its 100th anniversary, managed to conduct a great deal of business despite the distractions generated by the filing of a lawsuit by the AMA’s chief executive and the annual election process (Psychiatric News, July 20).

The subject of limitations and restrictions to access for mental health services proved to be a topic of both in-depth discussion and action during this meeting of the House of Delegates.

The AMA Council on Medical Service’s Report 9, “Access to Mental Health Services,” was supported by the Section Council on Psychiatry and well received by the house. The report looked at opportunities for, and obstacles to, enhancing access on different levels. Access to clinicians from a full range of mental health care disciplines was examined, as were limitations and barriers to a patient’s choice of health care professionals, geographical access, and access to culturally competent treatment.

The report concluded that problems to access are persistent and take on multifaceted forms as payment systems change. The enormous disparity and subjective restrictions in insurance coverage for mental illness were highlighted, as was the critical lack of coordination of care in mental health services.

The report recommended that the AMA’s longstanding policy in support of parity efforts be reaffirmed. It also recommended specific ways in which the AMA should advocate for the removal of barriers that keep patients from seeking and obtaining mental health services (see box).

Patrice Harris, M.D., an APA delegate to the AMA, provided significant input to the final version of CMS Report 9 as a member of Reference Committee G, which reviewed the report prior to its consideration by the full house.

Originally the report recommended that the AMA advocate that managed behavioral health care organizations “adopt an improved system of psychiatric referrals similar to that used in other medical and surgical specialties.” The input of Harris, a member of APA’s Board of Trustees, and the testimony of fellow APA delegates to the AMA, played a significant part in the reference committee revising that recommendation to ask that the AMA advocate “that all insurance entities facilitate direct access to a psychiatrist in the referral process.”

In addition, the report was amended to include a recommendation that reaffirmed the existing AMA policy (H-285.956), passed at the December meeting, which opposes the “carving out of treatment for mental illness from health plans and all policies that discriminate against the mentally ill in health plans.”

The amended Council on Medical Service Report 9 garnered significant support not only in reference committee, but also on the floor of the house, and was adopted.

Other Action on Carveouts

Once again, similar to efforts at last December’s AMA meeting (Psychiatric News, January 5), a resolution (709) was put forward, in this case by the Delaware state delegation, that opposed all carveouts of specific types of physician services and called on the AMA to communicate that position to the National Association of Insurance Commissioners. The reference committee again heard significant testimony, including comments by the Section Council on Psychiatry. The testimony reiterated APA policy on the subject and objected to resolution 709 as being too broad.

The reference committee concluded that most comments weighed against the resolution as being too broad and that many sought a better definition for the term “carveout.” Accordingly, the committee recommended a substitute resolution that directs the AMA to “oppose any carveouts which result in the denial of necessary and appropriate care and/or reduce access to care, and/or interfere in integrated care, and/or interfere with physicians initiating needed referrals.” The reference committee also recommended that the AMA further study the issue of carveouts and develop a clear definition of the term. The house approved the substitute resolution.

Medical Privacy

Of broader interest to all health care professionals, resolutions 240 and 246 and Board of Trustees Report 34 garnered significant testimony in reference committee as well as on the floor of the house.

Resolution 240 primarily sought the repeal of existing privacy regulations as contained in the Health Insurance Portability and Accountability Act (HIPAA). The reference committee voted to recommend that the resolution not be adopted, and the house referred the resolution to the AMA’s Board of Trustees.

Resolution 246 was adopted by the house after being amended. It primarily calls on the AMA to aggressively forward physicians’ concerns to both Congress and the Bush administration about the administrative simplification provisions within HIPAA with regard to the regulations concerning the use of so called “de-identified” information versus individually identifiable information. In addition, the resolution requires the AMA to seek changes, “including legislative relief, if necessary, to reduce the administrative and cost burdens on physicians.”

Report 34, an informational report that updates the AMA’s HIPAA-related activities to date, was filed.

Seclusion and Restraint

Reference Committee H of the House of Delegates proposed a substitute to Resolution 807, originally submitted by the Nebraska delegation. The substitute resolution directed the AMA to continue its legislative efforts to rescind the July 22, 1999, interim final rule governing the use of seclusion and restraint in hospitals. That final rule requires a face-to-face evaluation of a patient by a physician within one hour of the initiation of seclusion and/or restraint (Psychiatric News, July 6).

The substitute resolution also called on the AMA to study and report back at the December meeting on evidence-based measures that would permit physicians to exercise reasonable judgment in the ordering and use of seclusion and restraint. The resolution also calls for the dissemination of those measures to the Center for Medicare and Medicaid Services (formerly the Health Care Financing Administration), as well as to physicians.

Youth Issues

Resolution 413, sponsored by the American Academy of Child and Adolescent Psychiatrists (AACAP) and the American Academy of Preventive Medicine, sought a review of literature on the efficacy of intervention programs that are designed to reduce bullying behaviors. An amended resolution asking the AMA to address bullying behavior among youth was adopted by the house.

Resolution 412, jointly sponsored by APA and AACAP, requested that the AMA’s Council on Scientific Affairs prepare a report on childhood asthma, addressing its increasing incidence and the relationship between asthma and socioeconomic status, psychosocial factors, and environmental factors. The proposal received strong support in testimony in the reference committee and was adopted by the full house.

APA alternate delegate Saul Levin, M.D., provided strong testimony on the floor of the house on Resolution 414, introduced by the Rhode Island delegation. The resolution, which requires that the AMA ask youth-oriented organizations to reconsider exclusionary policies that are based on sexual orientation, won adoption by the full house after Levin’ss comments were widely supported.

No Moratorium

Finally, in spite of the efforts of the Section Council on Psychiatry and other delegations’ strong efforts, the house did not adopt a resolution (8) that would have called on the AMA to adopt as policy a moratorium on capital punishment in accord with APA policy. APA delegate John McIntyre, M.D., testified on APA’s position to the house.

The reference committee recommended, and the house adopted, a substitute resolution that stated the AMA does not take a position on capital punishment; however, “the AMA urges appropriate legislative and legal authorities to continue to implement changes in the system of administering capital punishment, if used at all, and to promote its fair and impartial administration in accordance with the basic requirements of due process.”

The proceedings of the AMA’s House of Delegates 100th anniversary meeting can be accessed on the Web at http://www.ama-assn.org/ama/pub/category/4563.html. ▪