The flurry of health care activity late in the lame-duck session of
Congress did not include an annual increase in funding for health care or
medical research programs.
A burst of health care-related legislative action in the dying hours of the
109th Congress provided some early holiday gifts for psychiatry and people
with mental illness, but the level of federal funding for mental health
programs remained unchanged from the previous fiscal year.
Congress passed legislation (HR 6408) last month to cancel for one year a
5.1 percent reduction in Medicare physician reimbursements that was scheduled
to take effect this month (Psychiatric News, January 5). The
legislation also provides a 1.5 percent increase in reimbursements to
physicians who agree to report data on certain quality-of-care measures. The
approach lays the groundwork for higher payments to physicians who meet
specific treatment goals in the future, according to congressional staff. Such
programs are often categorized as pay-for-performance plans.
“We're grateful Congress acted in a timely way to avoid draconian
cuts, and we were pleased to work with [the American Medical Association] and
other medical specialties to achieve this,” said Nicholas Meyers,
director of APA's Department of Government Relations.
Meyers noted that the quality-data component of the legislation “has
risks” that could create problems for physicians and said his office
plans to continue “studying those as this moves forward.”
Among the pay-for-performance issues APA will continue to track is whether
regulators select valid performance measures.
The action on Medicare reimbursements was one of the few major actions that
Congress took before its recess. Legislators voted to delay the completion of
nine of 11 Fiscal 2007 appropriations bills, however, passing a continuing
resolution to fund operations for most federal agencies until mid-February.
The move maintains funding levels for most government programs, including all
health care programs, at the level of the last fiscal year.
APA helped to head off a major reorganization of the National Institutes of
Health (NIH) that critics, which included medical and patient groups, said
would have taken most oversight authority from Congress and given it to the
NIH director. APA opposed this proposal because it would have allowed the
director to reduce the size or scope of mental health research without
notifying the public or seeking public comment. Instead, Congress passed the
first reorganization of NIH in 13 years last month in a measure (HR 6164) that
lays out a more limited reorganization and enhances the director's
The measure also extends the public-notification process from 90 to 180
days when proposed changes at NIH are announced, which will give advocates
more time to respond, and streamlines NIH reporting requirements to reduce the
use of incompatible accounting and research grant systems among NIH's various
“It was a bill the NIH advocacy community could live with,”
said Lizbet Boroughs, deputy director of APA's Department of Government
In addition, the NIH reauthorization included a redistribution of $271
million in unused State Children's Health Insurance Program (SCHIP) funds from
prior years to 14 states that face deficits in their programs in Fiscal
A catchall veterans measure (S 3421) also passed last month may help
address a long-standing APA complaint that veterans have to wait for extended
periods for assessment and treatment, including for mental health care.
The measure increases access through the authorization of funding for two
new treatment facilities, to be located in Charleston, S.C., and Denver. It
also authorizes $180 million for mental health care at veterans readjustment
centers in Fiscal 2007 and requires the Department of Veterans Affairs (VA) to
cooperate with the Department of Defense (DoD) to improve treatment of
posttraumatic stress disorder (PTSD).
Specifically, the legislation directs the VA's National Center on PTSD to
work with DoD physicians to improve their treatment of PTSD “through
training, treatment protocols, Web-based interventions, and the development of
Meyers praised the legislation's efforts to reduce mental health assessment
and treatment waiting times for veterans by increasing the VA health system's
overall outpatient capacity.
“This measure emphasized the importance of this issue to APA and
Congress— that the DoD knows it is dealing with family members affected
by mental illness in addition to members of the military,” Meyers
Physicians' administration of buprenorphine in outpatient settings can
expand under another late-session measure (HR 6344) passed by Congress. The
measure raised the limit for individual physicians treating opioid addiction
with buprenorphine from 30 patients to 100 patients (Psychiatric
News, January 5). Physicians, who need to complete specified training
before they can prescribe buprenorphine to opiate addicts, must prescribe the
drug for a year before the measure will allow them to reach the new
APA had complained that the 30-patient limit led many offices that provide
the treatment to keep patients waiting for weeks or months for it.
Among other measures passed at the end of the congressional session were
limited health information technology (HIT) provisions, which were included in
the reauthorization of the Ryan White CARE Act (HR 6143). The measure would
fund demonstration programs, including one to develop a “standard
electronic client information data system” that could provide
beneficiary data more quickly to HHS. The new Congress is expected to
reconsider a much broader HIT measure, though the 109th Congress consistently
raised concerns among physicians about the fiscal and privacy impact of HIT
Texts of the measures passed by the 109th Congress can be accessed
by searching on the bill number. Direct links to each bill were not available
at press time. ▪