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Capitol Comments
2008: APA's Year of 'Overnight' Success
Psychiatric News
Volume 44 Number 1 page 7-18

I'm writing this column at the end of 2008. The immediate demands of preparing for the inauguration of the Obama administration and developing our lobbying and political strategies for the 111th Congress have given us almost no time to savor the tremendous victories that APA leadership, members, and staff have secured for the profession and patients this year. That's unfortunate, because 2008 was the most remarkable single year for the advancement of APA's long-term legislative goals—and for mental health care in general—that I have seen in 30 years of service on Capitol Hill and at APA.

Readers know by now that between July and October, APA lobbying and political activity played a key role in helping to win passage of legislation to accomplish the following:

  • Ending (phasing out) Medicare's historic discriminatory 50 percent coinsurance requirement for outpatient mental health services under Part B.

  • Enacting a parity law for the treatment of mental health and substance use disorders for ERISA and large group health plans.

  • Requiring Medicare drug plans to cover benzodiazepines and barbiturates.

  • Codifying current subregulatory protections for access to all medications used to treat medically at-risk patients (including, for example, antipsychotics and anti-depressants).

  • Postponing until 2010 an underlying 10.6 percent reduction in Medicare's payment update for physicians and other health professionals.

  • Changing the budget neutrality requirement to a method that does not specifically disadvantage cognitive “low overhead” specialties such as psychiatry.

  • Temporarily providing a 5 percent bump in payments for psychiatric codes under Medicare.

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  • Ending (phasing out) Medicare's historic discriminatory 50 percent coinsurance requirement for outpatient mental health services under Part B.

  • Enacting a parity law for the treatment of mental health and substance use disorders for ERISA and large group health plans.

  • Requiring Medicare drug plans to cover benzodiazepines and barbiturates.

  • Codifying current subregulatory protections for access to all medications used to treat medically at-risk patients (including, for example, antipsychotics and anti-depressants).

  • Postponing until 2010 an underlying 10.6 percent reduction in Medicare's payment update for physicians and other health professionals.

  • Changing the budget neutrality requirement to a method that does not specifically disadvantage cognitive “low overhead” specialties such as psychiatry.

  • Temporarily providing a 5 percent bump in payments for psychiatric codes under Medicare.

  • I've been asked how it is possible that all this happened “all at once and overnight.” The short answer is that none of this happened “overnight.” To the contrary, these victories are the direct result of many years of work led by your talented and dedicated lobbying team in APA's Department of Government Relations, with the support of APA's Office of Healthcare Systems and Financing and Office of Communications and Public Affairs. Also playing a vital role were APA's elected leaders (particularly Nada Stotland, M.D., and Carolyn Robinowitz, M.D., the current and immediate past APA president, respectively, on whose watches the parity and Medicare endgames played out), the advocacy-related components of APA's governance system, and all APA members in the field, along with the crucial involvement of your dedicated executive staff in the district branches and state associations.

    Nor was this exclusively an “APA only” activity. The AMA has been a staunch and invaluable ally, as have the American Academy of Child and Adolescent Psychiatry, American Association for Geriatric Psychiatry, other specialty and subspecialty organizations, our counterparts at the National Alliance on Mental Illness and Mental Health America, the National Association of Psychiatric Health Systems and other hospital organizations, to name but a few. Notable also was the central role played by the APA-founded Coalition for Fairness in Mental Illness Coverage, which was most ably chaired by Pamela Greenberg, the executive director of the Association for Behavioral Health and Wellness—the national organization representing managed behavioral health care.

    I also include as key partners the staff and membership of the American Psychological Association. Yes, we have profound—and seemingly insoluble—differences over major policy issues such as psychologists' drive for prescriptive authority. Nevertheless, we collaborate a good deal more than we clash, and even when our disagreements are heated, we are able to set them aside in order to work closely together on issues such as parity and privacy.

    Your DGR lobbyists could not have better allies than the APAPAC Board of Directors, chaired by John Wernert, M.D. Your PAC contributions have opened many doors and given us the ability to develop long-term relationships with a steadily growing number of senators and representatives.

    Last, but by no means least, in achieving our “overnight success” are APA's CEO and Medical Director Jay Scully, M.D., and APA's Director of Advocacy, Gene Cassel. Lobbying is a very visible activity where the risk is great, the resource demands intensive, and the returns frequently years in the making. Dr. Scully's calm and steady support and Gene's wise counsel and deep personal commitment to APA's legislative and regulatory objectives have been invaluable.

    Our “overnight success” in 2008 has very deep roots and been long in the making. It's often said that victory has a thousand fathers, and I hope I've conveyed that this is absolutely true in the case of our victories in Medicare and mental health and substance use disorder parity. We are grateful for your efforts and continued support. ▪

    Nicholas M. Meyers is director of APA's Department of Government Relations.

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