APA Advocacy Agenda Focuses on Access Issues

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 Original article: 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.