Late-Term Votes Cause Mixed Emotions on MH Front

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.

NIH Gets Minor Reorganization

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 strategic-planning authority.

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 institutes.

“It was a bill the NIH advocacy community could live with,” said Lizbet Boroughs, deputy director of APA's Department of Government Relations.

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 2007.

Veterans Access Improved?

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 evidence-based intervention.”

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 said.

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 100-patient limit.

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 initiatives.

Texts of the measures passed by the 109th Congress can be accessed at<http://thomas.loc.gov> by searching on the bill number. Direct links to each bill were not available at press time. ▪