DPA - Delaware Psychological Association

Federal Advocacy

The Committee on Federal Advocacy is responsible for establishing and maintaining relationships with each member of Congress from the State of Delaware, ensuring that DPA's Federal Advocacy Coordinator is identified as an essential key contact in Delaware on mental health issues before the Congress.  Under the leadership of the Federal Advocacy Coordinator, the committee shall monitor federal issues and legislation impacting mental health and the profession of psychology through its ongoing relationship with the APA Practice Organization.  The Committee shall advise the Association's Executive Council and membership on all critical federal legislative issues, work with the Association Executive Director to communicate APAPO action alerts and coordinate grassroots response to these calls for actions.  As necessary, the Committee shall organize an effective grassroots network of psychologists within the State of Delaware.   Advocacy activity may take the form of letters or calls to Congress, meetings with Members of Congress, attendance at town hall meetings, op-eds, or letters-to-the-editor.
  • April 19, 2018 12:01 PM | Kelly Wetzel (Administrator)

    Federal Advocacy Update


    This year the Federal Advocacy Agenda will focus our efforts on passing the bipartisan, bicameral Medicare Mental Health Access Act, and to ask Congress to strengthen Medicaid expansion, rather than weaken it.  Additionally, we may call on our Congressional leaders to sign a Dear Colleague letter to the House and Senate Armed Services Committee leadership, urging them to exert appropriate, immediate oversight of DHA’s TRICARE program.

    The Medicare Mental Health Access Act (H.R. 1173, S. 448), would allow psychologists to practice at the top of their license in all Medicare settings. That is to practice without physician oversight in outpatient rehabilitation facilities, home health agency programs, partial hospitalization programs, and nursing homes to name a few. Health plans in the Private sector, as well as Tricare, the VA, and Medicare Advantage already allow this. We do know that delaying treatment of disorders such as depression, worsens outcomes by doubling the rate of hospitalization and ER visits in the Medicare population who also suffer from chronic conditions like diabetes or congestive heart failure. As the physician shortage worsens, there will be fewer people available to sign off to provide the required but unnecessary oversight.  Psychologist ask to be included in the Physician Definition of Medicare so that we may join the ranks of other doctoral-level, non-physician providers like podiatrists, dentists, chiropractors and optometrists. This will open the door to more complete mental health access for our Medicare patients. We are awaiting feedback as to whether any office would be willing to co-sponsor this legislation. We are more optimistic about this than in previous years!

    Medicaid should be strengthened rather than weakened.  With mental illness being  so prevalent (44.7 million) and serious mental illness also being relatively high (10.4 million), many people are already in need of treatment options. Add another 20 million people who suffer from a substance use disorder, and you can begin to understand that it would be important to support rather than dismantle the single largest payer of mental health services (25%) , and addiction treatment (21%). We know that 11 million were offered comprehensive behavioral health treatment by the ACA Medicaid expansion. Thank goodness because we know Medicaid recipients are more vulnerable with illness than the privately insured, being twice as likely to receive MH treatment,and 2.5 times more likely to need an ER for a serious health issue.  Medicaid is the healthcare safety net designed to help those in need. Lifetime limits, lockouts, and work requirements will deprive and disqualify many deserving, very low income people.  We were pleased to find that all of our Congressional member are extremely supportive of Medicaid and the ACA expansion in Delaware.

    Our need to ask our Congressional Members to sign the above mentioned Dear Colleague letter will continue to be assessed. Currently, Delaware is not one of the targeted states.  If there are problems with the local Tricare contracts, please let us know so that we may put you in contact with the right person.

    Check out the following link for DELAWARE CENTER for HEALTH INNOVATION 

    https://www.dehealthinnovation.org.  When you get there you’ll see the 5 committees. You can find out what each committee is about, and click on EVENTS to find out when the various committees meet. Interesting stuff for a state that aspires to in the top 5 best states for best healthcare outcomes!

    Respectfully Submitted

    Barbara Giardina 

  • October 02, 2017 11:36 AM | Kelly Wetzel (Administrator)

    The Merit-based Incentive Payment System or MIPS is the outgrowth of MACRA (Medicare Access and CHIP Reauthorization Act) a comprehensive payment reform system for Medicare providers. MACRA attempts to deal with increasing healthcare costs by evaluating services and rewarding quality of care. MACRA replaces  the use of both the Sustainable Growth Rate to contain costs and the Physician Quality Reporting System (PQRS) to assess service quality. MACRA also has another payment model called the Advanced Alternative Payment Model (APM), but most psychologists are not expected to provide services in the settings that would support its use.

    Psychologists are eligible to begin MIPS reporting in 2019, while physicians are expected to collect data in 2017. Although the program may change by 2019, psychologists can do practice reporting this year so that they can get CMS feedback. The MIPSPRO registry by Healthmonix is a great way to do this without concern for positive or negative Medicare fee adjustments. Participation in the MIPS program in 2019, will affect your 2021 fee schedule, and continued reporting will affect payment changes two years after each annual data collection.

    It is expected that most psychologists in Medicare who participate in MACRA, will use MIPS. To participate in MIPS, providers are asked to collect data in four domains to produce a composite score. The overall score determines if fee adjustments will be neutral, negative or positive. The four performance measures are Quality, Clinical Practice Improvement, Advancing Care Information and Cost. 

    The Quality measures for the current year, are PQRS measures which are in the Mental/Behavioral Health Specialty Measures Set. They range from Depression, Alcohol and Tobacco Screenings to Dementia Screening.  Quality measures contribute 60 % of the composite score.

    Clinical Practice Improvement measures allow individual providers to choose 4 activities from a list of 90 improvement activities and attest to enacting them for  a minimum period of 90 days.  The activities are assigned points and then summed and weighted to be 15% of the composite score. Some examples of this are: care coordination, emergency response and preparedness, and depression screening and follow up. A helpful website is qpp.cms.gov/Measures/ia.

    Advancing Care Information incorporates the idea of meaningful use of electronic health records. Psychologists were not includes in incentives for electronic health records, yet this measure contributes 25%  of the composite score. It is uncertain how the formula will be modified for us.

    Cost data is taken directly off the claims data. It will be used starting 2018.

    There are Low Volume Threshold (LVT) exclusions for MIPS participation.  Currently, if you treat 100 or fewer patients or are reimbursed $30,000 or less, you do need to participate in MIPS. It is expected that for 2018, the LVT will be 200 patients or $90,000, respectively.  If you do not participate, you will not be eligible for gains or losses accrued from MIPS, but your fees schedule may be frozen.

    Groups may also participate in MIPS by assigning Medicare billing rights to a group Tax ID.  Note that the LVT applies to the sum of services of the entire group, and not individual providers in the group. To qualify as a group there must be at least two MIPS eligible providers in the group.

  • February 24, 2017 3:02 PM | Kelly Wetzel (Administrator)

    2016 Summary of APAPO GR Activities, and a look ahead to 2017

    We have accomplished a lot this year and have significant challenges ahead. Here are some of the highlights from 2016, and our road map for 2017.

    Mental Health Reform

    After two years of grassroots efforts and State Leadership Conference (SLC) visits, the Senate voted 94-5, on December 7th, to pass federal mental health reform, as a part of the 21st Century Cures legislation.  This follows up on a 392-26 vote by the U.S. House of Representatives on November 30th.  President Obama signed the bill into law on December 13th.  Because of your efforts psychologists from around the country sent over 8,000 messages to Congress, urging their legislators to pass mental health reform.

    This new law strengthens enforcement of federal mental health parity law, eliminates the Medicaid same day exclusion rule (which prohibits separate payment for mental health and primary care services provided to a Medicaid enrollee on the same day), creates a new Assistant Secretary for Mental Health and Substance Use, who could be a psychologist, improves how the criminal justice system responds to mental health issues, and clarifies records’ privacy protections.  Further, the law creates or reauthorizes a wide range of federal mental health and substance use treatment and prevention grant programs, such as the Minority Fellowship Program, which boosts the number of providers in underserved areas, the National Child Traumatic Stress Initiative, and the Garrett Lee Smith Memorial Act to combat youth suicide. 

    Medicare Mental Health Access Act (H.R. 4277 / S. 2597)

    We continue to make slow but significant progress towards passage of the Medicare Mental Health Access Act, bipartisan legislation that would allow psychologists to provide Medicare services without unnecessary physician supervision.  This bill is sponsored by Representatives Kristie Noem (R-SD) and Jan Schakowsky (D-IL), and Senators Sherrod Brown (D-OH) and Susan Collins (R-ME).

    Your visits to your members of Congress during SLC and grassroots action have helped us gain 41 cosponsors on the House legislation, including eight Republican cosponsors, four of which are on the committee of jurisdiction, the Ways and Means Committee.  During the 2016 State Leadership Conference’s “Hill Day” over 400 psychologists made 332 Congressional office visits.  Thanks to your work we are well-positioned to reintroduce these bills at the start of the 115th Congress.

    Medicare’s Merit-Based Incentive Payment System

    In October the Centers for Medicare and Medicaid Services (CMS) released the final rule under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA is a major overhaul of the Medicare payment system, moving the program from fee for service to rewarding value rather than volume.  The Physician Quality Reporting System (PQRS) ends December 31st with many of the PQRS measures becoming part of the new Merit-based Incentive Payment System (MIPS).  Psychologists will not be subjected to MIPS until 2019 and so will not be required to report quality measures in 2017 or 2018.

    While psychologists are not required to report in 2017, they will have the opportunity to practice MIPS reporting in preparation for 2019. APAPO’s registry, APAPO PQRSPRO, is still available to collect, review, and submit MIPS data.  Any psychologist or other behavioral health provider interested in practicing MIPS reporting before 2019 is welcome to use the APAPO registry at the current annual cost of $199.  We recommend psychologists continue to report and become familiar with MIPS to position themselves for potential bonuses and avoid penalties in 2019.

    Over the past year Government relations advocated for CMS to reduce the burden of MIPS reporting and the agency has responded.  Originally CMS proposed a “low volume threshold”, which exempting providers who treat 100 or fewer Medicare beneficiaries and having equal or less than $10,000 from MIPS reporting.  Medicare has increased the low volume threshold for providers in 2017, if they treat 100 or fewer Medicare beneficiaries or they have $30,000 or less in Medicare charges.  The low volume threshold applies only to MIPS reporting in 2017, and it may change by the time psychologists are included in MIPS in 2019, nevertheless this change will give many psychologists in Medicare the option to participate in MIPS or not.

    2017 Physician Fee Schedule

    Significant challenges to psychologists pay in Medicare remain but payment at least remains stable, if low, with a slight decrease in payment of approximately 1.5%.  This appears to be the standard reduction for most providers in the program.  In addition, psychologists who did not successfully report measures under PQRS in 2015 will lose an additional 2% on all of their Medicare charges.

    CMS has added several new codes for 2017 to capture services under the Psychiatric Collaborative Care Model (CoCM) in which a primary care provider and a care manager work in collaboration with a psychiatric consultant, such as a psychiatrist. Psychologists cannot bill the collaborative care codes (G0502, -03, and -04) because the services involve evaluation and management (E/M), but they can provide behavioral care management services. The behavioral care manager does not have to be an employee of the primary care provider and may furnish services remotely.  CMS is also adding a code, G0507, for other Behavioral Health Integration (BHI) models of care. Direct billing of this code is limited to physicians and other health care professionals who can provide the BHI initiating visit, which CMS maintains is not within a psychologist’s scope of practice.

    Looking ahead to 2017

    2017 looks to be the busiest year for APAPO government relations in a decade, and we will need your help to address enormous challenges and to take advantage of opportunities for practicing psychologists as Congress and the in-coming administration move forward.  Private market insurance, and major Medicare and Medicaid reform appear imminent, again with challenges and opportunities.

    President-elect Donald Trump has made clear that his first priority is to repeal the Affordable Care Act (ACA).  Republicans who control Congress will likely succeed in repealing fundamental components of the Act, and have already signaled that they will do so before Mr. Trump’s first State of the Union address in late January.  The Senate will use a parliamentary procedure--known as “reconciliation,” which requires only a simple majority vote in both the House and Senate--to sunset major provisions of the law within a set time period, perhaps two years.  After the reconciliation vote repealing the ACA, Congress will then turn to developing and passing a replacement law.  Passage of a replacement bill will require 60 votes in the Senate, which would be possible only with bipartisan support.

    Without question, the ACA could be improved to make its provisions more affordable to consumers, but the law has extended coverage to 22 million uninsured in the small group and individual markets, it has mandated mental, behavioral and substance use coverage for millions of consumers and at parity with physical health coverage.  The law expanded Medicaid mental health coverage and incentivized state Medicaid expansion.  The law provided for several provider and patient insurance market protections, including provider nondiscrimination, network adequacy, guaranteed issue, coverage acceptance and renewal, and premium rating requirements.

    Together, we worked hard for the ACA’s passage.  We will be calling on you right after the New Year to help us preserve those aspects of the ACA that promoted and advanced your services and for those needing your services.  We will ask Congress not to repeal the law without simultaneously replacing it with a law that ensures coverage that provides access to comprehensive mental, behavioral and substance use services for those the law was meant to help, such as the small business owner and those who must insure themselves.

    Beyond but related to the ACA, here are some other issues we will be working on:

    • ·      The newly enacted mental health reform law, known as the Helping Families in Mental Health Crisis Reform Act, is a major overhaul of federal mental health funding.  We will be working on ensuring that the law is appropriately implemented.
    • ·      We will be right back promoting psychologists in the Medicare program with early reintroduction of the MMHA, but Medicare is undergoing a sea change with MACRA implementation.  With even greater potential impact, Republican leadership is interested in privatizing the entire program.  Medicare will remain at the top of our agenda.
    • ·      As mentioned, the ACA greatly expanded Medicaid mental health coverage by requiring that mental health be included as basic services in benchmark equivalent plans provided by states to beneficiaries, and that coverage must comply with the parity law.  Medicaid accounts for almost 25% of all U.S. mental health spending.  Republicans are considering reforming Medicaid by giving states block grants to operate their programs.  These grants could limit coverage, particularly in states with poorer populations and fewer resources.
    • ·      We will keep working toward better federal and state enforcement of the Mental Health Parity and Addiction Equity Act.  Nearly a decade after its passage, the law has yet to fully fulfill its promise of ending mental health benefits coverage discrimination.  The Helping Families Act will improve enforcement, but much is yet to be done, and ACA repeal would end the law’s application to the small and individual group markets.

    On behalf of Dr. Nordal and your APAPO government relations staff here in Washington, DC, we wish you happy and safe holidays, and we thank you for your dedication and hard work throughout the year.  

    For more information, contact APA Practice Organization Government Relations Office at Pracgovt@apa.org or (202) 336-5889.  Visit APA Practice Organization on-line at APAPracticeCentral.org/Advocacy.

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