Advocacy
is the pursuit of influencing outcomes — including public-policy and resource allocation decisions within political, economic, and social systems and institutions — that directly affect people’s current lives. (Cohen, 2001)
Click Here for information and photos from 2010 Advocacy Day.
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Important Medicare Payment Changes
There are two changes in Medicare payment that will be of interest to your members. Beginning January 1, 2012, there will be a 1% penalty on Medicare billing for physicians who are not e-prescribing. There are exemptions that may apply to some members. More information is available on the APA website. There are links there to the CMS rules on e-prescribing. In 2008, there was a 5% "bump" for psychiatric CPT codes for Medicare and Tricare. This ends on December 31, 2011. There is no expectation that this will be renewed. In fact, it is more likely that physician fees will be adversely affected as the AMA and the government struggle with the SGR "fix". The APA has suggested that shifting to E & M code usage where and when appropriate may help offset the presumed non-renewal of the 5% bump for psychiatric CPTs.
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Governor Quinn Signs New Illinois Parity Bill!
On August 18, 2011, Governor Quinn signed 6 bills addressing mental health issues. While IPS supported most of the bills, IPS was very involved in the drafting, negotiating and lobbying efforts for HB 1530. IPS started working on the bill with the Illinois Department of Insurance (DOI) in July 2010, helping to draft the bill. The bill was intended to overlay the Wellstone-Domenici Mental Health Parity and Addiction Equity Act onto the existing Illinois parity law. IPS successfully worked to gain support from legislators as well as advocacy groups, trade organizations, and other professional societies. The road was difficult given the strength of opposition by the insurance industry and business organizations. In fact, while IPS leaders were at the APA Annual Meeting, the National Federation of Independent Businesses negotiated an agreement on an amendment to the bill which would have allowed employers to choose which mental illnesses the employer wanted to cover! Upon the return of Ms. Sosa to Chicago, Ms. Sosa discovered this attempt to undermine the parity law and immediately contacted IPS lobbyist, John Potts, and explained that this amendment was completely unacceptable and that if this amendment was attached to the bill, not only would IPS not support the bill, but IPS would actively oppose the bill. Within ONE day, Mr. Potts secured a third amendment eliminating the employer’s choice provision and giving in on the provision, in the bill, that would have expanded the scope of parity’s applicability to include employers of all sizes.
Governor Quinn made the following statement in his press release:
Click here to read the full article.
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Potential Crippling Cuts to Medicare Reimbursment for Psychiatrists
Background:As many of you know, physicians and their patients are headed into a season of potentially enormous ramifications from Capitol Hill. Congress has created the Joint Select Committee on Deficit Reduction (known as ‘the supercommittee’) that is charged with reducing federal spending by at least $1.2 trillion before the end of the year, and health spending is expected to be a significant target. At the same time, Medicare provider payment rates are scheduled to be cut by almost 30% on January 1st, 2012.
The APA has partnered with the American Medical Association, state affiliates, and other national medical specialty societies in this coordinated call to action to convince Congress to shift the focus from destructive payment cuts to reforms that will stabilize the Medicare program. For additional background on this, click here www.psych.org/amasgr911 for information from the AMA.
Your Requested Action:
Join us in the campaign and send a message to your Senators and Representative by clicking here (url: http://ama.capwiz.com/ama/issues/alert/?alertid=53132696 )
Or, call using APA's toll-free Hotline: 1-866-727-4894. You will be connected to the Capitol Hill Operator. Ask for your Senators and Representative by name. Once you are connected to your Member's office, leave your name and address, along with our suggested message.
Suggested Message:
As a psychiatric physician and your constituent, I urge Congress to address the flawed sustainable growth rate (SGR) formula. Passing temporary patches that make future cuts steeper and escalate the costs of permanent payment reform is not the fiscally responsible course to take, nor does it support the long-term viability of important health care programs. I urge you to support SGR repeal as a critical part of the legislative package the Joint Select Committee on Deficit Reduction will ultimately develop before the end of the year.
APA's Political Action Committee (APAPAC) is working every day to bolster the advocacy and grassroots lobbying efforts of APA members. Help us make more of an impact by joining us today at http://www.psych.org/pac.aspx
THANK YOU for taking the time to be a part of APA's grassroots advocacy efforts! QUESTIONS OR COMMENTS ABOUT THIS BILL? CONTACT:
Nicholas Meyers, Director, Department of Government Relations: advocacy@psych.org
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Potential Crippling Cuts to Psychiatric Residency Training
Background: As negotiations continue over deficit reduction, proposals to slash GME payments between $14 and $60 billion over ten years have surfaced as a way to achieve savings. Any cut of this magnitude would significantly hinder the ability of teaching hospitals to train residents in specialty and primary fields of medicine, including psychiatry. Furthermore, cuts to GME would place in further jeopardy the country’s ability to care for an aging population and close a projected physician shortfall. The Association of American Medical Colleges predicts between 6,000 and 8,000 additional specialty and primary care residencies are needed each year over the next 20 years to avoid a crisis in care.
While the APA recognizes the need to curb the national debt, we don’t believe savings are truly achieved if they come from investments, such as GME, that help ensure the nation’s long-term viability. Therefore, we urge Members of Congress to oppose any cuts to GME that adversely affect specialty and primary care residencies.
Your Requested Action:
Please call your Senators and Representative and urge them to oppose suggested cuts for Graduate Medical Education in deficit reduction talks.
Call using APA's toll-free Hotline: 1-866-727-4894. You will be connected to the Capitol Hill Operator. Ask for your Senators and Representative by name. Once you are connected to your Member's office, leave your name and address, along with our suggested message.
Suggested Message:
As a psychiatric physician and your constituent I urge you to oppose suggested cuts for Graduate Medical Education in deficit reduction talks. Training additional physicians to address America’s current and future medical workforce shortage should be a priority; cuts in funding will reduce access to essential healthcare services. Please oppose these suggested cuts to the specialty and primary care physician workforce.
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IPS Passes New Parity Law
We are pleased to announce that HB 1530 (originally introduced by IPS and later consolidated with a similar bill introduced by the Department of Insurance) passed both the House and Senate and it is now on the Governor’s desk awaiting his signature. In short, this bill overlays sections of the Wellstone and Domenici Mental Health Parity and Addiction Equity Act of 2008 and the Patient Protection and Affordable Care Act onto the Illinois parity law. Some key elements of the bill are the addition of coverage for substance use disorders, preclusion of limitations on annual and lifetime benefits unless they are also imposed on med-surg coverage and the limits are imposed in the same manner to mental health benefits as med-surg benefits, and prohibition of non quantitative treatment limitations where there is no comparable med-surg limitation. If you would like to read more information about the bill, please go to [link]. Please contact Governor Quinn’s office to encourage him to sign the bill: http://www2.illinois.gov/gov/pages/contactthegovernor.aspx
Click here for more information.
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CMS Addresses APA Members' Concerns with E-Prescribing Incentive Program Proposed Rule
Several states' regulations now prohibit physicians from writing electronic prescriptions for controlled substances. These state regulations have remained in effect despite the rollout of the federal law's E-Prescribing Incentive Program and the passage of a federal law allowing for electronic prescribing of controlled substances. The Centers for Medicare and Medicaid Services (CMS) has responded to calls by the APA and the American Medical Association to expand the list of exemptions available to physicians under the Medicare E-Prescribing Incentive Program to include an exemption for physicians practicing in states with regulations that currently prohibit the writing of electronic prescriptions for controlled substances. On June 1, 2011, CMS issued a proposed rule that contains a list of additional exemptions for which physicians can apply. To avoid the 2012 e-prescribing financial penalty, physicians can report through an online web portal their eligibility for exemptions from electronic prescribing due to local, state, or federal law or regulation. The deadline for reporting is October 1, 2011. The CMS rule proposes the following exemptions to the E-Prescribing Incentive Program for physicians:
The APA thanks its members in New York for bringing to its attention the mismatch between New York's current regulations and the federal law, which presently permits the electronic prescription of controlled substances. The APA will be commenting on CMS's proposed E-Prescribing Incentive Program hardship exemption rule during a comment period that closes on July 25, 2011. Stay tuned for further updates.
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Recently, the National Association of Professional Psychology Providers (NAPPP) ran an ad campaign essentially slandering family physicians and their ability to prescribe by stating, ““WARNING: Having your family physician treat depression can be harmful to your health,” in an attempt to grab headlines. Outraged by the claims on the ad and the affiliated websites, the Presidents of the American Academy of Family Physicians, American Psychiatric Association, American Medical Association, American Osteopathic Association and the American College of Osteopathic Family Physicians sent a cease and desist letter to the Executive Director of NAPPP on February 9, 2011. We will keep you posted on new developments.
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Past Updates
Blue Cross Retreats on Preapproval for Therapy - Click here for PDF of article.
For BCBS of Illinois Providers: UPDATE 12/30/2010
More information on Healthcare Insurance Providers
New AMA Survey Invites Physicians to Weigh in on Burdensome Regulations
Understanding Recent Changes to the Illinois Mental Health and Developmental Disabilities Code
APA Advocacy Day Report
Health Reform, the 112th Congress & the Courts
President Obama Signs Medicare Extender Bill for 2011
William v. Quinn lawsuit
News on Medicare Payment and Health Reform - 3/3/10
IPS Praises Gov. Quinn for Signing Prison Medicaid Bill
Important Change in Rules for Providing Group Psychotherapy Services paid for by Medicaid
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