Make Your Voice Heard: ‘Engage 2014’

One important matter we are addressing affects our patients treated under Medicaid. The Affordable Care Act (ACA) increased Medicaid payments for certain evaluation and management (E&M) services to Medicare rates for 2013 and 2014 (often referred to as the “Medicaid bump”). While the original intent of this provision was to target primary care, the Centers for Medicare and Medicaid Services (CMS) expanded eligibility to include all subspecialists accredited by the American Board of Internal Medicine. Psychiatrists, obstetricians, and neurologists were excluded from the bump due to a technicality. When a physician—any physician—sees a new or returning patient in the office, we all bill using the same E&M codes.

More importantly, Medicaid is now the single largest payer of mental health care in the United States, and psychiatrists, including those in community-based hospitals and clinics, academic medical centers, and private practice, play a central role in treating Medicaid beneficiaries with serious mental illness. Approximately 4 in 10 psychiatrists treat Medicaid patients, who on average represent 20 percent of psychiatrists’ patient caseloads. Medicaid patients who have difficulty accessing appropriate mental health services are more likely to experience serious adverse health problems. According to the GAO, Medicaid serves more than 64 million Americans, and the most recent data suggest that more than half of high-expenditure Medicaid patients have a mental health condition—many with serious medical comorbidities for whom we are the principal physicians.

When Congress returns to Washington after the elections, APA will be advocating for the extension of the Medicaid bump, with the inclusion of psychiatry. In its current form, it is unfair to patients with psychiatric needs. This is especially true for poor and underserved women and children, who are the majority of Medicaid patients.

We urge Congress to protect patients with mental health needs: it’s time to extend and amend the Medicaid bump to include psychiatrists who engage in providing comprehensive, coordinated care. A fair Medicaid reimbursement policy would strengthen access to high-quality mental health care, integrate care, and improve overall patient health.

Another major focus of APA’s recent advocacy efforts has been comprehensive mental health legislation. While we have made great improvements in many areas of psychiatric care in recent years, there is still a lot of room for improvement in our country’s mental health care system.

A broad-based approach is needed to tackle this challenge. This would include such items as increased access to psychiatric physicians who provide evidence-based and integrated treatment in all care settings; true parity in insurance coverage; changes in the criminal justice system that encourage diversion from jails and prisons into safe, sensible treatment environments; common-sense reforms to HIPAA; renewed investment in our public mental health system; access to individualized treatment for people with serious and persistent mental illness such as Assertive Community Treatment and assisted outpatient treatment; addressing the psychiatric workforce shortage; and increased coordination and clinician—ideally psychiatrist—leadership of the federal government’s mental health agencies.

Legislation before Congress, the Helping Families in Mental Health Crisis Act, introduced by Rep. Tim Murphy (R-Pa.), addresses a substantial number of our priorities. Rep. Ron Barber (D-Ariz.) also introduced a reform bill, which includes language to increase the mental health workforce, which APA hopes will be included in any comprehensive legislation.

Just as mental illness is nonpartisan in its impact, we hope that lawmakers in both parties, in collaboration with the medical and advocacy communities, can send comprehensive, science-based mental health legislation to President Obama’s desk for his signature.

A third area is addressing the crisis in financing for health care research and reversing the downward trend in funding in recent years, including NIH and National Science Foundation funding. Effective research requires long-term investment, and we strongly urge an increase in NIH and related funding, especially at this moment of great opportunity in psychiatric research. The costs of investing in research are small compared with the ongoing costs of treating mental illnesses, including substance use disorders. The Obama administration’s BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies), aimed at transforming the way we prevent and treat brain illnesses and disorders, is an important step in the right direction. The House Energy and Commerce Committee, chaired by Rep. Fred Upton (R-Mich.), also launched an initiative earlier this year, the 21st Century Cures, aimed at accelerating the pace of cures and other medical breakthroughs in the United States. The committee has spent several months gathering information and soliciting input from APA and others and expects to draft legislation early in 2015.

With only weeks to go until the November elections, I urge you to become involved in this critically important advocacy work. Visit the Engage 2014 webpage here or contact the Department of Government Relations at (703) 907-7800 or [email protected]. It’s never been easier to move off the sidelines and help carry the ball. ■