In addition to the budget cuts in federal health care dollars for research, training, and treatment, the Congress is working on a measure likely to affect the members of The American Psychoanalytic Association.
Responding to the often-voiced concerns of mental health care specialists and the general public over the inadequacies of mental health care benefits provided under Medicare, Senators Spark Matsunaga and Daniel Inouye have sponsored legislation that would place payment of these services on a par with other health care services provided by the federal government. Entitled, “The Professional Mental Health Services Act,” the bill seeks expanded Medicare coverage for mental health services as long as such services have been determined to be safe, efficient, and appropriate. Also, for the first time, the bill provides for direct reimbursement to the psychologists, clinical social workers, and psychiatric nurses who perform these professional services.
In introducing the bill, Senator Matsunaga remarks that “this bill represents a reasonable, prudent, and responsible approach to the orderly expansion of mental health benefits under the Medicare program. In fact, it closely parallels the approach that has been pioneered by the Blue Cross and Blue Shield health insurance organizations in evaluating the safety, efficacy, and appropriateness of the services for which they provide reimbursement.” Although similar legislation was offered by Matsunaga in the last Congress, that effort failed to progress beyond the committee level.
The proposed bill calls for the creation of a fifteen-member Presidential commission, composed of recognized mental health care practitioners and researchers, including at least one psychiatrist, one clinical psychologist, one clinical social worker, and one psychiatric nurse specialist. The commission would be authorized to review and make recommendations to the Secretary of Health and Human Services on the combinations of patient characteristics, therapeutic techniques, therapist characteristics, and types of settings that would be reimbursable in treating specified mental problems. Payment for mental health professionals' services would be determined by the commission, unless the Secretary disagreed. The commission would also be empowered to propose changes to Congress for increases in mental health care services offered to beneficiaries of the federal programs.
The bill contains various other payment provisions in addition to the professional reimbursement clause. For example, the bill would eliminate the special fifty percent patient cost-sharing requirement that currently applies to Medicare payments for outpatient psychiatric benefits and would substantially increase the annual limit of $250 on the amount of outpatient psychiatric benefits a patient may receive. Medicare would also pay eighty percent of the reasonable charges for these services, up to an annual $1,000 maximum, as is presently the case for other physicians' services.
The legislation has been referred to the Senate Finance Committee. Hearings will be scheduled once Congress completes action on the federal budget.
The most significant feature of the proposed bill to psychotherapists is the requirement that efficacy of any treatment must be proven for it to be reimbursable. To “prove” efficacy of psychotherapy (and psychoanalysis) according to rigorous scientific standards is a formidable task and, depending upon the standards required, may become a major obstacle to reimbursement for such services.
Allan M. Fox, Esquire
Washington Counsel