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APA Policy Outlook for 2006
The American Psychiatric Association is keeping an eye on a host of issues for the New Year. Once again, securing parity for mental health care treatment is at the top of the APA's list of priorities. Other issues being watched by the organization are expansion of the psychiatric workforce, implementation of the Medicare drug benefit, and National Institutes of Health (NIH) funding, according to Nicholas Meyers, director of government relations at the APA, Arlington, Va.
Mental Health Parity
The APA hopes that Congress will pass legislation requiring nondiscriminatory coverage for treatment of mental illness. “We have last year's bill introduced in the House, with the addition of [parity for] alcohol and substance abuse treatment,” Mr. Meyers said. He said the group is waiting for Sen. Ted Kennedy [D-Mass.] and Sen. Pete Domenici [R-N.M.] to introduce companion legislation in the Senate. The last parity bill in Congress had the support of two-thirds of the Senate and half of the House. Why did it not pass? “Timing is everything. The issue isn't parity; it's business objections to what they perceive is a coverage mandate,” he said. Further, he said, Congress has been preoccupied with Iraq and issues such as Medicare and Medicaid.
Addressing Medicare
The parity bills now in Congress apply only to private health insurance plans, Mr. Meyers pointed out. The bills do not address Medicare, even though Medicare beneficiaries have to pay a higher copay–50% of the bill–for mental health care than they do for physical health care, for which they pay only 20%. There are bills in both the Senate and the House that would gradually phase out the 50% copay and lower it to 20%, the same as for all other services, he said.
New Drug Benefit
The APA also is aiming for technical changes to the new Medicare drug benefit–for instance, making sure mental health patients have appropriate access to psychotropic drugs. One problem is the exclusion of benzodiazepines from the new coverage, “but there are lots of ways of limiting access beyond not covering a drug, like tiered pricing and 'fail first' policies,” Mr. Meyers said. The association is concerned that various Medicare prescription drug plans are treating coverage for buprenorphine and other alcohol-abuse and opioid-dependence drugs in different ways. Then there is the fate of dual eligibles–mental health patients who are on both Medicare and Medicaid. They formerly got drug coverage through the Medicaid program, but they now will get coverage through Medicare. “This requires a broad knowledge base and a lot of work by psychiatrists, who will be asked questions by patients and have to know what happens if they prescribe a particular medication and it's not covered, or if the patient will have to pay more, or if it's not covered until the patient has failed on another drug that [the psychiatrist] knows isn't going to work.”
NIH Issues
The APA has two areas of concern when it comes to NIH: reorganization and budget issues, Mr. Meyers said. “Potentially, the reorganization of NIH would be an attempt to restructure it.” In written testimony to the House Committee on Energy and Commerce last July, NIH Director Dr. Elias A. Zerhouni did not address reorganization directly, except to say, “I agree that each institute and center should have a defined purpose in support of the overall mission of NIH.” He also talked about having an office that would coordinate research projects that spanned various NIH institutes. Mr. Meyers also is concerned about a slowdown in funding for NIH. He predicted that the agency would still get an increase in funding but that it would be smaller than that seen over the last several years.
Psychiatric Subspecialties
Another issue of importance to the APA is keeping up the supply of practitioners in some of the psychiatric subspecialties, particularly geriatric psychiatrists and child and adolescent psychiatrists. The association is interested in a bill sponsored by Rep. Patrick Kennedy (D-R.I.) that would allow the government to repay up to $35,000 in educational loans or provide scholarships to medical students who agree to provide child and adolescent mental health care for at least 2 years. On the geriatric side, the Positive Aging Act, sponsored by Sen. Hillary Rodham Clinton (D-N.Y.) in the Senate and Rep. Kennedy in the House, would establish a deputy director for older adult mental health services within the Substance Abuse and Mental Health Services Administration to “develop model training programs for mental health professionals and caregivers serving older adults,” among other responsibilities.
Privacy Concerns
Health privacy is also a major issue. “We have really serious concerns about maintenance of medical records confidentiality” under laws such as the Patriot Act and the Health Insurance Portability and Accountability Act, Mr. Meyers said. “We are concerned about the ability of government agencies to snoop in people's health records.” In addition, the advent of electronic health records brings its own privacy concerns. “On the plus side, electronic records help reduce medical errors and assure that physicians are able to get real-time records about what kind of medications patients are on,” he said. “On the other hand, unless there are acceptable standards for the protection of records, such as informed consent with regard to their release, we are obviously concerned about what effect this has on patients.”
APA Policy Outlook for 2006
The American Psychiatric Association is keeping an eye on a host of issues for the New Year. Once again, securing parity for mental health care treatment is at the top of the APA's list of priorities. Other issues being watched by the organization are expansion of the psychiatric workforce, implementation of the Medicare drug benefit, and National Institutes of Health (NIH) funding, according to Nicholas Meyers, director of government relations at the APA, Arlington, Va.
Mental Health Parity
The APA hopes that Congress will pass legislation requiring nondiscriminatory coverage for treatment of mental illness. “We have last year's bill introduced in the House, with the addition of [parity for] alcohol and substance abuse treatment,” Mr. Meyers said. He said the group is waiting for Sen. Ted Kennedy [D-Mass.] and Sen. Pete Domenici [R-N.M.] to introduce companion legislation in the Senate. The last parity bill in Congress had the support of two-thirds of the Senate and half of the House. Why did it not pass? “Timing is everything. The issue isn't parity; it's business objections to what they perceive is a coverage mandate,” he said. Further, he said, Congress has been preoccupied with Iraq and issues such as Medicare and Medicaid.
Addressing Medicare
The parity bills now in Congress apply only to private health insurance plans, Mr. Meyers pointed out. The bills do not address Medicare, even though Medicare beneficiaries have to pay a higher copay–50% of the bill–for mental health care than they do for physical health care, for which they pay only 20%. There are bills in both the Senate and the House that would gradually phase out the 50% copay and lower it to 20%, the same as for all other services, he said.
New Drug Benefit
The APA also is aiming for technical changes to the new Medicare drug benefit–for instance, making sure mental health patients have appropriate access to psychotropic drugs. One problem is the exclusion of benzodiazepines from the new coverage, “but there are lots of ways of limiting access beyond not covering a drug, like tiered pricing and 'fail first' policies,” Mr. Meyers said. The association is concerned that various Medicare prescription drug plans are treating coverage for buprenorphine and other alcohol-abuse and opioid-dependence drugs in different ways. Then there is the fate of dual eligibles–mental health patients who are on both Medicare and Medicaid. They formerly got drug coverage through the Medicaid program, but they now will get coverage through Medicare. “This requires a broad knowledge base and a lot of work by psychiatrists, who will be asked questions by patients and have to know what happens if they prescribe a particular medication and it's not covered, or if the patient will have to pay more, or if it's not covered until the patient has failed on another drug that [the psychiatrist] knows isn't going to work.”
NIH Issues
The APA has two areas of concern when it comes to NIH: reorganization and budget issues, Mr. Meyers said. “Potentially, the reorganization of NIH would be an attempt to restructure it.” In written testimony to the House Committee on Energy and Commerce last July, NIH Director Dr. Elias A. Zerhouni did not address reorganization directly, except to say, “I agree that each institute and center should have a defined purpose in support of the overall mission of NIH.” He also talked about having an office that would coordinate research projects that spanned various NIH institutes. Mr. Meyers also is concerned about a slowdown in funding for NIH. He predicted that the agency would still get an increase in funding but that it would be smaller than that seen over the last several years.
Psychiatric Subspecialties
Another issue of importance to the APA is keeping up the supply of practitioners in some of the psychiatric subspecialties, particularly geriatric psychiatrists and child and adolescent psychiatrists. The association is interested in a bill sponsored by Rep. Patrick Kennedy (D-R.I.) that would allow the government to repay up to $35,000 in educational loans or provide scholarships to medical students who agree to provide child and adolescent mental health care for at least 2 years. On the geriatric side, the Positive Aging Act, sponsored by Sen. Hillary Rodham Clinton (D-N.Y.) in the Senate and Rep. Kennedy in the House, would establish a deputy director for older adult mental health services within the Substance Abuse and Mental Health Services Administration to “develop model training programs for mental health professionals and caregivers serving older adults,” among other responsibilities.
Privacy Concerns
Health privacy is also a major issue. “We have really serious concerns about maintenance of medical records confidentiality” under laws such as the Patriot Act and the Health Insurance Portability and Accountability Act, Mr. Meyers said. “We are concerned about the ability of government agencies to snoop in people's health records.” In addition, the advent of electronic health records brings its own privacy concerns. “On the plus side, electronic records help reduce medical errors and assure that physicians are able to get real-time records about what kind of medications patients are on,” he said. “On the other hand, unless there are acceptable standards for the protection of records, such as informed consent with regard to their release, we are obviously concerned about what effect this has on patients.”
APA Policy Outlook for 2006
The American Psychiatric Association is keeping an eye on a host of issues for the New Year. Once again, securing parity for mental health care treatment is at the top of the APA's list of priorities. Other issues being watched by the organization are expansion of the psychiatric workforce, implementation of the Medicare drug benefit, and National Institutes of Health (NIH) funding, according to Nicholas Meyers, director of government relations at the APA, Arlington, Va.
Mental Health Parity
The APA hopes that Congress will pass legislation requiring nondiscriminatory coverage for treatment of mental illness. “We have last year's bill introduced in the House, with the addition of [parity for] alcohol and substance abuse treatment,” Mr. Meyers said. He said the group is waiting for Sen. Ted Kennedy [D-Mass.] and Sen. Pete Domenici [R-N.M.] to introduce companion legislation in the Senate. The last parity bill in Congress had the support of two-thirds of the Senate and half of the House. Why did it not pass? “Timing is everything. The issue isn't parity; it's business objections to what they perceive is a coverage mandate,” he said. Further, he said, Congress has been preoccupied with Iraq and issues such as Medicare and Medicaid.
Addressing Medicare
The parity bills now in Congress apply only to private health insurance plans, Mr. Meyers pointed out. The bills do not address Medicare, even though Medicare beneficiaries have to pay a higher copay–50% of the bill–for mental health care than they do for physical health care, for which they pay only 20%. There are bills in both the Senate and the House that would gradually phase out the 50% copay and lower it to 20%, the same as for all other services, he said.
New Drug Benefit
The APA also is aiming for technical changes to the new Medicare drug benefit–for instance, making sure mental health patients have appropriate access to psychotropic drugs. One problem is the exclusion of benzodiazepines from the new coverage, “but there are lots of ways of limiting access beyond not covering a drug, like tiered pricing and 'fail first' policies,” Mr. Meyers said. The association is concerned that various Medicare prescription drug plans are treating coverage for buprenorphine and other alcohol-abuse and opioid-dependence drugs in different ways. Then there is the fate of dual eligibles–mental health patients who are on both Medicare and Medicaid. They formerly got drug coverage through the Medicaid program, but they now will get coverage through Medicare. “This requires a broad knowledge base and a lot of work by psychiatrists, who will be asked questions by patients and have to know what happens if they prescribe a particular medication and it's not covered, or if the patient will have to pay more, or if it's not covered until the patient has failed on another drug that [the psychiatrist] knows isn't going to work.”
NIH Issues
The APA has two areas of concern when it comes to NIH: reorganization and budget issues, Mr. Meyers said. “Potentially, the reorganization of NIH would be an attempt to restructure it.” In written testimony to the House Committee on Energy and Commerce last July, NIH Director Dr. Elias A. Zerhouni did not address reorganization directly, except to say, “I agree that each institute and center should have a defined purpose in support of the overall mission of NIH.” He also talked about having an office that would coordinate research projects that spanned various NIH institutes. Mr. Meyers also is concerned about a slowdown in funding for NIH. He predicted that the agency would still get an increase in funding but that it would be smaller than that seen over the last several years.
Psychiatric Subspecialties
Another issue of importance to the APA is keeping up the supply of practitioners in some of the psychiatric subspecialties, particularly geriatric psychiatrists and child and adolescent psychiatrists. The association is interested in a bill sponsored by Rep. Patrick Kennedy (D-R.I.) that would allow the government to repay up to $35,000 in educational loans or provide scholarships to medical students who agree to provide child and adolescent mental health care for at least 2 years. On the geriatric side, the Positive Aging Act, sponsored by Sen. Hillary Rodham Clinton (D-N.Y.) in the Senate and Rep. Kennedy in the House, would establish a deputy director for older adult mental health services within the Substance Abuse and Mental Health Services Administration to “develop model training programs for mental health professionals and caregivers serving older adults,” among other responsibilities.
Privacy Concerns
Health privacy is also a major issue. “We have really serious concerns about maintenance of medical records confidentiality” under laws such as the Patriot Act and the Health Insurance Portability and Accountability Act, Mr. Meyers said. “We are concerned about the ability of government agencies to snoop in people's health records.” In addition, the advent of electronic health records brings its own privacy concerns. “On the plus side, electronic records help reduce medical errors and assure that physicians are able to get real-time records about what kind of medications patients are on,” he said. “On the other hand, unless there are acceptable standards for the protection of records, such as informed consent with regard to their release, we are obviously concerned about what effect this has on patients.”