APA Practice Organization safeguards Medicare reimbursements for psychologists

Advocates also targeted managed care rate cuts as a violation of federal parity rules.

APAPO made ensuring appropriate Medicare reimbursement for psychologists its top legislative advocacy priority in 2012. Along with grassroots psychologists, APAPO lobbyists called for alteration of the Medicare payment formula with letters and visits to officials in the Centers for Medicare and Medicaid Services and members of key health-related congressional committees. The current flawed formula reimburses expensive technology-based specialty services at a higher rate than lower-cost mental health and primary care services. 

APA’s Practice Directorate continued its multi-year initiative to evaluate the psychotherapy billing codes and recommend “work relative value units” for the new set of psychotherapy codes that take effect Jan. 1, 2013.

APAPO also collaborated with a dozen state psychological associations to advocate against reimbursement rate cuts that target only mental health care, especially those by Humana/LifeSynch, arguing that such payment reductions violate federal parity regulations and impair patient access to care. Action over the past 12 months included:

  • Issuing complaint letters to federal parity enforcement agencies and state insurance commissioners; 

  • Providing detailed arguments to the Illinois insurance agency refuting Humana’s claim that parity regulations do not apply to provider payment rates; and 

  • Launching a survey of psychologists in affected states to quantify the rate cut’s impact on network participation by providers and on patient access to services.