APA News 

4/1/13 - STOP CPT CODING ABUSES - ACHIEVE MENTAL HEALTH PARITY NOW

APA IS WORKING FOR YOU

CPT code changes were intended to more accurately reflect the work psychiatrists do and improve patient access to care, but instead have been used as an excuse by some payors to discriminate against psychiatric patients and their psychiatrists in violation of the Mental Health Parity and Addiction Equity Act (2008). The issues differ from state to state and from carrier to carrier. The APA Board of Trustees has committed significant APA resources, both financial and staff, to understand the situation and use all reasonable means, including litigation, to correct the abuses taking place.

GET PAID, ACHIEVE MENTAL HEALTH PARITY

APA staff and attorneys have already begun implementation of a solid plan of action to combat this abuse. However, you, the psychiatrists who contract with the payors, have the specific information we need to cause a change. The situation cannot be improved unless every one of you helps.

March 28, 2013 - APA Members Urged to Register CPT Coding Abuse by Insurers

APA is strongly encouraging its members to inform the Association of any problems of which they are aware stemming insurers' refusal to pay for services in accordance with the new psychiatry CPT codes that went into effect January 1. In an e-mail to members earlier this week, APA stated that "CPT code changes were intended to more accurately reflect the work psychiatrists do and improve patient access to care, but instead have been used as an excuse by some payors to discriminate against psychiatric patients and their psychiatrists in violation of the Mental Health Parity and Addiction Equity Act (2008). The issues differ from state to state and from carrier to carrier. The APA Board of Trustees has committed significant APA resources, both financial and staff, to understand the situation and use all reasonable means, including litigation, to correct the abuses taking place."

To ensure that insurers comply with the law, APA wants members' input as soon as possible so the Association can pursue action with the insurers in question, including filing of lawsuits to force compliance. "APA members must be willing to register their complaints with APA, and a few must be willing to participate as plaintiffs in a lawsuit if one is needed. This would require very little of your time and be at APA's expense," the message explained. Members can register complaints either by completing the form online here or by sending an e-mail to cptparityabuses@psych.org that includes the member's name, location, the insurance company in question, and details about the CPT coding problem. APA and its district branches/state associations have already begun actions against insurers in California, Connecticut, and New York.

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March 26, 2013 - As the Obama Administration moves forward in implementing a Medicaid expansion and essential health benefits as part of qualified health plans to be sold on state insurance exchanges, as well as within non-grandfathered individual and small group market plans, it’s incredibly important that the Administration hears from you as to what is not working with current enforcement of the federal mental health parity law, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

In past weeks, we’ve been told by the U.S. Department of Labor, the Department tasked with enforcing mental health parity in ERISA-governed health plans, that there are few to no parity complaints being filed on the Department’s website. We hear this in spite of receiving numerous complaints from our members on a weekly basis.

We strongly urge you to share with your state members our need for them to go to the DOL website and for ERISA plans, file a complaint against an ERISA plan at http://www.dol.gov/ebsa/aboutebsa/main.html under “Consumer Complaints.”

With 60-70 million additional Americans likely to soon be enrolled in plans that are required to comply with the federal mental health parity law, MHPAEA, it’s of paramount concern that HHS and DOL be apprised of what is currently not working. In light of the calendar for ACA implementation necessitating exchange health plans be certified and operable this October 2013, we expect final regulations on parity, as well as sub-regulatory (a letter or notice) or regulatory guidance (formal rule-making) on how the federal parity law, MHPAEA, specifically applies to Medicaid plans, in the next few months.

Please help us by going to DOL’s website and sharing alleged federal parity law violations in your own words. It would be most helpful if you would make a formal email complaint whenever there is an insurer who has denied mental health and/or substance use services for a patient who has a planned governed by ERISA and MHPAEA. We additionally request that you copy the APA on this email by additionally addressing the contents of your complaint email to APAMemberparityviolations@psych.org.

Below are some things you likely will want to include in your complaint. While we encourage you to include all of these factors, we also realize the importance of just having great volume in the number of complaints DOL finds. It’s okay to concise in informing DOL of how your patients’ insurers discriminated against your patients, so as to likely violate MHPAEA.

• The patient’s diagnosis
• The recommended treatment
• The insurance company name
• The employer through which the coverage is provided (if known)
• The insurance company’s reason for denial if one is provided. You can substitute a copy of the denial letter with the patient’s name and identifying information redacted if that is easier.
• If no reason is given for the denial, please indicate that as well.
• Whether the company puts numeric caps on the number of visits permitted, pulls a file for review after a given number of sessions is reached, or has refused to pay psychiatrists for the psychotherapy add on in the new CPT codes.

Thank you,

APA Division of Advocacy

Julie A. Clements, J.D., M.P.P.
Deputy Director, Regulatory Affairs
American Psychiatric Association
1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209
703.907.7842 (p) | 703.907.1083 (f)

Note: APA has also created a mental health parity guide. The guide is a good resource if you’re looking for comprehensible and comprehensive analysis of the parity law, including the legal test which must be applied to non-quantitative treatment limitations and an understanding of medical necessity criteria and the “recognized and clinically appropriate standard of care” exception.

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APA Calls for Anthem to Stop Discriminating Against Mental Health Patients

Arlington, Va. (March 14, 2013) - Today the Connecticut Psychiatric Society, the American Psychiatric Association (APA), and the Connecticut State Medical Society sent a letter to Anthem Blue Cros Blue Shield of Connecticut protesting the company’s implementation of  new CPT codes in a manner that these associations believe increases the financial and time burden on  mental health patients who seek treatment from psychiatrists and discourages psychiatrists from providing psychotherapy services to their patients.

The three organizations claim that Anthem is violating state and federal laws and regulations, including the Mental Health Parity and Addiction Equity Act (MHPAEA), the Connecticut Parity Law, HIPAA, and the Unfair Insurance and Unfair Trade Practices laws as they pertain to the treatment of patients with a mental or substance use disorder.

Anthem has responded to recent changes in the CPT codes for psychiatry by covering only patient visits that are to be reported for medical evaluation and management while not covering psychotherapy as a separate and equal category for payment. In addition, the associations believe that there is a significant disparity between the reimbursement rates that Anthem is paying to mental health physicians and those paid to other medical/surgical network providers. This policy violates the spirit, intent, and the letter of federal and state legislation that was designed specifically to prohibit insurers from discriminating against mental health and substance abuse patients through non-quantitative treatment limitations such as inequitable rates for mental health physicians, and requires that mental health benefits be covered in a manner that is equal to benefits provided for medical/surgical issues.

Noting that customers are paying into the Anthem plan with the understanding that they will have equal coverage for psychiatric services, Jacqueline Coleman, Executive Director of the Connecticut Psychiatric Society, said “We will not allow insurance companies to deny coverage that patients and their employers have paid for, nor will we ask psychiatrists to provide medically necessary psychotherapy for free to insured patients.”

“These practices are both unethical and illegal, said James H. Scully, Jr., M.D., APA Medical Director and CEO. “We worked very hard to enact mental health parity laws, and it is now clear that Anthem is seeking a way to avoid compliance. We are not prepared to allow them to skirt their obligations under the law.”

Psychotherapy is one of the cornerstones of treatment for mental health conditions, and by Anthem not accepting a separate billing code for it, psychiatrists face the choice of denying patients a critical part of their treatment, encouraging them to seek it from a different provider at additional cost and effort, or providing it at no cost. “No other medical specialty is being asked to deny crucial treatment for patients in need or to provide those treatments without payment from the insurer,” Scully added. “This situation is a perfect example of what the parity laws are designed to prevent.”

Matthew C. Katz, Executive Vice President and CEO of the Connecticut State Medical Society, noted that “Mental health parity is more than just words – it is a commitment to equality and fairness in the provision of quality mental, behavioral and substance abuse health care services. Coming at a time when our state is still recovering from the Newtown tragedy, it is more important than ever that those who need psychiatric services receive them, without discrimination or stigma. It is time for Anthem to act appropriately and honor its obligation to ensure access to mental and behavioral health services for the patients it insures.

The three associations state in their letter that patients are already missing appointments and taking on extra costs themselves, and psychiatrists are facing an impossible dilemma between providing treatments and being paid for their services. “Studies have shown that when people who need psychiatric services receive them, they have fewer general health problems and in the long run, have fewer health care costs than those who have no treatment,” said Dr. Scully. “These actions on the part of Anthem Blue Cross Blue Shield make no business sense, and they are causing needless suffering on the part of patients and their families. It’s time for Anthem to rethink its policies and do the right thing.”

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org. The Connecticut Psychiatric Society is a District Branch of the American Psychiatric Association composed of nearly 750 members which shares the same mission.

Founded in 1792, the Connecticut State Medical Society is the state’s largest physician organization, representing more than 6,500 physicians and physicians-in-training.

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American Psychiatric Association Participates in White House Discussion on Gun Violence 

ARLINGTON, Va. (Jan. 10, 2013) — Yesterday, Paul Appelbaum, M.D. represented the American Psychiatric Association at a meeting of the Vice President’s Task Force on Gun Violence at the White House. 

The Task Force, established by President Obama in response to the Sandy Hook Elementary School shootings and several other mass shootings, is expected to make recommendations on actions to prevent future tragedies. Dr. Appelbaum, Dollard Professor of Psychiatry, Medicine and Law at Columbia University, is past APA President and current chair of the APA Committee on Judicial Action.

“Substantial research shows that the vast majority of people with serious mental illnesses never act violently, and the vast majority of violent crimes—96% by the best available estimate—are not perpetrated by persons with mental disorders,” said Dr. Appelbaum. “Nearly two-thirds of firearm deaths are suicides and about one-third are homicides.”

Mental illnesses are treatable and with the appropriate services and support, people can and do recover from a mental illness.  “Research suggests that individuals with mental illness who engage in regular treatment are considerably less likely to commit violent acts than those in need of, but not engaged in, appropriate mental health treatment. Yet funding for mental health services has been cut significantly in recent years—public sector appropriations alone have dropped by $4 billion dollars over the last 4 years,” said Appelbaum.

Dr. Appelbaum noted, “We are facing an opportunity to begin rebuilding a system of care that has been decimated over the last several decades by the progressive withdrawal of resources in both the private and public sectors,” and he outlined four possible approaches to this issue:

1)       Appointment of a presidential commission to develop a vision for a system of mental health care – The last major reconceptualization of how to deliver mental health care in this country began more than 50 years ago and we now require a different vision to help shape the next half-century of mental health and to create a positive legacy from the tragic events that led to the creation of this task force.

2)       Creating a mechanism for facilitating response to key mental health issues – Designation of a member of the White House staff as the point person for mental health issues could facilitate a response.

3)       Improving early identification of young people with mental health problems – The American Psychiatric Foundation, an arm of the APA, has developed a highly effective program for outreach to schools, called Typical or Troubled? The program works with school systems throughout the country to help identify warning signs of mental health problems in teens and teach educators how to respond to them.

4)       Sensible, non-discriminatory approaches to keeping firearms out of the hands of dangerous people –Nearly 20,000 gun suicides occur in the U.S. each year, and guns are used in more than two-thirds of all murders.

The APA is ready to work with the Administration and the Congress on comprehensive policy initiatives to improve access to and quality of mental health services and public safety.  See Dr. Appelbaum’s full comments.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.  

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December 2012

Mental Health Parity Guide

APA has created a mental health parity guide to assist employers in selecting health plans for their employees that are compliant with the federal parity law, the Mental Health Parity and Addiction Equity Act of 2008. This document analyzes in layman’s terms the substance of the parity regulations which have been issued, and it sets forth a litany of questions employers should follow and attempt to answer when trying to assess whether the health plan choices they are considering would be deemed compliant with the federal mental health parity law, MHPAEA.

The guide is a good resource if you’re looking for comprehensible and comprehensive analysis of the parity law, including the legal test which must be applied to non-quantitative treatment limitations and an understanding of medical necessity criteria and the “recognized and clinically appropriate standard of care” exception.