May 1st, 2017

Bill would allow supervision-free practice under Medicare

Federal legislation introduced in the House and Senate in February would allow psychologists to practice independent of physician supervision under Medicare.

The bipartisan legislation (S.2597 or H.R. 4277) would amend title XVIII of the Social Security Act, treating psychologists as physicians providing clinical psychology services under the Medicare program, the Medicare Mental Health Access Act reads.

This year is the third in a row this legislation has been introduced, said Doug Walter, JD, associate executive director for government relations for the APA Practice Organization, a legally separate advocacy arm of the American Psychological Association, which also supports this legislation.

The bill is a small change to the law that won’t have a large financial impact, Walter said. “It will probably cost something since it will expand care for beneficiaries who need behavioral and mental health care,” he said.

As the law stands, unnecessary oversight can delay treatment, he said. “Psychologists are currently prohibited from practicing independent of physician supervision under Medicare in many treatment settings, even when authorized to do so under their state’s licensure law,” according to the organization’s Web site.

Changing the law will benefit patients in need of behavioral and mental health services, Walter said. “Psychologists are a major provider of mental and behavioral health services to Medicare beneficiaries, but are unable to provide their full range of services due to Medicare’s outdated and inappropriate physician oversight requirements.”

No physician oversight is required in private sector health plans, Medicare Advantage plans, the Veterans Health Administration and TRICARE, Walter said. “Medicare is the only health care payer which continues to require physician oversight or supervision of psychologists in outpatient rehabilitation facilities, partial hospitalization programs and other treatment settings outside of a psychologist’s own office,” according to the organization.

The bipartisan legislation introduced in February simply includes psychologists with other providers in the Medicare program. Medicare allows other providers – dentists, podiatrists, chiropractors, and optometrists to practice independent of physician supervision, according to the APA Practice Organization. Psychologists are the only doctoral-level providers in Medicare not on the list.

Psychologists’ scope of practice is established by state law, not federal law, the organization says, and psychologists are licensed to practice without supervision in all states and the District of Columbia. “This is really an access issue to encourage mental health providers to participate in the program,” Walter said.

The act, co-sponsored by Maine U.S. Sen. Susan Collins (R) and Ohio U.S. Sen. Sherrod Brown (D), has been referred to the Senate Committee on Finance. The legislation introduced by Rep. Kristi Noem (R-South Dakota) has also been referred to the House subcommittee on Health.

Several phone and emails requests for comment from Collins on the Mental Health Access Act were not returned.

“At this point there is not much movement on Medicare at all (in Congress),” Walter said. “I would suspect that when we get to later in the year, this type of legislation could see movement. We’ll just continue to try and build that support.”

By Rivkela Brodsky

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