The National Psychologist

Vol. 8 No.3 May/June 1999

 

Medicare Update

Options are available for psychologists when negotiating with Medicare

Question 1: "I have been providing psychological services to a retirement community for several years. Recently the facility encouraged their residents to sign up with a Medicare Health Maintenance Organization (HMO). The facility then contracted with a psychologist who is a panel provider covered under the HMO. I thought that patients have the freedom to choose their own psychologists. Does Medicare prohibit me from providing my services as usual?"

Answer: Patients who have chosen the Medicare HMO continue to have mental health benefits just as in traditional Medicare, but typically HMOs restrict payment to selected providers and hospitals. You will no longer be able to bill under Medicare, part B, for those beneficiaries signed up with the HMO. The benefit to the patient is the elimination of traditional Medicare co-payments and deductibles. You can check to see if the HMO plan is taking applications for mental health providers. If you have had a cordial relationship with the administration of the retirement facility, it may be helpful to send a letter of reference in your behalf.

You also have the option of negotiating a contract for your services with current clients and their family if they agree to pay privately. You may want to consult with an attorney specializing in healthcare before doing so. You may also need to notify the administration of the facility of such a private contract. You can make the argument for the need for continuity of care. If the patient and family want to pay for your services, it is unlikely that the administrator will prohibit you from doing so.

One proactive tactic is to call the provider relations staff of the managed care companies in your area and attempt to get on their preferred-provider panels, regardless of whether they offer special programs for seniors. In many markets, most provider panels are closed, but do not give up: changes are so rapid in managed care that it really does pay to keep on trying and to hedge your bets by keeping in regular, personal contact. Remind provider relations staff of your specialty and experience in geriatric mental health, and give them outcome data and case studies for the kinds of specialized services you offer. Why? Because Medicare will become increasingly managed, and you do not know which managed care companies in your market will get a piece of the pie. It is your responsibility as a specialist in geriatric behavioral healthcare to educate the staff at managed-care companies about what you can offer clients and their families.

Question 2: "Now that the Bi-partisan Commission on Medicare came to no consensus, what are professional associations doing to influence the Health Care Financing Administration (HCFA) or any future Medicare reform efforts?"

Answer: The National Coalition on Mental Health and Aging, a group founded in1991 that is composed of over 45 federal agencies and national organizations, has been proactive in mental health reform affecting older adults. Members of the Coalition including Willard Mays, chairperson, met with representatives of HCFA earlier this year to identify barriers that impede the provision of mental health services to nursing home residents in the Medicare and Medicaid programs.

The Coalition is tentatively planning a conference in the fall of 1999 on emerging issues in mental health and aging that include education and training needs, integrating health and behavioral health services for older adults, and managed care trends.

Question 3: "What is the function of the APA Committee on Aging (CONA)?"

Answer: In 1997 the APA Committee on Aging (CONA) changed from an ad hoc group and gained permanent status within APA. It is comprised of six members and chaired by Steve Zarit, Ph.D. from Penn State. A main focus of CONA is to develop and coordinate information about aging for professionals, policymakers, and the general public. For example, CONA has distributed the APA publications, What Practitioners Should Know About Working with Older Adults and Older Adults’ Health and Age-Related Changes: Reality Versus Myth.

According to Weldon Bagwell, APA’s Aging Issues Officer, CONA has recently become involved in the National Coalition on Mental Health and Aging. CONA members serve as monitors to other APA committees. For example, the committee reviewed guidelines being developed for doing psychotherapy with lesbian, gay, and bi-sexual individuals. Missing from the document was mention of issues pertinent to older adults who are gay, and committee members are making revisions to the document. CONA is exploring information on the cost-savings associated with timely provision of psychological services for older adults. For more information, contact through email: wbagwell@apa.org.

 

Question 3: "What other groups are available for psychologists to join to become active in practice and policy issues of aging?"

Answer: APA’s Division 12 (Section II) is specifically devoted to clinical geropsychology. One major accomplishment from has been the development of a working document on qualifications for practice in clinical geropsychology. To read the current version, log onto www.iog.wayne.edu/apadiv20/qualtf7a.htm.

 

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