Magazine article Clinical Psychiatry News

HCFA Reform Shifts from Legislation to Regulation

Magazine article Clinical Psychiatry News

HCFA Reform Shifts from Legislation to Regulation

Article excerpt

WASHINGTON -- The time is ripe for regulatory relief and reform, according to policy analysts and lobbyists.

Currently, there are three mental health issues that can be addressed by the Bush administration--without the need for legislation, explained Michael Bromberg, chairman of Capitol Health Group, a Washington-based lobbying firm. They include the prospective payment system (PPS) for psychiatric hospitals, seclusion and restraint rules, and the National Commission on Mental Health.

Though the details of the National Commission on Mental Health have yet to be worked out, the National Association of Psychiatric Health Systems (NAPHS) is pushing to gain representation on the commission. The organization also is placing special emphasis on achieving regulatory relief for psychiatric hospitals. NAPHS executive director Mark Covall outlined the organization's advocacy agenda at the annual meeting of the NAPHS:

* Payment reform. The Medicare PPS for psychiatric hospitals must be implemented by Oct. 1, 2002, according to the Balanced Budget Refinement Act of 1999. Research projects funded by the Health Care Financing Administration are underway to tease out the details. Health Economics Research, a research organization based in Waltham, Mass., is looking at the cost structure of different types of facilities and at patient characteristics that predict variations in resource use.

The inpatient psychiatric PPS should be based on an acute care model, not a post-acute care model, which has been implemented in nursing homes and rehabilitation facilities, Mr. Covall said. The PPS plans enacted previously were built around the minimum data set and the resident assessment instrument, which focus on chronic, long-term issues.

Such diagnostic and assessment tools are not necessary in psychiatric hospitals to determine payment rate, he said. There is not a tremendous variation in resources used per day. An administratively simple system--without complex assessment tools--makes the most sense.

NAPHS urges HCFA to develop a simple PPS model for psychiatric hospitals and then determine whether more variables must built into the equation, rather than build upon the post-acute care model without the assessment tools, Mr. Covall said. Hopefully, the research findings will be considered in HCFA's report to Congress, which is due this October, and provide a clearer picture of the specific parameters needed for a sound payment system.

* Access and coverage. NAPHS wants to build momentum for the federal parity legislation (S.543), sponsored by Sen. Pete Domenici (R-N.M.) and Sen. Paul Wellstone (D-Minn.). Given Sen. Domenici's strong commitment to this issue and that the current parity law expires Sept. 30, 2001, Congress is expected to do something.

It's important to point out that the legislation does not mandate coverage; rather, it requires equal coverage for physical and mental health in health plans that currently offer mental health coverage. Also, studies have shown that parity is affordable, with a less than 1% increase in insurance premiums. …

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