Laws & Regulations
Thinking of joining? We encourage you to learn about all that the APA and PaPS can do for you and your career. Contact the PaPS administrative office to request our Member Outreach Brochure. We can be reached at papsych@papsych.org or (800) 422 - 2900.
Need to renew your current membership? Renew online!
Need to renew your current membership? Renew online!
More from APA
Mental Health Parity resources from the APA:
The Consumer Portal:
Consumer Guide to Disclosure Rights
Warning Signs - Plan or Policy Non Quantitative Treatment Limitations (NQTLs) that Require Additional Analysis to Determine Mental Health Parity Compliance (pdf)
What can Psychiatrists do to Help Enforce Parity (pdf)
The Stepping Up Initiative resulted from a partnership of The American Psychiatric Association Foundation, the Council of State Government Justice Center, and National Association of Counties.
White House Task Force Releases Report
White House Task Force on Parity releases report with recommendations to federal legislators to ensure enforcement.
White House Report (pdf)
Fact Sheet (pdf)
Mental Health & Substance Use Final Report (pdf)
DSM 5 Coding Updates
On October 1st, ICD issue updates to ICD-10. APA's Office of Healthcare Systems and financing provides updated DSM V codes.
DSM 5 Coding Updates 2016 (pdf)
The Following Message is Sent on Behalf of Dr. Saul Levin, APA CEO and Medical Director
On October 14, 2016, the Centers for Medicare and Medicaid Services issued the Final Rule setting policies for new Medicare payment reforms and quality reporting under the Medicare Access and CHIP Reauthorization Act (MACRA). This new rule will change the way our members practice into the future. In our response to the proposed rule, we raised several concerns regarding its impact on psychiatric practice and some of our advocacy efforts have paid off.
1) A large number of psychiatrist will be exempt.
Now, psychiatrists who have no more than 100 Medicare patients or no more than $30,000 in annual Medicare billings will be exempt from quality reporting requirements in 2017. As a result of these changes, CMS projects that 49% of psychiatrists who see Medicare patients will be exempt under the “low volume threshold;” another 8% will be exempt because they just enrolled in Medicare that year; and close to 1% will be exempt because they qualify for the incentive for “advanced” alternative payment models. However, these psychiatrist can still choose to participate in the MIPS program – and potentially qualify for a bonus – if they wish to do so.
2) Flexible reporting period in 2017.
Psychiatrists who choose to participate in the MIPS program can ease into reporting in 2017 due to relaxed “Pick Your Pace” reporting for that year.
3) Decreasing the requirements to meet “full reporting” in order to earn a bonus for 2017.
Many of the different categories reporting on practice improvement activities and quality measurement reporting have been reduced by one third.
4) Psychiatrists will not be penalized for seeing sicker, economically disadvantaged patients for the first year.
Unfortunately, as currently measured for the Value-Based Payment Modifier, negative adjustments have tended to go to those physicians who care for the most vulnerable populations. The new cost performance category measures Medicare spending for all of a psychiatrist’s Medicare patients. Contribution to the final score will gradually increase to 30% by 2021.
5) Psychiatrists can earn a bonus for some participation in alternative payment models (APMs).
Psychiatrists who have at least 25% of their Medicare covered services or 20% of their Medicare patients in certain “advanced” APMs are exempt from MIPS reporting in 2017 and can earn a 5% bonus in 2019.
Member education and guidance is coming! We will soon provide you with a MACRA Toolkit for Psychiatrists, as well as a series of webinars to educate psychiatrists on these new programs and requirements. More information will be available at www.psychiatry.org/MACRA and on the attached flier that I ask you to share with your colleagues.
The Consumer Portal:
- Intended to be used by consumers, patients and providers
- We encourage our members to use it to direct patients with parity issues and complaints
- http://www.hhs.gov/mental-health-and-addiction-insurance-help/index.html
Consumer Guide to Disclosure Rights
- Outlines insurance plan documents that patients and their providers can ask for and are entitled to see
- http://store.samsha.gov/shin/content//SMA16-4992/SMA16-4992
- Patient needs to question rates paid to MH/SUD providers
Warning Signs - Plan or Policy Non Quantitative Treatment Limitations (NQTLs) that Require Additional Analysis to Determine Mental Health Parity Compliance (pdf)
What can Psychiatrists do to Help Enforce Parity (pdf)
The Stepping Up Initiative resulted from a partnership of The American Psychiatric Association Foundation, the Council of State Government Justice Center, and National Association of Counties.
White House Task Force Releases Report
White House Task Force on Parity releases report with recommendations to federal legislators to ensure enforcement.
White House Report (pdf)
Fact Sheet (pdf)
Mental Health & Substance Use Final Report (pdf)
DSM 5 Coding Updates
On October 1st, ICD issue updates to ICD-10. APA's Office of Healthcare Systems and financing provides updated DSM V codes.
DSM 5 Coding Updates 2016 (pdf)
The Following Message is Sent on Behalf of Dr. Saul Levin, APA CEO and Medical Director
On October 14, 2016, the Centers for Medicare and Medicaid Services issued the Final Rule setting policies for new Medicare payment reforms and quality reporting under the Medicare Access and CHIP Reauthorization Act (MACRA). This new rule will change the way our members practice into the future. In our response to the proposed rule, we raised several concerns regarding its impact on psychiatric practice and some of our advocacy efforts have paid off.
1) A large number of psychiatrist will be exempt.
Now, psychiatrists who have no more than 100 Medicare patients or no more than $30,000 in annual Medicare billings will be exempt from quality reporting requirements in 2017. As a result of these changes, CMS projects that 49% of psychiatrists who see Medicare patients will be exempt under the “low volume threshold;” another 8% will be exempt because they just enrolled in Medicare that year; and close to 1% will be exempt because they qualify for the incentive for “advanced” alternative payment models. However, these psychiatrist can still choose to participate in the MIPS program – and potentially qualify for a bonus – if they wish to do so.
2) Flexible reporting period in 2017.
Psychiatrists who choose to participate in the MIPS program can ease into reporting in 2017 due to relaxed “Pick Your Pace” reporting for that year.
3) Decreasing the requirements to meet “full reporting” in order to earn a bonus for 2017.
Many of the different categories reporting on practice improvement activities and quality measurement reporting have been reduced by one third.
4) Psychiatrists will not be penalized for seeing sicker, economically disadvantaged patients for the first year.
Unfortunately, as currently measured for the Value-Based Payment Modifier, negative adjustments have tended to go to those physicians who care for the most vulnerable populations. The new cost performance category measures Medicare spending for all of a psychiatrist’s Medicare patients. Contribution to the final score will gradually increase to 30% by 2021.
5) Psychiatrists can earn a bonus for some participation in alternative payment models (APMs).
Psychiatrists who have at least 25% of their Medicare covered services or 20% of their Medicare patients in certain “advanced” APMs are exempt from MIPS reporting in 2017 and can earn a 5% bonus in 2019.
Member education and guidance is coming! We will soon provide you with a MACRA Toolkit for Psychiatrists, as well as a series of webinars to educate psychiatrists on these new programs and requirements. More information will be available at www.psychiatry.org/MACRA and on the attached flier that I ask you to share with your colleagues.
