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Legislative Update
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Could the Dysfunction in Congress Finally Be on the Wane?

By James Finley
Associate Executive Director and Director of Public Policy

After years of constant resistance, in recent weeks the Republican congressional drive to repeal and replace the Affordable Care Act (ACA) has begun to recede on Capitol Hill. 

Congressional opponents of healthcare reform have gone noticeably silent on their most critical legislative and political objective after strong enrollment numbers and increasing evidence that the program will not collapse as opponents had long predicted. 

It’s too early to say how this period of retrenchment will affect the legislative environment, but it is likely the first step toward normalization of the political environment for health and Medicare legislation. 
Medicare Legislation

AMHCA is encouraged that the Medicare environment could begin to improve as this divisive issue gradually recedes on the congressional agenda. For now we expect Medicare action will 

For the latest information on all of AMHCA’s congressional activities, follow our updates on:

build toward the formation of another Medicare vehicle after the November election. AMHCA is continuing to urge all its members to seek co-sponsors of our Medicare provider status legislation (S.562/HR.3662). 

The thaw in relations over the ACA was clearly reflected in the hearings on the nomination of a new Secretary of Health and Human Services (HHS). The current secretary, Kathleen Sebelius, announced her resignation on April 11. 

The woman nominated to succeed her, Sylvia Mathews Burwell, is riding easily toward confirmation as the next Secretary of HHS after several smooth confirmation hearings where the ACA did not figure prominently in the questioning. Burwell is currently director of the White House Office of Management and Budget, a post she has held since April 2013.

A final Senate floor vote on her confirmation is likely the first week of June. During the hearings, Burwell highlighted the need to reform Medicare to reduce program spending while expressing her intent to continue to improve the quality of care for beneficiaries. Her comments also recognized the problems posed by chronic illnesses and the important role private Medicare Advantage plans have in the program. 

In addition, she also voiced support for reviewing the Centers for Medicare and Medicaid Services (CMS) programs that expand alternate payment models, including bundled payments and Accountable Care Organizations. 

All of this new openness to change may help AMHCA in ultimately securing passage of Medicare provider status for the profession. 

ICD-10 Conversion Awaits a Rule

In late March, Congress surprised the Obama administration, hospitals, and many medical groups by adding a provision to unrelated Medicare legislation that delayed the transition deadline for the International Classification of Diseases codes, ICD-10, for one year until Oct. 1, 2015 (see the Legislative Update in the April and May issues of The Advocate). 

The deadline had been Oct. 1, 2014. The bill became Medicare law, and it mandates a delay in the adoption of ICD–10 billing code sets as the standard for all code sets. The delay was inserted into legislation after many providers and agency administrators learned that early demonstrations showed a “dismal” impact on worker productivity and coding accuracy. AMHCA did not take a stand on the legislation, but followed developments on behalf of its members. 

Due to productivity concerns, many providers wish to implement dual coding for a limited period to learn more about ICD-10 documentation and workflow requirements. Dual coding is expected to limit the possibility of financial waste, technical glitches, and training mistakes. HHS announced several weeks ago that it would end uncertainty around delay and issue a final rule for the switch to the 2015 deadline. 

However, the forthcoming rule may prohibit providers from voluntarily using the ICD-10 for billing purposes before October 2015. Large providers are expected to work dual coding into their plans, but until the rule is released, the new phase-in schedule is ambiguous for many providers. The forthcoming HHS rule will apply to Medicare and all HIPAA-covered entities, ensuring that all clinical mental health counselors must continue to use ICD-9-CM through Sept. 30, 2015. 

AMHCA members may learn more about ICD-10 im-plementation by reading the February Advocate article by Gary Gintner, PhD, LPC.

Veterans Affairs

In May, Congress shifted its attention to the very troubled management of the Department of Veterans Affairs, which continues to be widely criticized for failing to provide adequate mental health services, among other administrative failures. During this atmosphere of heightened congressional scrutiny, AMHCA is promoting action on AMHCA-endorsed Veterans Affairs intern legislation (HR.3499/S.1155).

TRICARE Certification Reminder

AMHCA strongly encourages all eligible CMHCs to consider seeking independent provider status under the TRICARE program during a grandfather period that ends in December 2014. TRICARE certification helps CMHCs to advance their professional standing at the federal level as well as ensures individual practitioners may serve TRICARE beneficiaries long into the future. 

Once the grandfather period closes on Jan. 1, 2015, practitioners who do not meet more restrictive certification standards will be permanently excluded from participation.