HHS Issues HIPAA Guidance Document on Sharing Information Related to Mental Health
The U.S. Department of Health and Human Services (HHS) recently released a new guidance document detailing how the HIPAA Privacy Rule operates to protect individual privacy rights with respect to mental health information. The guidance document clarifies when HIPAA permits health care providers to communicate with a patient's family members, friends, or others involved in the patient's care, depending on whether the patient is an adult or a minor and consider the patient's capacity to agree or object to the sharing of their information. In addition, the guidance further clarifies how providers may communicate with family members, law enforcement, or others when the patient presents a serious and imminent threat of harm to self or others.
Psychologists To Pursue Prescribing Authority in New York
We are taking this opportunity to communicate directly to our members about an issue of critical importance. Organized psychology has indicated its intent to pursue prescribing authority for psychologists in New York State in the coming legislative session
On November 29, 2013, CMS issued its interim final rule establishing Medicare RVU values for 2014. CMS accepted all the increased values recommended by the RUC for the new psychiatry psychotherapy codes to be used only in combination with an E/M code.
Obama Administration Issues Final Rule Implementing Mental Health Parity and Addiction Equity Act
On Friday, November 8, 2013, the Obama Administration issued a Final Rule implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). In general, NYSPA and the APA are pleased with the Final Rule, which includes clarification on many important issues, including insurer transparency, nonquantitative treatment limitations and reimbursement rates, among others.
To read the APA Talking Points on the Final Rule, please click here. To read the APA Talking Points on the Parity Law in general, please click here.
DOH Establishes Transition Period for I-Stop Compliance
As you know, the new I-Stop duty to consult goes into effect on August 27, 2013. The Department of Health recently posted the below message on its website, which indicates that all practitioners unable to establish an HCS account and access the PMP despite good faith efforts may continue to write prescriptions for Schedule II, III and IV medications. DOH expects this period of transition to last through October 2013.
The New York State Office of Mental Health (OMH) recently announced its Regional Centers of Excellence Plan a plan that calls for major changes in State-operated mental health services, representing a shift from inpatient services to community-based services.
On December 26, 2013, President Obama signed into law the Pathway for SGR Reform Act of 2013. This new law prevents a scheduled payment reduction for physician services covered under Medicare Part B. The new law also provides a 0.5 percent update for all Medicare Part B fees through March 31, 2014.
New Medicaid Dose Optimization Initiative to Take Effect November 14, 2013
The Medicaid Fee-for-Service program recently established a new Dose Optimization program, which will seek to reduce prescription costs by limiting the amount of pills a patient needs to take each day, while retaining daily dosing amounts. This initiative is expected to result in significant cost-savings for the Medicaid program, since, in many cases, pharmacies charge per pill dispensed.
Court Finds Plausible Parity Violations by United but Requires Claims To Be Brought Against Plan Sponsors
On October 31, 2013, United States District Judge Colleen McMahon dismissed a class action mental health parity lawsuit brought by four patients, a psychologist, a psychiatrist, and NYSPA (on behalf of its members and their patients) against UnitedHealth Group
The New York Times recently published an article entitled "Lacking Rules, Insurers Balk at Paying for Intensive Psychiatric Care," which addresses the failure of health insurance carriers to cover the cost of care for individuals with serious mental illness.
December 17th Medicare/CPT Coding Update Click here to register. No charge for Members. Non-member fee is $250.
NYSPA/APA Successful in Reversing Improper Denials of Claims Submitted To UBH/Optum
NYSPA was recently contacted by two members who had been receiving improper denials from United Behavioral Health/Optum for claims for the new combination psychotherapy CPT codes (e.g., 99212+90836), Optum was refusing to provide reimbursement for the psychotherapy add-on code because the provider had failed to document start and stop times for the psychotherapy portion of the session alone (as opposed to the E/M portion). This practice, clearly in violation of CPT, was being applied to both in-network and out-of-network benefits.
In response to our recent website article on the new PQRS 2015 payment reduction, NYSPA has received several inquiries from members regarding the use of Measure #9 (Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD).