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APA has developed a model contract and affidavit to assist members who must conform to the requirements of a new law if they enter into private payment agreements with their Medicare-eligible patients.
The law, which took effect on January 1, gives physicians and others who treat Medicare beneficiaries the option of delivering care without accepting Medicare payments.
APA's two-page model contract explains the critical components of the law, the obligations that opting out of the Medicare system impose on both the physician and the patient, and provisions for terminating the contract. The forms are posted on APA's Web site at www.psych.org/pub_pol_adv/mirin.html and also have been sent to all APA district branches and state associations.
The critical flaw in the private contracting law, in the view of APA and most other medical organizations, is that once a physician and a single patient agree that payment for all services will be made outside of Medicare, that physician is bound to forego all Medicare reimbursement for a two-year period for all of his or her Medicare beneficiary patients. APA is a strong backer of bills introduced in the Senate and House of Representatives to amend the new law so that a physician would be able to take advantage of the two-year mandatory opt-out for one or more Medicare patients individually without then being forced out of the Medicare system for all patients.
Bills to enact this modification have been introduced by Senator Jon Kyl (R-Ariz.) and Representative Bill Archer (R-Tex.), though neither House has scheduled action on its respective bills. The Senate did, however, pass a sense-of-the-Senate resolution in early April putting the body on record as favoring Kyl's amendment, but that vote did not have the power of law (Psychiatric News, May 1). The resolution stressed that "seniors have the right to see the physician...of their choice, and not be limited in such right by the imposition of unreasonable conditions on providers who are willing to treat seniors on a private basis. . . ."
"Until we can get a better version of the private contracting law enacted by Congress, APA will do whatever it can to help members comply with the present law. We believe the model contract and affidavit we developed will assist in that effort," said Ronald Shellow, M.D., chair of APA's Joint Commission on Government Relations.
Early data show that, as APA has long argued, the ability to shield confidential mental health records from the eyes of third parties is turning out to be a welcome alternative for patients.
The private contracting option, despite its restrictiveness, is proving to be a popular choice for a sizable number of psychiatrists and their Medicare patients. In fact by April more psychiatrists and their patients had taken advantage of the opt-out provision than had any other group of physicians and their patients, accounting for about 50 percent of the 280 or so affidavits filed with HCFA attesting to the implementation of a private contract with a Medicare-eligible patient.
It appears that the ability to shield data on mental health care, even if it costs patients more money than relying on Medicare would, also is an attractive option for patients of mental health professionals as well as those seeing psychiatrists. HCFA reports, for example, that about 70 percent of private-contracting affidavits submitted by nonphysicians have come from psychologists.
These Medicare private contracts do not automatically renew at the close of the two-year contract term. They must be formally renewed and the accompanying affidavit resubmitted to HCFA before the end of the two-year period that starts with the date of the original contract signing. -K.H.