February 5, 1999

As many members already know through previous Psychiatric News articles and postings on APA's Web site, the Health Care Financing Administration (HCFA) has published new regulations governing private contracts for services between Medicare beneficiaries and their physicians.

While HCFA regulations "grandfathered" existing opt-out affidavits and private contracts (those entered into before January 1, 1999), the regulations may require some changes to the private contract and affidavit templates published as a service to APA members in Psychiatric News and available from the Web site and APAfastFAX.

HCFA intends to publish template guidelines, but this is not expected for the next six to nine months. Because of this long delay, APA has committed the resources to enable its legal counsel to review the regulations and make any necessary changes to the Association's affidavit and private contract templates, as well as to the accompanying "Issues to Consider" overview published with the templates. New documents will be posted as soon as they are available, but in the meantime, APA members should be very cautious in using the old templates.

Another private-contracting issue of which members should be aware is balance billing. According to HCFA, some states have adopted laws that limit the ability of physicians to balance bill under Medicare, and that, depending on how these state laws are written, the limitations could affect the amounts billed under Medicare private contracts. Members may wish to consult with their district branch, state insurance commissioner, or local Medicare carrier for additional information.

For further information on these issues, call APA's Division of Government Relations at (202) 682-6060.